In a global workforce crisis, how do we ensure our workforce can meet the population’s healthcare needs?
The global workforce is in crisis and it is the time we truly appreciate the magnitude of this problem. The world population has increased so much in the past centuries, with a 7-fold increase in its’ size since 1800, that it can no longer be supported by the current number of healthcare workers.(1) Importantly, projections are estimating that this trend is not going to settle down anytime soon – the current population of 7.7 billion is to increase to over 8 billion in 2030 and over 9 billion in 2050.(2) This expanding population size does not only mean that supply cannot keep up with demand but also that the healthcare expenditure needed to train staff, support the services as well as care for the population is rising. Adding to this problem is an increasing number of countries that are becoming ageing nations, further altering the type and number of services that are in demand as well as increasing the expenditure even more. All this, contributes to the global workforce crisis and it is crucial we act now in order to ensure that health workforce can meet the needs of the population.
In the UK, the NHS is already short of 100,000 staff and these numbers could rise to as much as 350,000 in 2030 if more staff are not recruited or trained as soon as possible.(3) Worldwide, the shortage could amount to over 18 million workers by 2030.(4 p.46) Importantly, this staff deficit contributes to increased waiting times, reduced availability of services and declining quality of care. Training more staff could help lessen the effects of this crisis; however, some, like Mark Britnell, suggest that overproduction of health staff could also be beneficial.(5) Others also note how just expanding the workforce size is not going to completely avert the crisis as it is only going to serve as a short-term solution. That is to say, the problem lies deeper within the way system is organised and it is its reorganisation that could have a truly long-lasting effect.(6)
All in all, reorganising healthcare systems with an aim to enhance their working capacity is the key to accommodating the population’s healthcare needs. Ensuring adequate allocation of the health resources as well as organising an appropriate workforce could both improve the cost-effectiveness of interventions.(7) Given the limited resources of countries, it is vital that each nation implements evidence-based policies adjusted to their own needs and challenges. As mentioned earlier in this essay, the projected number of staff is likely to still be in deficit in the future; thus, it is crucial we reorganise the resources to enhance the working capacity of the national health services. Promoting utilising the workers’ full scope of skills within their specialty could serve as one of the interventions to improve efficiency of services. For instance, according to World Health Organisation midwives scope of skills could cover 87% of the needs for services within ‘sexual, reproductive, maternal and newborn health services.’(4 p.16) Another issue to be addressed is wasted healthcare spending which is estimated to be around 20% globally.(8) Introducing systems that could aid in reducing preventative medical errors, which account for more than 10% of wasted spending, could help retain much needed funds that could instead be used e.g. for improving the services and their availability.(9)
Incorporating new IT solutions, AI and robotics as everyday commodities in fostering better health could not only help improve accessibility, quality and monitoring of services but also allow for time-sensitive health interventions. The use of electronic health records (EHRs) could allow physicians to better manage patients’ conditions and prevent progression of e.g. diabetes, by more accurately identifying when an intervention or treatment modification is needed.(10) In Perth, Australia, the first-holographic doctor has been introduced allowing the physicians to see patient and their records online in real-life (11) Such a technology could greatly reduce hospital admissions and enhance better human resource management as the community health provider responsible for these services estimates that around 30% of all patients could be receiving care from home alone.(12) Digital solutions could also help improve vaccination rates in the poorest 73 countries where only 7% of the children are fully immunised.(13) Launched in 2016, the INFUSE platform allows for submissions of tested immunisation policies and interventions and later “infuses” them with funds to carry the interventions out in areas of need (14) This innovative approach not only helps to reach some of the most deprived areas of the world, often lacking access to digital solutions and facilities, but also helps prevent diseases and therefore reduce expenditure associated with their treatment and following hospital admissions.
Improving access to healthcare in rural and deprived areas could raise standards of care and help bridge the gaps in provision of health services both within countries as well as between low-, middle- and high-income countries. Much of the needed staff in rural and deprived areas are lost due to brain drain.(15) To put this problem into imagination, rural areas are home to half of the world’s population; however three quarters of the physicians are concentrated in urban areas.(16 p.1) Developing nations spend $500 million each year to educate health workers who then leave to work in high-income countries.(17) In terms of workers maldistribution, large majority of doctors would actually not consider moving to rural areas at all, as in the case of 86% of Australian physicians.(18) One of the solutions to alleviate this problem is introducing incentives to retain staff in rural areas. Zambia’s program in which 25% bonus is added to retain staff within the country and an extra 25% within rural areas has been effective in decreasing migration of nursing staff.(16 p.3)
Improvement of living conditions and opportunities in the rural areas could also help improve retention of staff, as: housing, quality of life and services, education, access to training, job opportunities are the highest ranked factors attracting people to live in urban areas.(19)
Treatment of chronic and geriatric diseases also constitutes a significant challenge that needs to be addressed during the global workforce crisis. With increasing number of countries becoming ageing nations, the prevalence of both chronic and geriatric diseases is rising. Notably, chronic diseases constitute about half of the disease burden worldwide.(20) More staff training is, therefore, needed to educate workers on these specific conditions, focus on their prevention, help to increase the accuracy of medical diagnoses and raise overall health of the population. Reinventing the home care system could also enhance healthcare. Germany’s long-term care programme allows patients and their family members to decide on their care provider and home visit times. The flexibility of this model enables the elderly to choose the best care provider for them at no additional cost – the programme is paid for by long-term care insurance funded from employer’s payments.(21)
Introduction of ‘enhanced’ care packages with regular GP visits for care home residents could also prove beneficial as such an intervention in Nottingham has seen a 29% reduction in emergency department admissions.(22)
All things considered, in order to ensure workforce can meet the needs of the population, we have to come up with a long-term plan encompassing reorganising healthcare and introducing country-specific interventions. These solutions would help in increasing the number of staff, improving access to healthcare and its quality, as well as foster disease prevention. Better planning of human and capital resources could all aid in enhancing cost-effectiveness and increasing capacity of health systems. After all, we need to remember that we all have finite resources and amount of time, but with good strategic planning averting the global workforce crisis is nothing but a possible to accomplish challenge.
Wiktoria Milczynska is a medical student at King’s College London. She is currently intercalating in Anaesthesia and Critical Care BSc at Imperial College London. She is interested in global health and management.