Health workers can see where the health problems are at the coal face. They diagnose, treat and comfort people in ill-health. As leaders in society and healthcare, they are trusted and able to promote daily practices and overarching policies that can connect the daily conditions of people’s lives to their chances of recovery from ill-health. They can draw leaders’ attention to needed prevention efforts and health systems coverage issues that address the problems faced by patients they see every day in the clinics and hospitals. They also have a central role in addressing action on the social determinants of health (SDH) to promote health equity both as individuals, and as the health workforce collectively. The 2030 Agenda for Sustainable Development and the Sustainable Development Goals (SDGs) have created an organizational space and capacity, which will enable health workers and the health workforce to effectively engage, work and partner with other sectors towards achieving the SDGs.
LINKS TO SDGS:
Health workers address issues at the community level (the frontline), champion community health needs, and make services more patient-centred. Health workers are key partners in health care delivery and play a critical role in promoting equitable expansion of coverage for a range of preventive, promotive and curative services related to reproductive, maternal, newborn and child health, infectious diseases and noncommunicable diseases. Health workers are the critical pathway to attaining the health targets in SDG 3, and make important contributions to addressing other SDGs. For example, a study of data over two decades for middle and low income countries found that around 50% of reductions in mortality for children under five years is derived from health sector interventions. However, income inequalities within countries had a negative impact on child mortality, and 50% of child mortality reductions is attributed to conditions outside the control of the health sector (source: https://www.who.int/bulletin/volumes/92/7/14-138131/en/).
Immense strides have been made in improving health around the world. Despite this progress, there is still a long way to go. To avoid preventable deaths, reduce maternal mortality, and decrease HIV/AIDS prevalence, not only are resilient health systems needed – action on the determinants of health and all the SDGs is required. Innovative methods are being developed by health care providers under the banner of “screening for the social determinants of health” (source: https://jamanetwork.com/journals/jama/fullarticle/2749417). This allows health services to address the interface between the care system and the context within which patients are living. This is leading to huge savings and far higher effectiveness rates. Furthermore, the role of health workers regarding noncommunicable diseases (NCDs) is an increasing priority, as NCDs are responsible for an increasing proportion of the global burden of disease, which cannot be addressed by the health sector alone. These examples show how cross-sectoral enabling factors are becoming increasingly needed for health systems and other sectors to achieve the SDGs and support action on the determinants of health.
In addition, health workforce investments create education opportunities, decent jobs and career pathways for youth in low- and middle-income countries, especially in rural economies. Not only are direct jobs created in the health workforce, but also in auxiliary services like laundry, catering, whole sale and retail suppliers and the like. Creating jobs for health workers, and particularly for youth and women, will not only contribute to SDG 3, but will impact SDG 4 (education), SDG 5 (gender equality) and SDG 8 (decent work and inclusive growth).
HOW DO WE ENGAGE WITH OTHER SECTORS:
The 2030 Agenda establishes a convergent, coordinated and mutually reinforcing policy environment that will allow health workers to act between and across sectors. This will require that health workers and the health workforce embrace and adopt new ways of working and learning. Policy makers, educators and trainers, and students engage in reframing and reorienting health workforce education and training, including but not limited to;
- intersectoral planning to reorient the health workforce towards integrated people centred health services and lifelong learning systems;
- implementing socially accountable and transformative health workforce education and training agenda, that includes community based, engaged and distributed experiential learning and education;
- integrate education and training on the social determinants of health into pre-service (undergraduate and postgraduate) health workforce curricula, as well as in-service and continuing professional development programmes;
- partnering with communities and other sectors in curriculum development, monitoring and evaluation, and assessing the impact of action;
- each health worker taking responsibility for advancing their understanding of the SDH during their lifecourse.
In the workplace and in the community, health workers should:
- engage and partner with communities and other sectors to take action on the social determinants as an integral and central part of their daily practice;
- utilise their roles within the health system (eg. clinicans, managers and employers) and outside the health system (eg. example, community leadership roles) to engage and partner with others promote health equity;
- work as advocates at all levels and sites to address health inequities, including at a national and global level through interscetoral action and a health in all policies approach.
Possible challenges for health workers when addressing the health equity:
- Reorientation towards delivering integrated people centred health services.
- Aligning with policies that ensure that they have the right skills and competencies, and they are deployed and retained in the right numbers and in the right places.
- This requires creating an enabling environment through intersectoral policy and planning, and mechanisms to address structural determinants, including;
- Further strengthen policies, strategies and plans as appropriate, through intersectoral policy dialogue among the relevant ministries that may include ministries of health, education, finance and labour;
- Increase fiscal space through effective co-financing and target investments to promote and reinforce intersectoral cooperation, and including committing budgetary resources for transformative health workforce education and training and lifelong learning opportunties;
- Regulation, for example accreditation mechanisms, see WHO Policy Brief on Accreditation of Institutions for Health Professional Education http://whoeducationguidelines.org/sites/default/files/uploads/whoeduguidelines_PolicyBrief_Accreditation.pdf
- Monitoring and evaluation, assessing the impact of action, to provide a better understanding of linkages and causal pathways and mechanisms;
- Institutional commitment and leadership at all sites and levels.
In terms of institutional and instructional reform in the development of health workers:
- Education and training institutions should consider innovative expansion of faculty, through the recruitment of community-based clinicians and health workers as educators;
- Education and training institutions should consider designing and implementing continuous development programmes for faculty and teaching staff relevant to the evolving health-care needs of their communities.
- Education and training institutions should consider using targeted admissions policies should be adopted to increase the socio-economic, ethnic and geographical diversity of students.Faculty development and career pathways
Education and training institutions should consider adapting curricula to the evolving health-care needs of their communities.
KEY TOOLS AND EXAMPLES TO SUPPORT THIS ACTION:
THEnet schools, including;
Training capacity in research on social determinants of health (RSDH) in low and middle-income countries (LMICs) in Asia – ARCADE RSDH
University College London, Institute of Health Equity,Working for Health Equity: The Role of Health Professionals