Tackling the primary healthcare workforce crisis: time to talk about health systems and governance—a comparative assessment of nine countries in the WHO European region
Abstract Background Primary healthcare has emerged as a powerful global concept, but little attention has been directed towards the pivotal role of the healthcare workforce and the diverse institutional setting in which they work. This study aims to bridge the gap between the primary healthcare poli...
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BMC
2024-12-01
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| Series: | Human Resources for Health |
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| Online Access: | https://doi.org/10.1186/s12960-024-00965-2 |
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| author | Ellen Kuhlmann Michelle Falkenbach Monica Georgina Brînzac Tiago Correia Maria Panagioti Bernd Rechel Anna Sagan Milena Santric-Milicevic Marius-Ionuț Ungureanu Iris Wallenburg Viola Burau |
| author_facet | Ellen Kuhlmann Michelle Falkenbach Monica Georgina Brînzac Tiago Correia Maria Panagioti Bernd Rechel Anna Sagan Milena Santric-Milicevic Marius-Ionuț Ungureanu Iris Wallenburg Viola Burau |
| author_sort | Ellen Kuhlmann |
| collection | DOAJ |
| description | Abstract Background Primary healthcare has emerged as a powerful global concept, but little attention has been directed towards the pivotal role of the healthcare workforce and the diverse institutional setting in which they work. This study aims to bridge the gap between the primary healthcare policy and the ongoing healthcare workforce crisis debate by introducing a health system and governance approach to identify capacities that may help respond effectively to the HCWF crisis in health system contexts. Methods A qualitative comparative methodology was employed, and a rapid assessment of the primary healthcare workforce was conducted across nine countries: Denmark, Germany, Kazakhstan, Netherlands, Portugal, Romania, Serbia, Switzerland, and the United Kingdom/ England. Results Our findings reveal both convergence and pronounced diversity across the healthcare systems, with none fully aligning with the ideal attributes of primary healthcare suggested by WHO. However, across all categories, Denmark, the Netherlands, and to a lesser extent Kazakhstan, depict closer alignment to this model than the other countries. Workforce composition and skill-mix vary strongly, while disparities persist in education and data availability, particularly within Social Health Insurance systems. Policy responses and interventions span governance, organisational, and professional realms, although with weaknesses in the implementation of policies and a systematic lack of data and evaluation. Conclusions Aligning primary healthcare and workforce considerations within the broader health system context may help move the debate forward and build governance capacities to improve resilience in both areas. |
| format | Article |
| id | doaj-art-03c84e220b9f4b009048a7aa50016bd9 |
| institution | Kabale University |
| issn | 1478-4491 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | BMC |
| record_format | Article |
| series | Human Resources for Health |
| spelling | doaj-art-03c84e220b9f4b009048a7aa50016bd92025-01-05T12:32:24ZengBMCHuman Resources for Health1478-44912024-12-0122111810.1186/s12960-024-00965-2Tackling the primary healthcare workforce crisis: time to talk about health systems and governance—a comparative assessment of nine countries in the WHO European regionEllen Kuhlmann0Michelle Falkenbach1Monica Georgina Brînzac2Tiago Correia3Maria Panagioti4Bernd Rechel5Anna Sagan6Milena Santric-Milicevic7Marius-Ionuț Ungureanu8Iris Wallenburg9Viola Burau10Institute for Economics, Labour and Culture, Goethe-University FrankfurtEuropean Observatory on Health Systems and PoliciesDepartment of Public Health, Faculty of Political, Administrative and Communication Sciences, Babeș-Bolyai UniversityWHO Collaborating Center for Health Workforce Policies and Planning, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNLNIHR School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of ManchesterEuropean Observatory on Health Systems and Policies, London School of Hygiene & Tropical MedicineEuropean Observatory on Health Systems and Policies, London School of Hygiene & Tropical MedicineLaboratory for Strengthening Capacity and Performance of Health System and Workforce for Health Equity, Institute of Social Medicine, Faculty of Medicine, University of BelgradeDepartment of Public Health, Faculty of Political, Administrative and Communication Sciences, Babeș-Bolyai UniversityErasmus School of Health Policy & Management, Erasmus University RotterdamDepartment of Public Health, University of AarhusAbstract Background Primary healthcare has emerged as a powerful global concept, but little attention has been directed towards the pivotal role of the healthcare workforce and the diverse institutional setting in which they work. This study aims to bridge the gap between the primary healthcare policy and the ongoing healthcare workforce crisis debate by introducing a health system and governance approach to identify capacities that may help respond effectively to the HCWF crisis in health system contexts. Methods A qualitative comparative methodology was employed, and a rapid assessment of the primary healthcare workforce was conducted across nine countries: Denmark, Germany, Kazakhstan, Netherlands, Portugal, Romania, Serbia, Switzerland, and the United Kingdom/ England. Results Our findings reveal both convergence and pronounced diversity across the healthcare systems, with none fully aligning with the ideal attributes of primary healthcare suggested by WHO. However, across all categories, Denmark, the Netherlands, and to a lesser extent Kazakhstan, depict closer alignment to this model than the other countries. Workforce composition and skill-mix vary strongly, while disparities persist in education and data availability, particularly within Social Health Insurance systems. Policy responses and interventions span governance, organisational, and professional realms, although with weaknesses in the implementation of policies and a systematic lack of data and evaluation. Conclusions Aligning primary healthcare and workforce considerations within the broader health system context may help move the debate forward and build governance capacities to improve resilience in both areas.https://doi.org/10.1186/s12960-024-00965-2Primary healthcareHealthcare workforce crisisHealth workforce policyHealth systemsGovernancePolicy implementation |
| spellingShingle | Ellen Kuhlmann Michelle Falkenbach Monica Georgina Brînzac Tiago Correia Maria Panagioti Bernd Rechel Anna Sagan Milena Santric-Milicevic Marius-Ionuț Ungureanu Iris Wallenburg Viola Burau Tackling the primary healthcare workforce crisis: time to talk about health systems and governance—a comparative assessment of nine countries in the WHO European region Human Resources for Health Primary healthcare Healthcare workforce crisis Health workforce policy Health systems Governance Policy implementation |
| title | Tackling the primary healthcare workforce crisis: time to talk about health systems and governance—a comparative assessment of nine countries in the WHO European region |
| title_full | Tackling the primary healthcare workforce crisis: time to talk about health systems and governance—a comparative assessment of nine countries in the WHO European region |
| title_fullStr | Tackling the primary healthcare workforce crisis: time to talk about health systems and governance—a comparative assessment of nine countries in the WHO European region |
| title_full_unstemmed | Tackling the primary healthcare workforce crisis: time to talk about health systems and governance—a comparative assessment of nine countries in the WHO European region |
| title_short | Tackling the primary healthcare workforce crisis: time to talk about health systems and governance—a comparative assessment of nine countries in the WHO European region |
| title_sort | tackling the primary healthcare workforce crisis time to talk about health systems and governance a comparative assessment of nine countries in the who european region |
| topic | Primary healthcare Healthcare workforce crisis Health workforce policy Health systems Governance Policy implementation |
| url | https://doi.org/10.1186/s12960-024-00965-2 |
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