Definition

The World Health Organization defines a health worker as a person “engaged in actions whose primary intent is to enhance health.” Health workers in most countries consist of two main groups: the health care providers, such as physicians, nurses, pharmacists, public health specialists, and affiliated professions; and health system workers such as regulators, planners, and managers who are not involved in the direct delivery of care but rather ensure that health systems function appropriately.

Relevance

The health workforce is the single largest expense element in any health care system (as much as 60-80 percent of total recurrent expenditures depending on the country) and is a key factor in reaching health care goals, as the availability and training of health workers directly impacts quality, access and appropriateness of care.

Costs related to health workforce and training issues are expected to increase across countries due to a number of emerging changes in global health care systems, including:

• demographic and epidemiological trends (i.e., the aging of nations with an increasingly disproportionate elderly population,increasing lifestyle-related morbidity, overall increase in multiple, preventable chronic conditions in younger productive years, and the need for health care workers to coordinate both health and social services);
• impact of training health professionals in new diagnosis and treatment technologies as well as the growing demands of better educated and informed citizens (i.e., electronic medical records, telemedicine, and technical treatment improvements in the delivery of care); and
• increased mobility and migration of health workers (i.e., from public to private sector and rural to urban areas of a country, as well as international migration), which impacts workforce density and access to care.

Context

In order to address the complexities of health workforce and training issues, many countries are reforming how they educate, train, and distribute providers to meet their unique health system needs. Health workforce planning is based on many factors, including migration, payment levels, incentives, and scope of practice issues.

The key driving forces for developing effective workforce policies include the demographic and disease burden changes across Europe and other countries; health system characteristics such as financing, technology, and consumer preference; the macro-level context of each country, including other domains like labor, education, and public sector reform; and external levers such as globalization. Given these drivers, global health workforce challenges include adequate number of health care providers, skill mix (balancing health teams with higher demands for long term health care and social services), workforce distribution, and working conditions such as compensation.

In addition, countries have varied educational and regulatory structures for health care professionals which may also impact the workforce and training of health care workers. For example, the training curricula for nurses is often not scientific or competency based across countries, qualifications are not always equivalent to a university degree, and several countries have more than one level of qualified nurse.Another difficulty is understanding nursing roles and standards across cultures, a problem that can interfere with harmonizing nursing curricula across countries.

Several innovative options are presented below to highlight the issue of workforce shortages, particularly in nursing, which is a common workforce concern among many countries.

Innovative Options to Address Nursing Shortage Issues

Australia

The Nursing Reconnect program in Australia was developed in order to encourage nurses to return to their profession after being out of the health care job market by offering free re-fresher courses, higher salaries, scholarships for post graduate education, and funding for continued education. Participants study at a pace suited to meet their own professional background and personal demands.

Canada

Canada has implemented a variety of programs to increase the number of nurses and the quality of care provided by nurses through different avenues including:

• Increasing seats in nursing education programs by more than 10 percent;
• Offering re-location assistance;
• Establishing quality workplace initiatives and practice programs;
• Establishing loan forgiveness programs at a rate of 20 percent a year, for nursing students who relocate to work in remote areas of the country; and
• Approving regulations of the creation of nursing councils and encouraging the participation of nurses in decisions about patient care to name a few reform efforts.

WHO Europe

WHO Europe is using an integrated nursing curriculum strategy that includes an appropriate balance of theory and practice, a student-centerd approach, and a focus on achievement of competency in practice.

United States of America

Shared governance allows nurses a “voice” in developing the delivery of care in private and public settings. The Hunterdon Healthcare System Nursing Division, based in the State of New Jersey, implemented shared governance as its practice in delivering care in 1989. This accountability-based model includes five nurse councils and supports the professional nurse in his/her practice and work environment while fostering the growth and development of new leaders.