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
Kuhlmann E. Falkenbach M. Brînzac M.G. Correia T. Panagioti M. Rechel B. Sagan A. Santric-Milicevic M. Ungureanu M.-I. Wallenburg I. Burau V.
December 2024BioMed Central Ltd
Human Resources for Health
2024#22Issue 1
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.
Comparative assessment , European region , Governance , Health systems , Health workforce policy , Healthcare workforce crisis , Policy implementation , Primary healthcare
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Institute for Economics, Labour and Culture, Goethe-University Frankfurt, Eschersheimer Landstraße 121, Frankfurt, 60322, Germany
WHO Collaborating Center for Health Workforce Policies and Planning, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisbon, Portugal
European Observatory on Health Systems and Policies, Brussels, Belgium
Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, United States
Department of Public Health, Faculty of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
Center for Health Workforce Research and Policy, Faculty of Political, Administrative and Communication Sciences, Babeș-Bolyai University, Cluj-Napoca, Romania
Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Lisbon, Portugal
NIHR School for Primary Care Research, Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, United Kingdom
European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London, United Kingdom
WHO European Centre for Primary Health Care, Almaty, Kazakhstan
Laboratory for Strengthening Capacity and Performance of Health System and Workforce for Health Equity, Institute of Social Medicine, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
Department of Public Health, University of Aarhus, Aarhus, Denmark
Institute for Economics
WHO Collaborating Center for Health Workforce Policies and Planning
European Observatory on Health Systems and Policies
Department of Health Management and Policy
Department of Public Health
Center for Health Workforce Research and Policy
Associate Laboratory in Translation and Innovation Towards Global Health
NIHR School for Primary Care Research
European Observatory on Health Systems and Policies
WHO European Centre for Primary Health Care
Laboratory for Strengthening Capacity and Performance of Health System and Workforce for Health Equity
Erasmus School of Health Policy & Management
Department of Public Health
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