Editor’s note: Amanda McClelland, a registered nurse, is the senior vice president of Prevent Epidemics at Resolve to Save Lives, where she leads a global team working to accelerate progress to make the world safer from the next epidemic. Follow her on X: @AmandaMcClella2.
Though it doesn’t get much press, there’s a looming crisis: The world does not have enough health care workers, and demand for them is growing faster than supply. The World Health Organization (WHO) projects a gap of 10 million health workers by 2030.
Although no country is exempt from this growing problem, 89% of the shortage is concentrated in low- and middle-income countries. Many countries still struggle to meet the international minimum target set by WHO of 44.5 health workers for every 10,000 people.
This problem is compounded by health workers leaving their home countries to pursue opportunities elsewhere. An estimated 75,000 nurses have left Nigeria since 2017. More than 4,000 health workers left Zimbabwe between 2021 and 2022, and nearly the same number of nurses left Ghana in 2022 alone.
High-income “destination” countries – such as the United States, Canada, the United Kingdom and Australia – are also responsible for recruiting health care workers to address their own shortages, thereby shrinking the workforce in some of the world’s most vulnerable countries.
WHO developed a “red list” in 2020 to highlight countries with severe shortages and discourage high-income countries from recruiting health care workers from these places. The list includes 55 countries, with eight additions in just the past year. My organization, Resolve to Save Lives, works with several countries on the list – including Ethiopia, Democratic Republic of Congo, Ghana, Nigeria and Zambia – by providing funding, additional staff, resources and technical collaboration.
The red list is an important step in attracting attention to the problem, but it’s not a solution.
A long-term solution must address the key factors pulling health care workers away from their home countries in the first place, including low salaries, unsafe working conditions and a lack of an adequate social safety net.
Take the example of community health workers, a significant and increasingly important part of the global health care workforce. About 86% of them are not paid or are underpaid. Many health care workers lack sufficient personal protective equipment, and WHO estimates that as many as 180,000 health care workers died during the first year of the Covid-19 pandemic alone. In some countries, health care workers have faced stigmatization, harassment and violence, leading to mental health issues and even death by suicide.
Beyond our ethical obligations to health care workers, failing to provide them with adequate support and protections also generates enormous economic costs. Our recent study with the World Bank calculated the economic burden of health care worker Covid-19 infections: The cost of a single infection ranged from $10,105 in Colombia to more than $34,000 in South Africa. But a new report by the Frontline Health Workers Coalition offers hope for the uphill battle that lies ahead. For every dollar spent on supporting these workers, as much as $10 can be saved.
Every country must do more to protect those who work to protect us. This requires a holistic approach: setting policies to build and maintain a healthy workforce, properly allocating resources to protect it, and being accountable for the results.
Three immediate actions countries can take to strengthen their health care workforce:
- Improve working conditions and incentives. We cannot expect health care workers to stay in low- or middle-income countries – or even the profession – if they are not adequately compensated. Provision of incentives for those who work in underserved areas is a priority. Workers also need to be protected, not just from infectious diseases but also from violence. They need appropriate and functional facilities that enable them to do their work safely and provide quality care, consistent access to personal protective equipment, and mental health and support services.
- Data-driven policy. Only what gets measured can be improved. The lack of consistent and reliable information hinders efforts to properly protect, strengthen and sustain the workforce. Countries need to invest in regular data collection that tracks health care worker infections and deaths at regional and national levels to better inform and improve policies that prevent and control health care infections. Countries should also strengthen surveillance systems to understand the burden of violence and work-related mental health issues, and use that information to improve working conditions and safety.
- Training and workforce development. Countries can invest in a pipeline of new health care workers and new technologies, such as telemedicine and AI tools that support diagnostics, to allow better utilization of the staff they have. Countries can create public-private partnerships to develop and deploy tech solutions that can serve as force multipliers for the existing health care workforce, supporting workload management and quality of care for patients.
To make the world safer and to address the increasingly dire gap in health care workers, we must take better care of the ones we have. At the 75th World Health Assembly in 2022, countries committed to supporting health care workers. Commitments are important, but now it’s time to act.