Countries can capitalize on the lessons learned and progress achieved during COVID-19 to strengthen the health and care workforce

Health and care services are labour intensive, and the health and care workforce (HCWF) is essential to their effective delivery and to achieving universal health coverage (UHC), health security and the sustainable development goals (SDGs). The COVID-19 pandemic highlighted and exacerbated longstanding HCWF challenges that pose ongoing threats to health systems worldwide, such as shortages, maldistribution in rural and other underserved areas, and insufficient skill-mix. Yet, it also brought the HCWF to the forefront of the policy agenda and sparked rapid innovation and policy adoption, showing that changes to and improvement upon the status quo are possible.

Increased demand for services during the COVID-19 pandemic spurred the implementation or enhanced use of numerous measures to strengthen HCWF capacity. Strategies and supportive policy measures for HCWF pandemic response focused on three areas: surging the supply and availability of health and care workers (HCWs); optimizing their use; and enhancing HCW support and protection. Some initiatives were only short-term strategies, but others have potential to be continued. Learning from these experiences and progress achieved can help countries to strengthen the HCWF, health systems, and the health and well-being of all, now and in the future.

COVID-19 demonstrated that changes to scope of practice and the introduction of team-based roles are possible and central to an effective, sustainable workforce

Many countries redeployed, reskilled or enabled HCWs to take on new roles during COVID-19, to meet new needs and maintain health care services. HCWs proved that they were willing and able to adjust and optimize their roles to meet service needs effectively. The health system must capitalize on these changes and adopt team-based practice across all health and care services and functions. This enhancement will allow for more efficient health service delivery for patients. Implementation options include the optimization of multidisciplinary and team-based work, expanding professional support roles to broaden the skill-mix, and increasing the involvement of patients and their caregivers in home-based prevention, care and support. During the pandemic, the adoption or expanded use of some of these changes were only possible as they had agreement from health sector actors – such as professional bodies – that may have resisted their implementation in the past. Building on these innovations can only be sustained if all stakeholders continue to engage with change. High-quality education and training will also be needed to allow the HCWF to meet new responsibilities.

The use of technology and digital tools expanded during COVID-19 and can be built on to enhance access, as well as efficiency and productivity of care delivery

Information technology (IT) and digital tools, particularly those used to promote remote consultations, allowed health systems and health professional education to overcome COVID-19 challenges and maintain care continuity. They hold enormous potential to improve the efficiency and delivery of health care and patient outcomes, while simultaneously reducing workloads and supporting and protecting the HCWF. To facilitate their continued use, countries need to continue to create an enabling environment for their use, including by ensuring the development of strategies, regulation and investing in infrastructure. Efforts will also be needed to develop digital health competencies among HCWs. However, attention must be given to ensure that quality is not compromised and that inequities in access to care are not enhanced.

The pandemic highlighted how important protection, support and tailored gender-responsive measures are in maintaining HCWF capacity

Governments implemented a range of protective and supportive measures to maintain HCWF capacity, making considerable efforts to protect the security, safety, and physical and mental health of HCWs during COVID-19. Physical safety protections – such as provision of personal protective equipment (PPE) and violence protection measures – were key in reducing infection and death, as well as abuse and harm of the HCWF. Mental health and well-being measures like helplines, counselling and peer support, were rapidly developed with the aim of sustaining HCWF capacity during the pandemic, as were support measures beyond the health sector, including financial support, transportation and safe accommodation.

These measures have long-term applications to protect and support HCWs and reduce attrition. For example, multipronged efforts are needed that address the organizational and systems-level drivers of poor mental health and burnout, including identifying barriers to accessing mental health support and awareness raising for all staff; and reducing risk factors, such as by reductions in workload and schedule changes, or improvements to communications and teamwork. Moreover, improved working conditions and support are obligations of employers and, together with fair pay, are good practice in order to retain workers.

COVID-19 highlighted that the successful design of support and protection measures, and their implementation, hinge upon an understanding of the specific needs of the populations for whom they are intended. In particular, support measures should be gender-responsive. While women make up the majority of the HCWF globally, they experience pay inequalities and are under-represented in leadership roles. They were also disproportionately negatively affected by the pandemic – especially in terms of experiencing burnout and mental health conditions – and have experienced large declines in labour force participation globally. Addressing gender-based inequalities will be crucial in helping to retain and attract HCWs going forward.

The flexibility of regulatory, financial, quality and technical measures was critical in enabling the implementation of HCWF strategies and is the way forward

Legislation, regulations and licensing were all adapted and often relaxed to facilitate changes such as increasing workloads to surge capacity among the existing workforce; implementing skill-mix changes by modifying scopes of practice; and utilizing digital technologies. Systems need to be able to make such adaptations and evolve to support HCWF reforms. This implies reviewing the legislative framework in which the HCWF operates to ensure regulatory flexibility so the HCWF can adapt quickly to their dynamic surroundings. It also means that licensing and credentialing must become more flexible overall.

All these measures show the value of responsiveness. They also highlight how important it is to have an emergency response plan that covers surge capacity strategies for the HCWF, and sufficient staff, resources and governance structures in place to implement the plan. The pressures the HCWF faced also uncovered more structural challenges which need to be addressed urgently. These include governance for HCW safety and wellbeing; an education and training system to enable an agile response to changing needs; and effective data monitoring and analysis capacities to support planning and service delivery. All these need to be strengthened and resourced. The crisis also highlighted the importance of effective governance structures and mechanisms to coordinate. Governance that could link the health and education sectors, for example, was critical, as was the ability to put in place flexible and adequate health financing. There is a need to strengthen capacity and coordination, and the governance mechanisms that ensure both.

Effective political leadership starts from the top and sets the agenda throughout government and society

Strong leadership during the pandemic showed that a whole-of-government approach is possible, fruitful and should be continued. The challenges facing the HCWF are immense and demand the highest level of political commitment and engagement to secure financing, strengthen governance and prioritize long-term commitments for HCWF capacity and needs in the future. This implies that political leadership must direct resources and solutions to building HCWF capacity, filling gaps in public health to prepare for future emergencies, ensuring that education and training is adaptable to future needs, and using data and monitoring effectively to ensure proper HCWF planning.

As countries transition from crisis management to recovery, heads of state and government must make tangible commitments to strengthen and support the HCWF in the long term. This will ensure that health systems are better prepared in the face of future shocks and restart progress towards achieving UHC, health security and SDGs after the setbacks of the pandemic. The HCWF is central to the achievement of health goals and will repay political commitment by strengthening social cohesion, solidarity and security.