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Global health and care worker compact: technical guidance compilation

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1 Background

  1. The COVID‐19 pandemic, highlighting the extraordinary work performed by health and care workers under extraordinary conditions, has drawn attention to the need for renewed and continued focus on their occupational health and safety; fair remuneration; protection from harassment, violence, stigma and forced labour; and support with needed resources to carry out their vital responsibilities. Estimates suggest more than 115,500 health and care workers may have died due to COVID‐19 between January 2020 and May 2021. Infections and their longer‐term impacts; mental health issues, including due to burnout, fatigue, stress and violence; labour protests; and departures from service are further reducing the workforce and demands for service are increasing to catch up on essential services and deliver COVID‐19 tools simultaneously. COVID‐19 has exacerbated pre‐existing challenges of maldistribution, shortages and an inadequate skills mix; attention and realization highlighted by the pandemic should be channelled into concrete action, change and investment.

  2. Health and care workers need safe, healthy, supportive, and dignified conditions of work. This compact provides recommendations on how to protect health and care workers and safeguard their rights, and to promote and ensure decent work, free from racial and all other forms of discrimination and a safe and enabling practice environment. A wide range of existing international conventions, instruments, treaties and resolutions (collectively, “legal instruments”) inform these recommendations, ranging from human rights, labour rights, humanitarian law and other treaties to United Nations declarations, WHO Global Code of Practice on the International Recruitment of Health Personnel and the WHO Global Strategy on Human Resources for Health 2016‐2030. Each section includes extensive referencing to the relevant legal and other normative instruments, offering a compendium of resources for further technical guidance as appropriate.

  3. While COVID‐19 is the immediate motivation behind this compact, the recommendations it contains help make progress to meet the United Nations and WHO health and development goals, including universal health coverage and the 2030 Agenda for Sustainable Development, and its central commitment to leave no one behind, and reconfirming the objectives to the Global Strategy on Human Resources for Health: Workforce 2030. Achieving these goals requires overcoming a projected shortage of over 18 million health workers by 2030, including by leveraging the findings of the High‐Level Commission on Health Employment and Economic Growth related to the positive impacts of health workforce investment on education, gender transformative policy and action, job creation and economic development. Ageing populations in many countries are driving further demands for health and care workers. Increasing the number of health and care workers and ensuring their equitable distribution with a skills mix adapted for context is critical for our entire populations, and above all for marginalized, disadvantaged, and underserved populations. Failure to do so, especially in the face of additional COVID‐19 challenges, puts health systems and the health of every person at risk.

  4. Health and care workers are people whose work is primarily intended to enhance health, and to provide health services, compassionate care, and assistance to patients, older adults, people with disabilities, and convalescent individuals. These personnel include sometimes marginalized segments of the workforce, such as caregivers, direct care workers in home and community‐based settings, workers in nursing facilities, health workers in vocational, undergraduate and post‐graduate education, community health workers, healthcare assistants, hospital attendants, and domestic workers with care responsibilities.

  5. Health and care workers require the skills, resources, employment security, adequate and regular remuneration and safe, healthy, and supportive environments that enable them to deliver respectful, quality care to all people. Safe healthcare delivery cannot happen without appropriate education, oversight, and implementation of relevant infection prevention and control practices, so that health and care workers can protect themselves, patients, and their community. Additionally, t broader significance of the large proportion of women who compose the health and care workforce must not be forgotten. Ensuring safety from sexual harassment and gender‐ based violence, as well as safeguarding the rights of health and care workers is not only critical to securing the right to the enjoyment of the highest attainable standard of health of everyone, but also is an important element of achieving gender equality and women’s empowerment and participation in full and productive employment and decent work. Further, investment in health worker jobs contribute to addressing poverty, education, economic growth and development ambitions.

  6. Accordingly, WHA 74.14 requested the development of this global health and care worker compact to provide a succinct compilation document, based on already existing documents of relevant international organizations, that aims at providing Member States, stakeholders and relevant other organizations with technical guidance on how to “protect health and care workers and safeguard their rights, and to promote and ensure decent work, free from racial and all other forms of discrimination and a safe and enabling practice environment, in line with the WHO Global Code of Practice on the International Recruitment of Health Personnel.” The ‐process to develop this care compact (figure 1) was based on a scoping review of relevant international instruments and key stakeholder interviews conducted i by WHO Collaborating Centre on Global Health Law, O’Neill Institute at Georgetown University; subsequent drafts of the document underwent WHO internal review and consultation with other relevant partners; and, finally, through an open consultation with Member States. The WHO Health Workforce department has coordinated the development of the document and will be available to support to Member States in implementation of relevant recommendations.

  7. While governments are responsible for protecting health and care workers’ rights, a whole‐of‐society approach is needed, including private, non‐governmental, and faith‐based employers of health and care workers, the international community, and the public, to respect health and care workers’ rights. Safeguarding the rights of health and care workers to decent work is also integral to overcoming health and care worker shortages and retaining existing health and care workers. This includes safe, healthy, and enabling work environments. Adequate and safe staffing levels are needed to protect both workers and those in their care.

  8. This compact also aims to ensure that health and care workers understand their rights and global commitments to them, and are empowered to ensure accountability for respecting, protecting, and fulfilling such rights.

  9. This compact is intended to provide technical guidance to Member States and is not legally binding, nor does it suggest what legally binding obligations may exist, which depends on each State’s obligations. The technical guidance draws extensively from existing international legal instruments, labour law and States’ obligations. This reference document is a foundation for further development and application in sub‐national, national and global reviews and policy dialogue. Within the planned activities for 2022‐ 2023, the WHO Secretariat will develop operational tools and guidance to utilize the care compact to rapidly assess, review and monitor good practice.

  10. Achieving these ends, in turn, calls for increased and sustained investments in the health and care workforce, including education, training and protection (e.g., prevention of violence and harassment in the workplace), facilitating financial security and employment policies for health and care workers, and preventing discrimination in the workplace, paying workers and build the necessary support structures, with increased international assistance by governments in a position to do so. Without increased funding, countries cannot develop the health and care workforces that they require to deliver the health and care services that are critical to fulfilling the rights of our populations. In this regard, investments in the health workforce and care economy should be recognized as economically beneficial investments. As such, removing health worker hiring freezes and other policies and barriers that preclude adequate staffing that enables safety and is a desirable ambition within budgetary and other fiscal policy strategies and decisions.

  11. In line with the WHO Global Code of Practice on the International Recruitment of Health Personnel, there is a need for enhanced technical, financial, and other support to source countries of migrant health workers, to avoid and prevent private sector active recruitment of health personnel from countries facing critical health worker shortages.