Health Policy February 20, 2019
Plugging the Gap

By Dr Mark Britnell - World Healthcare Journal

By 2030, the World Health Organisation predicts the world will be short of 18m health workers.

Demand for health services is growing fast. Not only are our populations growing, but they are also ageing and ailing. The most recent Global Burden of Disease study from 2016 shows that while life expectancy is rising, a greater proportion of those extra years are spent in ill health, as the global incidence of non-communicable diseases, like diabetes and heart disease, soar. The honourable commitment made by all UN countries in 2015 to achieve Universal Health Coverage by 2030 has only added fuel to the fire – by steadily converting what was previously unmet need into fully-funded demand.

For years, high-income countries like the US and Europe have been able to buy themselves out of trouble. Swathes of migration have characterised the international health labour market, with currents trending from East to West and South to North across the globe. Increasingly, however, high-income countries are finding that even where the money exists, the staff don’t.

“I see the most innovative use of health workers’ time in countries where their skills are most scarce”

The answer is not the “predict and provide” workforce planning of old. Traditional models of care are too labour intensive and expensive to scale – instead, we need innovative thinking about how best to curb demand, improve the productivity of staff, and make that workforce more motivated and agile. Fortunately, I see pockets of excellence everywhere.

In the Netherlands, patients using the district nursing service Buurtzog require almost a third fewer care hours because of a commitment to continuity
of care, from highly trained professionals, who are well integrated with other health and social services, (though total care costs remain the same). When Germany introduced Long Term Care Insurance in 1995, providing payments to friends and relatives to help care for their loved ones at home, the demand for care assistance from the state halved in three years.

We tend to shy away from labour productivity in healthcare but it doesn’t have to mean working harder, just smarter. I see the most innovative use of health workers’ time in countries where their skills are most scarce. At the Aravind Eye Care Hospitals in India for example, ophthalmic surgeons only ever perform that part of the operation that requires their presence, while the tasks not requiring surgical skills are carried out by trained support staff.

While US surgeons average around 400 surgeries a year, Aravind surgeons average closer to 1000. In South Africa, community health workers diagnose and manage HIV, whilst in Mozambique, nurses have been trained to perform caesarean sections. In Bangladesh, a digital healthcare service called Tonic reports dealing with up to 70 per cent of its calls and enquiries online or on the phone, with artificial intelligence algorithms guiding consultations.

Inevitably we will need more staff, more generalists than specialists, practicing in the community rather than hospital and they will need to be digitally and tech-enabled with a more flexible mindset - skills will decay quickly unless we learn to re-learn. In return, however, we need to treat our health staff better. The UK estimates its nurse vacancy rate would be half what it is now if retention rates had remained stable for the last 5 years.

Solving the global workforce crisis in healthcare will not be easy. But as I point out in my forthcoming book, “Human: Solving the global workforce crisis in healthcare,” it will be worth it. When KPMG helped introduce National Health Insurance to the Bahamas in 2016, the estimated return on investment to GDP was 9 to 1. Health is wealth, and spending on our healthcare workers is an investment, not a cost.


E: mark.britnell@kpmg.co.uk | T: +44 20 76942014


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