TEL AVIV – Ageing doctors and overworked staff are just two of the consequences of the severe shortage of health care workers, even in the comparatively wealthy Europe region of the World Health Organization (WHO).

“In one out of three countries in the region, more than 40% of the doctors are older than 55 years of age,” Tomas Zapata, Unit Head at the WHO Europe Health Workforce and Service Delivery, told the WHO Europe regional committee meeting, which took place in Tel Aviv, Israel this week.

“This means that in those countries more than 40% of the doctors will retire in the next 10 years. This is a crisis. This is a ticking time bomb. If we don’t take action now, we’ll have huge shortages in 10 years in addition to those that we have now,” added Zapata, the author of a report on the issue that was launched at the meeting. 

COVID-19 toll on health workers

Some 50,000 healthcare workers in Europe have died as a result of COVID-19, and health worker absences in the European Region increased by 62% during the first wave of the pandemic in 2020, according to WHO.

The pandemic also took a severe toll on the mental health of the workers. In some countries, over 80% of nurses reported some form of psychological distress caused by the pandemic and as many as 9 out of 10 nurses planned to quit their jobs. 

“I often work shifts without even the possibility to go to the toilet, without breaks or time to eat,” German midwife Annika Schröder told a panel devoted to the health workforce in the European Region. “The doorbell and the phones ring while we rush from one room to the other. On average, I take care of two women in labour at a time. 

“This is not how I imagined my profession or my everyday working life to be. I am often exhausted and tired. The shortage of midwives makes births unsafe. And since the pandemic things have got even worse.”

Huge disparities between member states

The European region can in general boast a high number of healthcare workers. Data shows that the region enjoys 80 nurses, 37 doctors, 8 physiotherapists, 6.9 pharmacists, 6.7 dentists and 4.1 midwives per 10,000 people.

However, huge gaps between countries remain. The doctor-, nurse- and midwife-to-population density ranges from 54.3 per 10,000 people in Turkey to over 200 per 10,000 people in Iceland, Norway, Monaco, and Switzerland.

As highlighted by Zapata, the report also offers several action points, including aligning education with health service needs, improving health information systems and digitalization of services and raising awareness about the needs of health systems in governments. 

“We also need to improve working conditions of the health workforce and this also links to the next point, which is protecting their health and well-being,” he said. “A big lesson we learned from the COVID pandemic is how we can really make efforts to improve health and well-being of our health workers.”

Regional and national needs

 People from a range of countries shared experiences about tackling the challenges related to healthcare staff. 

In Georgia for instance, over 85% of healthcare providers are currently privately employed, said Tamar Gabunia, a Deputy Minister. 

“Many factors have led us where we stand right now, including commercial interests and market factors dictated by human resource-related developments,” she remarked.  

“Now it’s time to change the situation. Our government is really very keen to achieve universal health coverage and we all know that health systems cannot function without human resources,” she said, emphasizing that they have been working hard to solve the issues related to recruiting and retaining health personnel.

In Romania, there are 700 towns and villages without doctors, said Prof Alexandru Rafila, Bucharest’s Health Minister. 

“When we discuss inequalities we are not talking just about inequalities between countries but also inside the countries,” he said. “I think the involvement of the local authorities is crucial in order to respond to some of these issues.” 

He said that Romania is getting ready to launch a new strategic approach: “The WHO/Europe will give us the technical assistance needed for the development of human resources in the health sector and we are glad to be part of this process and to host a special meeting on the topic in March 2023.”

More support from WHO

When COVID-19 hit Israel in the early spring of 2020 its health system, as in the rest of the world, was severely strained.

“We had several new challenges,” Dr Shoshy Goldberg, head of Nursing Administration at the Israeli Ministry of Health, recalled. “We didn’t know anything about the disease at the beginning, and we had been in shortage of manpower in all the occupations in the system for more than 10 years.”

Goldberg explained that the Israeli Health Ministry was able to hire new staff and train thousands of people in a short period of time. 

According, Dr Natasha Azzopardi-Muscat, WHO Europe’s Director of Country Health Policies and Systems, the report highlights the huge diversity between the different countries in the region and the need to work with every nation to find solutions that fit their contexts.

“This is not a “one size fits all” approach,” she said. “But with the support of the Regional Director, we shall also be increasing our capacity to support countries in this area.”