Health services and employment

Employment trends

There are 59 million full-time paid health workers worldwide according to the World Health Report 2006 (WHO); two thirds are health service providers, including doctors, nurses and midwives, and one third comprise management and support workers. The total number of health workers may be much higher, as generally limited data may not capture all health care workers employed in other sectors than the health services nor persons providing care in informal settings.

The trend towards decentralization of health services and the shift from curative to preventive care have led to a multiplicity of employers and working environments in industrialized countries. While medical doctors face a decline in average income and job security in many countries, employment opportunities for nurses are increasing. Often there is a shortage of qualified personnel in specialized fields.

In the transitional economies of Central and Eastern Europe, restructuring of public health services has seriously affected the employment situation of health workers. Due to extensive cost-containment measures, redundancies appear to be unavoidable, and workloads continue to increase.

In middle-income countries, overall health sector employment is increasing in response to the demands to extend basic health services to previously excluded groups, and to upgrade the quality of care. Training sufficient personnel, providing them with jobs and retaining them in the national workforce are major challenges today. In low-income countries, where an accessible basic health infrastructure remains to be built, the mostly public health services have to cope with a scarcity of trained health care workers. Many low-income countries are unable to improve the pay or employment conditions of their health care personnel. In these countries, public expenditure for health services is on average below 1% of GNP.

The labour market for health workers has become increasingly international. Trade agreements between countries are beginning to address the international accreditation of professionals in order to facilitate their mobility. A significant number of workers tend to migrate to countries where the working and employment conditions are more favourable. Consequently, many developing countries face serious shortages of qualified personnel. Innovative retention strategies or incentives, including, but not limited to remuneration, are being investigated.

The introduction of information technology is offering new employment opportunities for health professionals. Telehealth (providing medical/nursing advice and in the future treatment using electronic means of communication, diagnostic screening and even surgery) will inevitably challenge the traditional concepts of employment, methods of work, working conditions, professional regulation, labour relations and accountability.

Useful links/resources

• World Health Report 2006, Working together for health