Healthcare workers are catalysts for improvement, not a cost to the system

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TThe White House Covid Summit recently convened world leaders, multilateral organizations, global health experts and the private sector to fight the pandemic. We have had the privilege of being a stakeholder representative of Seed Global Health, who works with governments to empower health workers in countries with critical shortages.

The main call of the summit was for collective action to cure the Covid-19 pandemic and protect against future global health threats. To that end, we heard a dialogue that focused on global vaccine justice; to improve global manufacturing capabilities for Covid-19 vaccines, personal protective equipment, diagnostics and treatments, including oxygen; and financial commitments to ensure global health security and preparedness.

What we didn’t hear was a lot of discussion about the one success factor of all these initiatives: the “health heroes” of the world. This failure came as a surprise, given that health workers are the foundation of health systems. They deliver every element of the pandemic response and manage the crises that come with it.

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As Covid-19 has pushed people into poverty, increased food insecurity, curtailed access to health care worldwide, reversed advances in maternal and child mortality, and worsened outcomes in infectious and chronic diseases, this increased burden of disease will increase Health care needs only increase the workforce.

Despite these truths and the worldwide loss of more than 100,000 health workers during this pandemic, the global community has not yet proven that together they will change course. Without significant changes in priorities, health workers will continue to be underfunded, undervalued and underprotected. This failure is greatest in low and middle income countries (LMICs) and feeds long-standing inequalities in the global health workforce.

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Long before the advent of Covid-19, healthcare workers in low- and middle-income countries faced significant occupational hazards. They are at least three times more likely to be diagnosed with tuberculosis and up to six times more likely to be hospitalized with drug-resistant tuberculosis than the general population in countries with high disease burden. Health workers in Guinea, Liberia and Sierra Leone were at least 21 times more likely to contract Ebola than the population they cared for during the 2014-2015 outbreak. At least 513 health workers died of Ebola during this period, resulting in a decrease in health workforce of up to 8% in the affected West African countries.

The effects are lasting: post-Ebola investments for Guinea, Liberia and Sierra Leone fell deplorably below the forecast need for recovery; These countries now need up to a 10-fold increase in their health workforce in order to achieve regional averages and international minimum benchmarks for the ratio of health workers to the population.

There will be a shortage of more than 18 million health workers worldwide by 2030, disproportionately high in low- and middle-income countries. Inadequate staffing is already exacerbating the physical and mental health care demands in these countries, fueled by inadequate resources, immense workloads and emotional exhaustion from the toll of witnessing people die preventably. Although difficult to quantify, burnout rates among doctors and nurses are high in African countries – over 80% in some hospitals. Burnout and work stressors, on the other hand, are the main causes of the migration of health workers abroad, which further exacerbates the shortage of personnel in the health sector.

The WHO estimates that the average investment required to grow the health workforce over a 20-year period to meet demand is approximately $ 488 million per year per country.

The necessary funds to fill these funding gaps are indeed in place; there is a lack of international political will. Domestic governments, funders, philanthropy and the private sector have the resources to work together to meet these needs, but according to experts at WHO and the World Bank, these stakeholders often see the recurring costs of developing and hiring strong health workers as a protracted financial burden that they don’t want to wear over time.

Covid-19 offers an opportunity to change that narrative. As healthcare workers are recognized for their services, the international community must recognize that the financial and other consequences of not investing in global healthcare workers are far more devastating than the up-front costs of empowering them.

According to WHO researchers, losing a doctor in Kenya costs more than $ 500,000. And estimates like these do not take into account the potential longer-term consequences of burnout and trauma to health workers that lead to decreased quality of care and brain drain from the health sector or abroad.

There are also innumerable multiplier effects of the employment of health workers. Supporting an appropriately planned, trained, and distributed workforce can reduce long-term inefficiencies in global health spending. Investing an additional 2% of gross domestic product (GDP) in the health, social and education sectors increases the overall employment rate by up to 6%. It may not seem like much, but with the overall unemployment rate in low and middle income countries above 6% in 2020, it could mean huge growth.

Investing in the workforce is also critical to inclusive growth. Promoting safe and secure employment in this sector will reduce gender gaps, as women take up 60 to 70% of jobs, and promote formal work, social inclusion and equal opportunities. The ultimate return on investment in health is estimated at 9: 1, with each additional year of life expectancy resulting from this investment increasing GDP per capita by 4%. In other words, improving people’s health and investing in the health sector can add value to nations.

The World Health Organization has declared 2021 the year of health and care workers. But at the end of the year that statement will sound hollow unless the global commitments to end this pandemic and protect the world from future health crises include sustained actions to protect and empower health care workers around the world.

It’s not about identifying needs; These are clear: Prioritize vaccine and protective equipment health workers now while increasing the global and domestic investment needed in the long term for salaries, education, infrastructure and work ethic. This requires the decision to no longer portray health workers as a cost to the system, but rather to appreciate them as catalysts for better health, economic growth, national security and well-being. It is a decision to recognize them as the “heroes” they always have been.

Pooja Yerramilli is an internal medicine specialist at Massachusetts General Hospital and Boston Health Care for the Homeless, and a policy advisor for Seed Global Health, which works with governments to invest in health capacities for national, economic, and human security. Vanessa Kerry is an Critical Care Physician at Massachusetts General Hospital in Boston, Associate Professor of Medicine and Director of the Global Public Policy and Social Change Program at Harvard Medical School, and CEO of Seed Global Health.


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