The Importance of Investing in Health Worker Safety for More Resilient Health Systems

There is renewed attention on health workforce protections as health systems rebuild after the pandemic. Now is the time to bolster health systems so that health workers can deliver health for all more safely.

Despite the pandemic’s spotlight on the key role of health workers for health system resilience, there is still increased global concern about health workers’ wellbeing. In addition to disease exposure, health workers face occupational risks, exposure to chemicals, and physical hazards on the job, including violence and harassment from patients or colleagues. In addition, they face psychosocial and mental health risks, including a growing risk of burnout, which has resulted in a mass exit from the practice.

Health worker safety has an impact on health care delivery and patient safety. Imagine if you had to decide to undergo a medical procedure performed by either a well-paid, well-rested, healthy clinician at an adequately staffed facility, or by an underpaid, overworked, stressed clinician at an understaffed facility. The choice is clear! We must put health workers at the center of health systems investments in primary health care (PHC) during crises that stress health systems and beyond.

Moving from Post-Pandemic Awareness to Action

Seeking to institutionalize best practices from centuries of labor and human rights movements, at the 75th World Health Assembly in 2022, the World Health Organization (WHO) developed the Global health and care workers compact. A compilation of technical guidance, it focuses on four interrelated areas:

1. Preventing harm through protection from occupational hazards, violence, and harassment, in fragile and conflict situations, and through mental health and psychosocial support;
2. Inclusivity, including equal treatment and non-discrimination;
3. Providing support, including fair and equitable compensation, social protection, and enabling work environments; and
4. Safeguarding rights, in consideration of both collective and individual empowerment.

The White House’s Global Health Worker Initiative also focuses on protecting and supporting health workers as a key pillar. For example, it recently supported the WHO to operationalize a surveillance system to capture data on health worker attacks in complex humanitarian emergencies. In addition, with many countries increasingly investing in community health systems to achieve health for all, all health workers deserve fair remuneration, protective equipment, and employer support when traveling to the most rural, remote, and underserved communities—especially women. Female health workers, while representing 70% of the global workforce, hold only 1 in 4 health system leadership roles. This can result in decisions that fail to consider gender dynamics. For example, when personal protective equipment (PPE) is designed for men, it may not adequately protect women health workers from hazards on the job.

In May 2024, the WHO and partners—including the Frontline Health Workers Coalition, of which Chemonics is a member and I am a Steering Committee member—held the inaugural Africa Health Workforce Investment Forum in Namibia, where they launched the Africa Health Workforce Investment Charter and subsequent Windhoek Statement. With engagement from ministers of health, finance, and civil service alongside donors and partners, participants continued to strategize how to convey that the health sector is not a ‘consumptive’ sector, but rather a ‘productive’ one, yielding a 10:1 return on investment. To paraphrase Dr. Joseph Cabore of the WHO Regional Office for Africa, “People say that health workers are the ‘backbone’ of the health system, but I would argue that they are the lifeblood.”

Recommendations for Action

Engage multisectoral partners in system-wide approaches: Health workforce investments require a diverse range of sectors and systemic approaches to address deeper challenges and be impactful. Beyond health, effective and strategic investments require collaborations with the finance, education, labor, and sometimes foreign affairs sectors. With country governments in the lead, external partners and the private sector alike need to align the ways money is spent on training, supporting, equipping, and remunerating health workers. Far too often, investments are fragmented and ad hoc. Chemonics’ technical partnership with The World Bank’s The Global Financing Facility (GFF) provided an overall strategy and specific, country-level recommendations for streamlining human resources for health initiatives sustainably. More efficient use of resources can ensure a more adequate, well-coordinated response in an emergency.

Focus on the PHC workforce: It is estimated that 90% of health needs can be addressed through primary care services, and investments at this level of the health system will help overcome the greatest challenges to health worker safety. In our FHWC Case for investing in Primary Health Care Workers, we recommend investing in safe and decent work for all health workers, especially women and community health workers. Essential infrastructure – such as electricity, water, and sanitation—and gender-sensitive policies—such as maternity leave and childcare support—can simultaneously support higher quality services and a more motivated PHC workforce.

Strengthen global health security competencies locally through continued learning: Now is a crucial opportunity to build future health workforce capacity to prevent, detect, and respond to public health emergencies. When local health system actors are able to conduct community-based disease surveillance, contact tracing, infection prevention and control, and refer suspicious illness to the health system, it contributes to greater health security. Health workers’ capacity in such pandemic preparedness and response also requires that they are knowledgeable about their own health, well-being and safety—a “win-win” for global health security. We need to invest in more practical, competency-based learning and continual professional development opportunities for these integrated and essential public health functions, including at the community level.

Support resilience through mental health support: As the lead implementer of the USAID Human Resources for Health in 2030 (HRH2030) Program, Chemonics and partners such as URC, Vitalk, and the University of Malawi - UNIMA innovated during the COVID-19 pandemic by deploying a digital chatbot to health workers in Malawi so they could assess and access resources to promote their mental health and wellbeing. Our study showed that the chatbot helped reduce depression, anxiety, and burnout, which is important in a context with mental health professionals are scarce, and 3 in 4 health workers suffer from burnout.

With long-term, system-wide workforce investments grounding well-coordinated, country-led strategic plans, health workers can receive the protections and support they need to thrive. A safe, motivated workforce can deliver health for all and address existing health workforce challenges and increase resilience to future shocks.

As a multi-sectoral development partner committed to taking integrated, system approaches to address intractable challenges, Chemonics is committed to working with diverse partners to build more resilient health systems around the world, including in fragile and conflict-affected contexts. But we need increased global support and solutions to further build up health workers’ resilience because they are the lifeblood of the health system.

This post was originally posted on the Chemonics International LinkedIn page.