Several countries at the World Health Assembly (WHA) called for enforcement clauses to be included in the World Health Organization’s (WHO) code on international recruitment as wealthier countries continue to recruit health workers from poorer countries.

Regions will take up discussion on how to strengthen the code, based on an expert advisory group’s assessment, and their suggestions will be tabled at next year’s WHA, delegates at the current WHA resolved on Monday (26 May).

Countries also passed a resolution aimed at accelerating action on the global health and care workforce.

The resolution requests the WHO Director-General to prioritize resources to support policy development and implementation of the health and care workforce priorities outlined in the Global Strategy on Human Resources for Health: Workforce 2030.

This includes fostering regional and global collaboration, and supporting member states to manage and develop their health and care workforce.

By 2030, there will be a global shortage of 11.1 million health workers and there is fierce competition for doctors and nurses in particular.

South-South collaboration

Small island developing states (SIDS) and African countries were outspoken about their battles to retain health workers.

Jamaica, Samoa and Barbados  all spoke of struggling to retain staff despite improving pay, working conditions and training, owing to “aggressive recruitment” of their health workers.

Jamaica said that “South-South collaboration” has been the only successful strategy to address the shortage of specialist nurses.

“Jamaica extends its appreciation to our long standing partner, Cuba, we engaged partners such as Nigeria and new partners, the Philippines and India,” the country noted.

Through collaboration with the Pan American Health Organisation (PAHO), Jamaica is developing a human resource for health policy and action plan and conducting a health labour market analysis. It should be noted that the latter is the first for the English speaking Caribbean. 

“The ongoing migration of our health care workers poses a serious threat to our health system. We urge the WHO and international partners to amplify advocacy on its impact in SIDS like Jamaica, and to actively promote fairer, more ethical recruitment by high income countries.”

Barbados called for a “binding framework to protect health worker rights and align migration with national priorities”.

Africa faces ‘critical challenges’

Ghana, speaking for Africa, said that the region “continues to face critical health workforce challenges, including acute shortages, gender inequities, skill imbalances and the maldistribution of personnel”. 

These issues have been exacerbated by migration, limited funds and “fragile working conditions”.

“The evolving healthforce migration requires that Western countries that demand Africans must contribute to the training of more workforce,” said Ghana.

Sudan reported that the conflict has had a “devastating impact on the already strained health workforce sector, where a sizable number of health workers have left the country or displaced internally due to the security situation. Those who remain in the front line are subjected to major risks, strain and work overload.”

Meanwhile, the small country of Eswatini acknowledged that it was unable to employ 10% of its health workforce because of financial constraints.

Zimbabwe endorses a “global solidarity fund to help mitigate the impact of health work in immigration in low and middle income countries”.

Community health workers

Thailand for South-East Asian Region (SEARO) reported that the region had 4.2 million community health workers that played a vital own role in healthcare services.

SEARO wants the development of a “global health and care workforce compact, accompanied by a five year roadmap aimed at strengthening national workforce capacity and addressing the projected global health workforce shortages”.

Poland, speaking for the European Union and candidate members, stressed that “protection from any form of violence, discrimination, unsafe working conditions, and respect for human rights, as well as due appreciation in all its forms, are preconditions for attracting and retaining the health workforce”.

In light of the shortage of health workers, Poland stressed the importance of “digital upskilling” to address the digital health transition. 

“The WHO Academy offers a unique opportunity to strengthen the skills and capacities of human resources in health,” Poland noted, of the new facility hosted by France.

“Health policies must promote equity and gender responsive approaches support women’s meaningful participation and leadership. Currently, women form 70% of the health workforce, but hold less than 25% of senior roles with a 24% pay gap,” Poland noted.

Dr Bruce Aylward, WHO Assistant Director-General of Universal Health Coverage, said that there that been an increase in the projected gap for health care workers by 2030.

“That is alarming, especially in the context of official development aid cuts that are already hitting some of the most important cadres, like community health workers.”