Universal health coverage: why health workers count

In a recent blog, my colleague Lara wrote about the growing support for universal health coverage (UHC) as a global health priority.

In many countries, UHC is limited, at least in part, by shortages of skilled health workers, particularly in remote and rural areas. As part of the Health Workers Count coalition, I have co-authored a briefing outlining some of the reasons why health workers are important to any country’s efforts to achieve UHC.

Without sufficient numbers of appropriate health workers at the primary-care level, it won’t be possible to increase coverage of essential services.

Even if medicines are readily available and provided for free at the point of use, they won’t reach the people who need them without health workers.

Furthermore, if health workers don’t have adequate training and support, the quality of the services they can provide will be low, which could lead to communities losing faith in their health system.

Expanding coverage

The role of frontline health workers should be maximised since they are the first and often only point of contact with the health system for millions of people.

Given the right training, support, incentives and supervision, frontline health workers without professional qualifications (such as community health workers) can help to expand coverage of key services to otherwise underserved populations.

Reducing out-of-pocket payments – an important aspect of many equitable health financing reforms – can have negative consequences for health workers if not implemented alongside broader efforts to strengthen health systems.

Removing financial barriers to access helps to increase demand, however health workers often rely on formal and informal direct payments to supplement low salaries and cover the costs of running facilities.

In such situations, health workers face the double burden of reduced income and increased workload. In order to retain and motivate health workers, and to discourage them from charging informal fees, strategies to achieve UHC must ensure that health workers are adequately compensated and facilities are sufficiently resourced.

In Sierra Leone, for example, preparations for the Free Health Care Initiative involved a review of the health workforce and a substantial increase in salaries.

The solution

As more countries move towards UHC, it’s important they recognise health workers as a key part of the solution and take action to train, deploy, equip and support a strong health workforce.

All countries should develop and implement a costed, national health workforce plan with a special focus on covering the poorest and most excluded segments of society.

Governments should also raise sufficient resources for health, with adequate investment in long-term health worker training, recruitment, support and retention.

Donors and development partners should also increase financial and technical support to developing countries wishing to strengthen their health workforces and move towards UHC.

You can download the full briefing from Health Workers Count here.