What can intersectoral governance do to strengthen the health and care workforce?: Structures and mechanisms to improve the education, employment and retention of health and care workers [Internet]

Excerpt

The COVID-19 pandemic showed the capacity of different sectors to come together to achieve remarkable outcomes. The lessons generated are key to informing post-pandemic health systems policy. They offer powerful evidence on how best to work across sectors to educate, employ and retain a sustainable health and care workforce (HCWF) to deliver on the ambitions of universal health coverage (UHC), health security and the Sustainable Development Goals (SDG).

If governments are to take forward the policies and practices that worked, they should know the following.

1. Providing political leadership from the top can set an agenda for HCWF development across the whole-of-government and the whole-of-society

   1. Sectors cooperated to really good effect during the pandemic because top-level leadership insisted on the finance, economy, education and health sectors working together.

   2. Only the most senior (and serious) government commitment can make HCWF education, employment and retention everybody’s concern and this means:

      1. –

         putting in place a strong legal and political mandate for intersectoral measures;

      2. –

         institutionalizing routine and consistent inclusion of HCWF issues in planning and decision-making in all relevant sectors;

      3. –

         securing proper funding for intersectoral action.

   3. It is important that high-level political commitment is sustained across electoral cycles.

   4. A clear government policy prioritizing long-term human capital development in the health and care economy will signal to all involved that the HCWF matters.

2. Making intersectoral collaboration effective means sustained investment in relationships with key sectors and strategies that build trust

   1. Health sector leaders, ministries of education and finance reached new understandings during the pandemic and created new networks.

   2. Sustaining trust and collaboration with other sectors is the way to maintain networks and support the HCWF effectively both in normal times and in emergency.

   3. The health sector needs to demonstrate to its counterparts that it is a partner that can be trusted to plan effectively, articulate evidence-based demands and deliver efficiently.

   4. Health champions who understand the perspective of other sectors and look for win-wins are best placed to build long-term relationships that work.

3. Countries need to strengthen intersectoral governance mechanisms to make them work for the HCWF agenda

   1. Cross-government committees, specially convened multi-sector working groups and ad hoc tools enabled rapid and innovative responses to COVID-19.

   2. There is a need to build on existing intersectoral mechanisms and implement new ones to sustain the benefits and this means:

      1. –

         revisiting the tools at both administrative and political levels;

      2. –

         linking funding to HCWF development, mobilization and retention;

      3. –

         political engagement to ensure health is not crowded out.

   3. The lessons of the pandemic suggest there should be particular investment in:

      1. –

         mobilizing cabinet and parliament;

      2. –

         extending the scope of existing intersectoral committees, working groups and commissions.

   4. Engaging to diverse stakeholders, including communities and civil society.

   5. International support mechanisms can also be exploited to boost effective work across sectors.

4. The health and care sector needs to develop reliable data and forecasting if other sectors are to take it seriously.

   1. The complexity and scale of HCWF needs in terms of supply, demand and distribution has become abundantly clear.

   2. Being able to specify what health systems need in terms of the HCWF is key to responding and requires:

      1. –

         stronger data collection, analysis and reporting to the public domain;

      2. –

         improved forecasting and scenario planning for health and care services and all public health functions, including emergency preparedness and response;

      3. –

         linking data to models of care and explicit reform goals;

      4. –

         breaking down needs in terms of competencies, practice activities, distribution and aims.

   3. Quantifying HCWF needs will strengthen credibility with other sectors and help make the case for investment.

5. Governments need to change the investment narrative for the health and care sector and spell out the co-benefits for other sectors of investment in the HCWF

   1. The pandemic demonstrated how much the health system and the HCWF does to support populations, keep individuals healthy and enable economic activity.

   2. Analysing and presenting the co-benefits of investing in the HCWF is a key tool for securing political, parliamentary and stakeholder support and investment.

   3. Transparency on co-benefits can also help convince other sectors of the value to them of working with health in terms of:

      1. –

         the education, employment and gender dividends arising from a deliberate expansion of human capital for the health and care economy.

      2. –

         the creation of counter-cyclical employment and jobs in areas of underemployment.

      3. –

         the health, safety and productivity of all workers; and

      4. –

         postponement of early retirement on health grounds.