The global healthcare landscape faces an unprecedented challenge: a severe scarcity of healthcare resources and limited accessibility. Even before the outbreak of COVID-19, structural issues such as a lack of long-term workforce planning, inadequate retention, the international migration of healthcare professionals, and an ageing workforce already set the stage for this predicament. However, the solutions are just as complex.
International mobility challenges
Approximately 30 per cent of all foreign-born or foreign-trained doctors and nurses employed in OECD countries originate from lower-middle and low-income nations, constituting a substantial proportion of migrant healthcare workers. The United States, for instance, heavily relies on foreign-born healthcare workers, with over 2.6 million immigrants, including 314,000 refugees, working in healthcare roles in 2018. This demographic accounts for 28 per cent of physicians, 24 per cent of dentists, and 38 per cent of home health aides in the US.
Countries like the Philippines have faced long-standing nursing "brain drains”, which have evolved into full-blown crises. The Philippines stands as the largest supplier of foreign-born Registered Nurses (RNs) in the US, comprising five per cent of the RN workforce. Nearly 7,000 Filipino nurses departed the country between January and August 2021, seeking opportunities abroad, especially in the US and the UK. In the UK, Filipino nurses make up a substantial 27 per cent of the nursing staff.
Remunerating healthcare talent
The crisis in the Philippine healthcare workforce has reached a fever pitch, with nurses taking to the streets to demand improved remuneration, working conditions, risk allowances, hazard pay, and political reforms. The WHO's State of the World's Nursing 2020 report warns that, without immediate action, the Philippines will face a dire shortage of 249,843 nurses by 2030.
To address the needs of healthcare workers, especially in lower- and middle-income countries, the WHO recommends a range of mitigating measures and retention packages. These include enhancing salaries, ensuring pay equity, improving working conditions, creating opportunities for professional development, and enabling nurses to fully use their education and training.
The investment needed to secure the additional 5.9 million nurses required worldwide amounts to just US$10 per capita in low- and middle-income countries, according to the WHO. Achieving this level of funding necessitates innovative solutions from both the public and private sectors.
Emerging initiatives are stepping up to tackle these challenges. For instance, InvestEd's "Frontliners First: Nurse Education Loan Program" in the Philippines offers college students loans to fund their nursing education, along with coaching and mentoring for post-graduation success. In Indonesia, DANAdidik, a peer-to-peer crowdfunding platform, provides interest-free micro-loans to students who repay supporters upon graduation, thereby reducing the financial burden of pursuing a career in healthcare.
Workforce planning
Increasing training and diversifying routes into healthcare employment will only be effective if people choose to practice their profession and build a career within it. The global healthcare industry is struggling with extreme worker dissatisfaction, and in countries like the UK that rely on a foreign-dominated workforce, strike action, burnout, and demotivation are making the situation worse. Recent OECD data shows that the UK has the lowest ratio of practicing doctors per 1,000 people, suggesting a churn in practitioners.
“The UK needs to show it has a globally competitive healthcare sector that people want to work in. Reducing the reliance on globally trained healthcare professionals during a staffing shortage isn’t viable,” says Tania Bowers, Global Public Policy Director at the UK’s Association of Professional Staffing Companies (APSCo).
With healthcare strikes in the news once again in the UK, Bowers points to workforce planning as a way to manage emerging staffing crises. “While attracting resources is a problem, retention issues also prevail and haven’t been covered in much detail. Workforce unrest and burnout are real problems in the healthcare sector and if these aren’t adequately addressed, the success of any recruitment strategies will be limited,” she says.
Shared medical appointments: a demand-side solution
Overburdened healthcare systems exacerbate the crisis by leading to extensive wait times for appointments and procedures. This overcrowding not only hampers the patient experience but also strains healthcare facilities' resources, resulting in increased costs.
Shared Medical Appointments (SMAs), however, offer a promising demand-side solution. SMAs involve multiple patients with similar medical needs or conditions attending an extended appointment with a healthcare provider. These group visits have been effective for patients with various medical conditions, from chronic illnesses to mental health concerns.
Researchers from ESMT Berlin conducted a large-scale randomised controlled SMA trial at India's Aravind Eye Hospital. The study involved 1,000 patients with primary glaucoma, randomly assigned to either one-on-one appointments or SMAs with five patients over four successive routine follow-up visits scheduled four months apart. The results were striking: SMAs significantly improved patient satisfaction, knowledge about their condition, and medication compliance, all without compromising follow-up rates or clinical outcomes.
“The demand for healthcare worldwide is soaring and exceeds supply,” says lead researcher Nazlı Sönmez. “In underdeveloped countries, especially, the patient-to-doctor ratio is staggering, and patients face high barriers to receiving care. We must use innovative solutions, like shared medical appointments, to meet this demand. Failure to do so would deprive a huge number of people of their fundamental human right to healthcare access.”
SMAs hold the potential to expand access to public healthcare, reduce costs in private care, and enhance medical outcomes, particularly for conditions like Type 2 diabetes, in both primary and secondary care settings. In the US, the Cleveland Clinic has adopted SMAs across various specialities, resulting in improved patient outcomes, increased satisfaction, and reduced costs compared to traditional individual appointments. The UK's National Health Service (NHS) has also embraced SMAs, particularly for chronic disease management, with patients benefiting from peer support and enhanced education during group appointments, leading to better adherence to treatment plans and improved health outcomes.
The challenges facing healthcare systems worldwide are undeniably daunting. A comprehensive approach encompassing supply-side solutions, such as investment, education, and workforce development, and demand-side solutions like SMAs, aims to bridge the skills gap and ensure that healthcare remains accessible, efficient, and patient-centred for all, even amid escalating demands and limited resources.
