Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, UK.
Int J Health Plann Manage. 2024 May;39(3):879-887. doi: 10.1002/hpm.3766. Epub 2024 Jan 26.
Future global health security requires a health and care workforce (HCWF) that can respond effectively to health crises as well as to changing health needs with ageing populations, a rise in chronic conditions and growing inequality. COVID-19 has drawn attention to an impending HCWF crisis with a large projected shortfall in numbers against need. Addressing this requires countries to move beyond a focus on numbers of doctors, nurses and midwives to consider what kinds of healthcare workers can deliver the services needed; are more likely to stay in country, in rural and remote areas, and in health sector jobs; and what support they need to deliver high-quality services. In this paper, which draws on a Policy Brief prepared for the World Health Organization (WHO) Fifth Global Forum on Human Resources for Health, we review the global evidence on best practices in organising, training, deploying, and managing the HCWF to highlight areas for strategic investments. These include (1). Increasing HCWF diversity to improve the skill-mix and provide culturally competent care; (2). Introducing multidisciplinary teams in primary care; (3). Transforming health professional education with greater interprofessional education; (4). Re-thinking employment and deployment systems to address HCWF shortages; (5). Improving HCWF retention by supporting healthcare workers and addressing migration through destination country policies that limit draining resources from countries with greatest need. These approaches are departures from current norms and hold substantial potential for building a sustainable and responsive HCWF.
未来的全球卫生安全需要一支能够有效应对卫生危机以及人口老龄化、慢性病增加和不平等加剧带来的不断变化的卫生需求的卫生和保健工作者(HCWF)。COVID-19 已经引起了人们对 HCWF 危机的关注,预计 HCWF 的数量与需求相比存在巨大差距。应对这一问题需要各国超越对医生、护士和助产士人数的关注,转而考虑什么样的卫生保健工作者能够提供所需的服务;更有可能留在国内、农村和偏远地区以及卫生部门工作;以及他们需要什么样的支持来提供高质量的服务。在本文中,我们借鉴了为世界卫生组织(WHO)第五届全球卫生人力资源论坛编写的政策简报,审查了全球在组织、培训、部署和管理 HCWF 方面的最佳实践证据,以突出需要战略投资的领域。这些包括:(1)增加 HCWF 的多样性,以改善技能组合并提供文化上适宜的护理;(2)在初级保健中引入多学科团队;(3)通过更多的跨专业教育来改变卫生专业教育;(4)重新思考就业和部署系统,以解决 HCWF 短缺问题;(5)通过支持卫生保健工作者和通过目的地国家政策解决移民问题来留住 HCWF,这些政策限制了从最需要的国家抽取资源。这些方法背离了当前的规范,为建立一支可持续和响应迅速的 HCWF 提供了巨大的潜力。