Health workforce

Health Workforce Demography

Side Event Prince Mahidol Award Conference 2017

30 January 2017, Bangkok Thailand

Session Report

Summary of Session

The session brought together stakeholders and experts in health workforce, labour markets, and demography, to present a framework for health workforce demography, including examples related to ageing, gender, and international migration. The session highlighted the fundamental importance of understanding the population of health workers, including relevant demographic tools, in order to achieve UHC and SDGs.

The session engaged over thirty participants, including representatives from government, international organizations, academic institutions, and civil society, in discussion on the value of understanding the demographic characteristics of health workers, as a complement to a health labour market understanding.

The session concluded with agreement to build on the momentum of the session through further elaboration of the health workforce demography framework at the upcoming Fourth Global Forum for Human Resources for Health in November 2017.

Speakers

Ashish Bajracharya, Population Council; Jim Campbell, World Health Organization; Ibadat Dhillon, World Health Organization; Asha George, University of the Western Cape, Christopher Herbst, The World Bank; Andrea Nove, Novametrics Ltd;

Content

Jim Campbell introduced the purpose and objectives of the session. He placed the health workforce demography framework within the broader context of the health labour market, as well as that of the WHO Global Strategy on Human Resources for Health and the recent Report of the High Level Commission on Health Employment and Economic Growth.

Ashish Bajracharya spoke to the importance of understanding demographic processes, and value of demographic tools, to better project and match the demand for health services and the supply of health workers. As illustration, he contrasted ageing transition in Japan to a similar, though accelerated, transition occurring in Nepal. As a supplement to classical demographic tools, Ashish additionally introduced tools of social demography as a means to understand the composition and needs of specific populations, with Cambodia’s Garment sector used as illustration.

Christopher Herbst built on Ashish’s presentation by highlighting that while often unrecognized health has its own labour market; one of particular importance from both the employment and economy perspectives. Christopher pointed to how longstanding health workforce challenges can be explained and addressed through a health labour market approach. He concluded by pointing to examples of specific health labour market analysis, as contained in the book Health Labour Market Analyses in Low- and Middle- Income Countries: An Evidence-Based Approach.

Andrea Nove, building on the first two presentations, made the point that much as demography matters at the population level, so too does it matter at a health workforce level. Andrea then presented a health workforce demography framework that builds on the standard demographic approach. Enrolling in health worker education, attrition from education, joining/rejoining the workforce, leaving the workforce, size and composition of work teams, alongside migration, age, gender, and ethnicity were identified as key elements to understanding the health workforce population. An example from Ghana illustrated the importance of understanding demographics of the health workforce. Following responses to questions for clarification from the audience, specific elements of the health workforce demography were presented.

Asha George spoke to the importance of understanding and responding to gendered nature of the health workforce. She pointed out that over 2/3 of the global health workforce female, with the number likely to be substantially larger if all those providing health care were counted. . Asha pointed to the need to ensure the rights and working conditions of all health workers, recognizing that predominantly female. She spoke to the existence of gender-based wage gaps, as well as gaps in leadership and career advancement. Asha concluded by highlighting the need for appropriate measurement, valuing, and rewarding of women in the health workforce.

Ibadat Dhillon followed by speaking on the topic of international migration of health workers. Ibadat presented data reflecting the increasing magnitude of health worker migration, as well as increasingly complex patterns of movement and complexity of the international migration of health workers. The dichotomy of source and destination countries was questioned. An illustration from Kerala was provided that captured the demographics of emigrant physicians from Kerala. The presentation concluded with examples of innovative practice in collaboration.

Wonchat Subhachaturas utilized the health workforce demography framework to analyse Thailand’s health workforce. Wonchat presented the age, gender, and rural/urban distribution, by cadre, on Thailand’s health workforce. He pointed to the increasing feminization of the medical workforce in the younger age groupings; in significant contrast to earlier patterns. He concluded by pointing to the increasing importance of gender-sensitive employment policies with respect to Thailand.

The session concluded by an open and wide ranging discussion amongst the audience and presenters on the framework proposed, as well as its component parts. The session concluded with a call to continue the analytic work underpinning the framework.

Jim Campbell closed by reiterating the importance of understanding the health workforce as its own population and invited participants to engage in the approach. He pointed to the upcoming Fourth Global Forum on Human Resource for Health in Ireland as an opportunity to reconvene and continue to build a shared understanding in the area.