Kuhlmann Ellen, Falkenbach Michelle, Brînzac Monica Georgina, Correia Tiago, Panagioti Maria, Rechel Bernd, Sagan Anna, Santric-Milicevic Milena, Ungureanu Marius-Ionuț, Wallenburg Iris, Burau Viola
Institute for Economics, Labour and Culture, Goethe-University Frankfurt, Eschersheimer Landstraße 121, 60322, Frankfurt, Germany.
WHO Collaborating Center for Health Workforce Policies and Planning, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisbon, Portugal.
Hum Resour Health. 2024 Dec 31;22(1):83. doi: 10.1186/s12960-024-00965-2.
Primary healthcare has emerged as a powerful global concept, but little attention has been directed towards the pivotal role of the healthcare workforce and the diverse institutional setting in which they work. This study aims to bridge the gap between the primary healthcare policy and the ongoing healthcare workforce crisis debate by introducing a health system and governance approach to identify capacities that may help respond effectively to the HCWF crisis in health system contexts.
A qualitative comparative methodology was employed, and a rapid assessment of the primary healthcare workforce was conducted across nine countries: Denmark, Germany, Kazakhstan, Netherlands, Portugal, Romania, Serbia, Switzerland, and the United Kingdom/ England.
Our findings reveal both convergence and pronounced diversity across the healthcare systems, with none fully aligning with the ideal attributes of primary healthcare suggested by WHO. However, across all categories, Denmark, the Netherlands, and to a lesser extent Kazakhstan, depict closer alignment to this model than the other countries. Workforce composition and skill-mix vary strongly, while disparities persist in education and data availability, particularly within Social Health Insurance systems. Policy responses and interventions span governance, organisational, and professional realms, although with weaknesses in the implementation of policies and a systematic lack of data and evaluation.
Aligning primary healthcare and workforce considerations within the broader health system context may help move the debate forward and build governance capacities to improve resilience in both areas.
初级卫生保健已成为一个具有强大影响力的全球概念，但对于卫生保健劳动力的关键作用以及他们工作所处的多样化机构环境，却很少有人关注。本研究旨在通过引入一种卫生系统和治理方法来确定有助于在卫生系统背景下有效应对卫生保健劳动力危机的能力，从而弥合初级卫生保健政策与当前卫生保健劳动力危机辩论之间的差距。
采用了定性比较方法，并对丹麦、德国、哈萨克斯坦、荷兰、葡萄牙、罗马尼亚、塞尔维亚、瑞士和英国/英格兰九个国家的初级卫生保健劳动力进行了快速评估。
我们的研究结果揭示了各卫生保健系统之间既有趋同性又有显著的多样性，没有一个系统完全符合世界卫生组织提出的初级卫生保健的理想属性。然而，在所有类别中，丹麦、荷兰以及在较小程度上的哈萨克斯坦，比其他国家更接近这一模式。劳动力构成和技能组合差异很大，而在教育和数据可得性方面仍然存在差距，特别是在社会医疗保险系统内。政策应对措施和干预措施涵盖治理、组织和专业领域，尽管在政策实施方面存在弱点，并且系统性地缺乏数据和评估。
在更广泛的卫生系统背景下，将初级卫生保健与劳动力因素结合起来，可能有助于推动辩论向前发展，并建立治理能力，以提高这两个领域的复原力。
