What Does Decent Work Mean for Health workers?
With the World Health Worker Week in progress, there has been a lot of focus on affirming the pivotal role of health workers in health. Dr Tedros, the Director-General of the World Health Organization (WHO), aptly stated that “there is no health without health workers”. This important step – of recognizing them in and of themselves as individuals with fundamental rights than just a “delivery platform” for patient care – is legitimately the way forward to developing sustainable health systems. Safeguarding the dignity of health workers is crucial in bridging the gap in health worker shortfalls, meaningfully contributing to Sustainable Development Goals or achieving Universal Health Coverage.
Health workers’ rights highlight the interdependence and confluence of rights in that the right to decent and safe working conditions along with freedom of assembly, freedom from discrimination and right to due process drives the attainment of the right to health. International human rights law, in particular Article 7 of the International Covenant on Economic, Social, Cultural Rights, calls for “just and favourable” work conditions including the “right to safe working conditions”. This is further explicated in the General Comment on Right to Work, which sets out respect for workers rights as well as individual’s fundamental rights, a living wage, and respect for workers’ physical and mental integrity, as the main components of decent work. The International Labour Organizations (ILO) Decent Work Agenda encapsulates these principles into four strategic objectives which include promoting productive employment, guaranteeing rights at work, extending social protection and promoting social dialogue.
Ensuring decent work should not stop at improving recruitment, training, motivation and retention of the health workforce but be cognizant of the inherent occupational risks of being a health worker. For starters, we need to acknowledge the discrimination, sometimes culminating into abuse and violence, health workers face during the course of their employment. The UNAIDS and WHO Agenda for Zero Discrimination in Health Care statement recognizes institutional discrimination perpetuated by co-workers and employers but stops short of specifically recognizing that abuse, violence or discrimination maybe perpetuated by patients or their families as well. Many a times discrimination is related to the health worker’s gender, race, national or ethnic origin, disabilities and even health status. Also, unsafe working conditions – e.g. lack of water and sanitation, lack of retractable needles increasing the potential for needlestick and sharps injuries, lack of personal protective equipment – do not allow health workers to deliver care commensurate with their skills. Recently, attacks on health workers have escalated, further adding to already precarious work situations experienced in humanitarian settings. Alarmingly, in some incidences, health workers have been denied access to injured persons or are forced to be complicit in mistreatment and harm. These violate established principles of medical neutrality and contravene the Geneva Conventions.
Evidence shows that inadequate investment in health workforce leads to uncoordinated, piecemeal, and stopgap initiatives and solutions that may show transient positive results but does not improve patient quality of care or national health systems functioning on the long run. These structural failures become even more pronounced in resource strapped settings in low- and middle-income countries. Even, last minute influx of financial resources and logistical information cannot contain health emergencies without a robust healthcare workforce, as seen during the Ebola outbreak. Role optimization to community health workers and volunteers has been instrumental both in emergency situations and health care systems affected by brain drain, but this alone cannot sustain population health needs. Moreover, these positions are still riddled with inconsistent standards, lack of adequate legislation and regulation, exposure to occupational hazards, little or no pay, and unacknowledged and unaddressed personal repercussion including facing stigma in their own communities.
Therefore, we cannot hope to increase access to health workers or make sustained progress on the right to health without ensuring a basic minimum in safety and working conditions globally. Further, it makes a strong case for utilizing a rights-based approach to implementing the Global Strategy on Human Resources for Health: workforce 2030 and the subsequent joint WHO/ILO/OECD five-year action plan for health employment and inclusive economic growth (“Working for Health”). Besides, how can we hold health workers accountable for their responsibilities if we cannot ensure their rights.