All countries of the WHO European Region – comprising 53 Member States across Europe and Central Asia – are currently facing serious challenges related to health and care workers, according to a new report released today by WHO/Europe. An aging workforce is one of them. The study found that 13 of the 44 countries that reported data on this issue had a workforce with 40% of medical doctors aged 55 and over.
An aging health and care workforce was a serious problem before the Covid-19 pandemic, but it’s even more of a concern now, with burnout and demographic factors contributing to an increasingly shrinking workforce. Adequately replacing retiring doctors and other health and care workers will be a major policy concern for governments and health authorities in the coming years. WHO/Europe is urging countries to act now to train, recruit and retain the next generation of health and care workers.
Another key finding of the report is the poor mental health of this workforce in the region. Long working hours, inadequate professional support, severe staff shortages, and high covid-19 infection and death rates among frontline workers—especially in the early stages of the epidemic—have left their mark.
During the first wave of the outbreak in March 2020, health worker absenteeism in the region increased by 62 percent, and mental health issues were reported in all countries in the region. In some countries, more than 80% of nurses reported some form of psychological distress as a result of the pandemic. The World Health Organization/Europe reports that 9 out of 10 nurses say they intend to leave their jobs.
“My own personal journey through this pandemic has been a rollercoaster,” said British nurse Sarah Gazzard. “I was holding the phone to a dying woman’s ear as her son said his last goodbye. This was very, very difficult for me, so I sought support to help me cope.”
A mixed picture in the region
While the region’s 53 countries have an average high supply of doctors, nurses and midwives compared to other WHO regions, countries in Europe and Central Asia still face significant shortages and gaps, with significant regional disparities.
Health worker availability varies 5 times across countries. The overall density of doctors, nurses and midwives ranges from 54.3 per 10 000 people in Turkey to 200 per 10 000 people in Iceland, Monaco, Norway and Switzerland. At the regional level, Central and Western Asian countries have the lowest density, while Northern and Western European countries have the highest.
“Manpower shortages, inadequate recruitment and retention, migration of skilled workers, unattractive working conditions and poor access to continuing professional development opportunities are undermining health systems,” said Dr. Hans-Henry P. Cluj said the European Director of the World Health Organization.
“These include inadequate data and analytical capacity, poor governance and leadership, lack of strategic planning and insufficient investment in workforce development. In addition, the World Health Organization estimates that around 50,000 health and care workers in Europe could lose their lives due to Covid-19.”
Dr. Kluge warned, “All of these risks represent a ticking time bomb that, if not addressed, could result in morbidity across the board, longer wait times, more preventable deaths, and health system collapse.” Now is the time to act on the health and care workforce shortage. In addition, countries are responding to the challenges of an acute economic crisis that calls for effective, innovative and smart approaches.
Mrs. Annika Schroeder is a midwife from Germany, who works in a hospital where about 950 births are performed every year. There, the challenges mirror those seen in the region. “I often work shifts without a chance to go to the toilet, a break or time to eat,” she told WHO/Europe.
“The doorbells and phones ring as we rush from one room to another. On average, I wait for 2 women in labor at the same time. That’s not how I envisioned my career or my day-to-day work life. I am often tired and exhausted. A shortage of midwives makes childbirth dangerous. And since the outbreak, things have only gotten worse. It is affecting the physical and mental health of our midwives, mothers, women in labor and infants,” explained Ms. Schroeder.
According to the latest data for 2022, the region has an average of:
- 80 nurses per 10,000 people
- 37 doctors per 10 000 people
- 8 physiotherapists per 10,000 people
- 6.9 pharmacists per 10,000 people
- 6.7 dentists per 10 000 people
- 4.1 midwives per 10 000 people.
In the WHO 2016 Global Manpower for Health Strategy, the overall health worker density level was set at 44.5 doctors, nurses and midwives per 10 000 people. All countries in the region are currently above par, but that doesn’t mean they can’t afford to be complacent. There are significant gaps and shortages in health and care workers, which will only get worse without policies and procedures to address the problem.
Rising to the Challenge: Country Examples
“Countries need to rethink how they support and manage their health workforce. They need to design strategies that reflect their individual circumstances and needs, because there is no one-size-fits-all approach,” said Dr. Natasha Azzopardi-Muscat, Director of the Department of National Health Policies and Systems at WHO/Europe.
“The region is at a critical juncture: strategic planning and smart investment are critical next steps to ensure our health workers have the tools and support they need to care for themselves and their patients. If we fail to rise to this challenge, society will pay a heavy price. This new report and the information it contains about each of our member states It offers solutions and opportunities that should not be missed.
Many countries in the region have begun to take bold and innovative steps. In Ireland, where there will be more people over 65 than under 14s by 2028, the government has introduced an improved community care program to help the aging population maintain their independence. The program will bring improved community care services to towns and villages across the country, taking pressure off the hospital system.
In Kyrgyzstan, the government has introduced a payroll system for primary health care. The aim is to attract more doctors by increasing the salaries of those who perform well in their practice. As 30% of family doctors will be at retirement age by 2020, the system also provides for specialists to retrain as family doctors.
The UK government is constantly recruiting overseas-trained nurses and midwives to replace those retiring or leaving the profession. There are currently around 114 000 foreign trained nurses registered – an increase of 66% since 2017/2018. In contrast, the number of trained nurses in the European Union/European Economic Area (EEA) fell by almost 18%. This probably reflects a major shift from recruiting nurses from the EU/EEA to other regions and countries, particularly India, Nigeria and the Philippines, rather than the UK’s decision to leave the EU.
Despite progressive measures in many areas, much more investment, innovation and partnerships are needed to avoid further health and care workforce shortages in the future. WHO/Europe urges all member states – even those currently with above-average labor densities – not to waste time in adopting the following. 10 actions to strengthen the health and care workforce;
- line up Education with public needs and health service requirements
- Consolidation Professional development to equip the workforce with new knowledge and skills
- Expansion Use of digital tools to support human resources
- Develop Strategies to recruit and retain health professionals in rural and remote areas
- Creating Working conditions that promote a healthy work-life balance
- keep out Workforce health and mental well-being
- build up Leadership capacity for workforce management and planning
- to improve Health information systems for better data collection and analysis
- Increase Public investment in workforce education, development and protection
- Facilitation Use of funds for innovative HR policies.