Countries are most likely to have laws about health workers’ pay and least likely to provide them with mental health services and protection against discrimination.

There is also little correlation between a country’s wealth and the protection it offers its health workers.

These are some of the findings of a study of over 1,200 laws relating to health and care workers from 182 countries led by the O’Neill Institute for National and International Health Law and the World Health Organization (WHO).

Researchers examined the countries’ laws to see how well they aligned with the Global Health and Care Worker Compact adopted by the World Health Assembly in 2021.

The Compact was introduced to provide countries with guidelines to protect their health and care workers – a response both to the huge price health workers paid during COVID-19 and the growing shortages of health workers.

Over 115,000 health workers were estimated to have died from the virus by the time the Compact was adopted, while there is a global shortage of over 10 million health workers.

Significant gaps

The research identifies key areas where governments can use law and policy to safeguard health workers’ rights, promote and ensure decent work free from discrimination, and a safe and enabling working environment.

Around 62% of the laws were aligned with the Compact, according to Matt Kavanagh, Director of the Center for Global Health Policy and Politics at the O’Neill Institute.

“Our analysis shows significant gaps. Nearly every country has multiple areas where national laws are not yet aligned with the Care Compact, although alignment is feasible,” Kavanagh told a media briefing on Tuesday. 

The findings were published in Plos Global Health on Monday and details about the countries’ laws are available on a dedicated website that will serve as a baseline 

“While 69% of countries have some form of health services guaranteed for health workers, only 20% of those ensure that mental health and well-being are covered,” Kavanagh noted.  Twelve percent of countries had zero provision for health for healthcare workers.

“This analysis highlights the need for, and opportunity of, law reform in countries throughout the world to elevate and protect the rights and well-being of health and care workers and, in doing so, improve health systems,” noted Kavanagh.

With 105 countries aligned to half of more of the Compact’s recommendations, Kavanagh  described the report as “half-full”.

“Law reform is a key piece of what might drive us toward better retention and better effectiveness of our health and care workforces.”

One of th biggest gaps is that community health workers are usually not protected and often do not earn even the minimum wage.

Health workers ‘are the health system’

Dr Atul Gawande, Assistant Administrator for Global Health at USAID, described the research as “transformative” as it provides both a baseline for countries to assess themselves against the Compact as well as the capacity to track progress.

“When we are talking about plans for strengthening systems, what we’re really talking about are plans for strengthening health workers. ‘Systems’ is abstract. Health workers are the system,” said Gawande. USAID assisted in funding the research.

Jim Campbell, Director of the WHO’s Health Workforce department, said the research marked a move “beyond political will into evidence-based policy”.

“Health systems are under huge challenges – population, ageing, conflict, humanitarian disasters, climate disasters. These are being transferred to the health and care workers worldwide,” he added.

With an estimated shortage of around 11 million health workers, “health systems will not have the capacity to respond to the demand, transferring a burden onto the workers that we seek to protect,” said Campbell.

“The first action has to be to invest in today’s workforce to seek those protections.”

Sub-optimal working conditions

Professor Laetitia Rispel from the School of Public Health at the University of the Witwatersrand in South Africa noted that slightly more than half of African countries had laws aligned with the Compact.

Yet Africa is going to be one of the worst affected by health worker shortages, Rispel noted.

“Sub-optimal working conditions, which are often most acute in the region, often serve as a push factor for health workers to migrate,” she warned.

Trade unionist Jillian Roque, Chief of Staff at the Public Services Labor Independent Confederation (PSLink) in the Philippines, also decried the “persistent gaps” in the protection of healthcare workers’ rights.

“In many areas, public health care workers are denied their fundamental rights to freedom of association and collective bargaining,” Roque said.

PSLink is part of the global federation of public sector workers, Public Services International (PS), which is fighting for “fair pay, decent work, equality and non-discrimination” through organising unions, said Roque. 

In the Philippines, unionists have been killed, harassed and “red-tagged” [labelled as communists], making it one of the 10 worst countries for workers in the world, she added.

Despite this, PSLink has successfully ensured the ratification of important conventions on occupational health and safety, the elimination of violence and harassment in the workplace and compelled the government to raise the salaries of nurses after filing a petition at the Supreme Court. 

Campbell noted that two-thirds of the global health workforce (67%) is women and this is often linked to the lack of protections.

Image Credits: Sophie Mautle/HeDPAC , PSLink.