Human resources for health (HRH) – whether doctors, nurses, public health professionals, health managers, community health workers, or allied health professionals – are most critical for making health systems strong, secure, and resilient. While health professional educational curricula mostly remained static, the needed competencies have been constantly evolving over decades in response to changing healthcare needs and the health-seeking behavior of patients, leading to competency deficiency in addition to numerical deficiencies across geographies and health systems. Many health systems were not prepared for the kind of public health shocks the world has been witnessing in recent years, including the COVID-19 pandemic, increased frequency of natural disasters, conflicts, and mass migrations Hence, there is a need for the countries to evolve specific action plans in light of these.
National HRH plans should be guided by the assessment of the health status (disease burden, longevity, and disability) of the population, healthcare needs on account of the current disease burden and projected growth over the next decades as per current growth trends, and simulated surges in healthcare needs or sudden disruptions to healthcare services during public health emergencies (PHEs). These should be projected at least over 15 years as the turnaround time for producing health workers, especially specialists is very long. The plans also should take into consideration the attrition rates on account of change or discontinuation of the profession, emigration to other countries, or deaths while planning the number of professionals needed. The planning should also factor in the adaptive innovations that emerged due to resource constraints like task sharing, task shifting, multitasking, telemedicine, self-care, etc. The productivity of local health workers should be taken into consideration. The benchmark health workers numbers laid down by WHO may not be applicable in a given context considering the above factors.
HRH education and training systems should undergo reforms in response to the changing competency needs. For example, clinical professionals who are groomed to take care of individual patients should also be oriented to their responsibility to overall population health and the role they can play in improving it. With rapid advances in medical, public health, and health management sciences, health workers have evolved into highly specialized in a particular aspect of these sciences. Education systems should orient students to the changing scenarios where they have to learn to work in multidisciplinary teams in a well-coordinated way along the patient’s journey. The students have to be prepared for the well or misinformed patients and their families due to easy access to health-related information on the net. Health workers need to be exposed to the rapid advances in digital technologies and how they might influence the way care is delivered. A clear understanding of public health emergencies is essential in addition to individual medical emergencies. Hence, the education and training systems should be redesigned as per the updated repository of competencies.
Health and related sciences are witnessing rapid advances in concepts and applications. There is a need for a continuous learning culture amongst health workers to keep up with new knowledge and skills. Age-old methods of bedside teaching rounds and daily case or topic discussions continue to be the best forms of continuous learning, in addition to the newer forms of virtual and self-learning methods. Despite access to unlimited knowledge on the net, nothing will replace the tradition of teacher-student learning or the Guru-Shishya Parampara prevalent from ancient times. It should become a culture rather than just completing the mandated CME credit hours to retain the licenses to practice. Self-assessment examinations might be useful for health workers to assess themselves. Relicensing exams have been well established in developed countries to ensure updated knowledge amongst medical professionals.
People look at healthcare services differently than any other service. People trust their healthcare workers with almost blind faith. Health workers have a moral and ethical obligation to do their best in doing no harm to patients, in relieving their suffering in a timely fashion, in helping their patients recover back to their normal selves in the shortest time possible, in preventing diseases, and in giving relief for terminal illnesses. Over the years, there has been a dilution in the moral and ethical fabric of health workers along with a dilution in the trust and the confidence that the patients used to have. The underlying factors may be financial, commercial, cultural, etc. There is a need to bring back the trust that is getting fast eroded.
Health workers also are getting disillusioned by the ground reality when they enter the provider system. As the supply of health workers is not catching up with the growing demands, the workers are being subjected to high levels of mental stress leading to early burnout. Hence, the leadership who are responsible for health workers should care for their employees to take better care of their patients. In addition to the traditional protection health workers are offered, they need special protection, especially during public health emergencies as vividly experienced during the COVID-19 pandemic. The majority of frontline health workers including community health volunteers are females, who have their families, especially dependent elders and children to take care of, more so during public health emergencies. These issues have to be kept in mind while formulating health worker welfare and protection policies and laws. Cared for health workers will care for their patients.
Digital transformation of healthcare will bring unique opportunities and challenges in the health workforce functions. Digital health literacy will become an essential competency of health workers. Telemedicine has the potential to address some of the current gaps in access to needed health workers, especially in remote areas. AI applications may aid healthcare professionals in making better clinical decisions and may aid patients and their families in informed decisions regarding tests and treatments. Wearable technologies, point-of-care diagnostics, and self-care applications are empowering patients and their families to make better decisions regarding their health and care needs. Realtime integrated health information systems will provide public health professionals additional tools in disease surveillance, public health education, and communications, issuing rapid alerts during PHEs, and imparting training to a large number of health workers during a crisis. In addition, there is a need for live national health professional registers (HPR) to have accurate information on the number, type, and distribution of health workers to make policy decisions and also to leverage to pool and mobilize human resources during public health emergencies as part of rapid response systems. It is recommended to create a reserve force to be deployed during PHEs.
Just as diseases know no borders, health workers know no borders. They cross borders in search of better monetary and professional satisfaction. In addition, they may be needed to cross borders to help under-resourced systems. There is a case to harmonize health professional education standards to facilitate cross-border movement, especially during pandemics. Some countries even require sub-national licensing with restrictions on crossing the state or provincial borders within a country. There is a need for laws to be preexistent that regulate cross-border movement of health workers during normal times and during periods of health crises.
In conclusion, how countries address the issue of human resources for health will determine whether they will be able to address the growing health and care needs of people during normal and crisis times. Hence, there is an urgent need for countries to formulate relevant policies and laws and to redesign education and training systems as part of the ongoing transformation of health systems.
Dr. N Krishna Reddy
President, InOrder