Your Royal Highness Princess Muna al Hussein,
Honourable Ministers, Excellencies, dear colleagues and friends,
Thank you all for your work this week.
I thank all speakers for their insights, and I thank all of you for your participation. The Forum has been a learning opportunity for all of us.
I have tried to attend as many sessions as I can. I have made notes of things that struck me, and I have been humbled by the personal stories we have heard from health and care workers around the world.
I have taken a lot of notes and learned a lot, so thank you so much.
Mark Harding in the UK, who saw many of his own colleagues and friends treated in the intensive care unit he was working in;
Silvana da Castro in Brazil, who continued her fight to provide essential health services during the darkest hours of the pandemic;
There are so many more.
I have been encouraged to hear of the actions, commitments and investments you are making to learn from COVID-19 and make progress.
We have heard from so many countries who have taken action to protect health and care workers: Bangladesh, Brazil, Côte d’Ivoire, Ecuador, Oman, the Philippines, Zimbabwe and more.
We have heard from professional associations and labour unions, who have played a key role in advocating for protection, decent working conditions and respect for labour rights.
I have also been encouraged by the examples of investment we have heard.
The pandemic struck hard, but it served as a laboratory for innovation.
Countries including Chile and Papua New Guinea streamlined their recruitment processes to quickly bring on board additional health workers.
We heard how during the past three years, Ghana has hired 90 000 new health workers, despite the difficult economic climate.
We heard how Kenya has doubled its health workforce, showing that ambitious goals can be reached.
We heard how the United States of America learned from developing countries, by hiring tens of thousands of community workers.
These lessons and innovations must not disappear with the pandemic.
We have also seen many fine examples of what it means to work together to achieve results.
We heard from the Islamic Republic of Iran about how it has institutionalized joint health and education planning.
We heard from Niger on how they are working across health, education, labour and economic development to expand the rural health workforce.
We heard how Italy worked with regulators and professional associations to expand the scope of practice of key occupations during the pandemic, including pharmacists.
We heard from Mozambique about establishing successful partnerships with the private sector, mobilizing resources to expand its health and care workforce.
These examples – and the many others I do not have time to mention – give me hope that together, we can overcome the global workforce crisis.
I am also encouraged by the support of bilateral donors including Switzerland and the United Kingdom for the Working for Health Multi-Partner Trust Fund;
And by the support and commitment of partners including the World Bank, the Global Fund, EIB, ADB ILO, UNESCO, the Buffet Foundation and more.
At the same time, it is clear that we face considerable challenges.
Dr Vytenis Adriukaitis pointed out what should be obvious: that we cannot address health crises, climate disasters and humanitarian emergencies with a shortfall of over 10 million health workers.
Martin Chungong and Cynthia Samuel-Olonjuwon both spoke powerfully about the glaring discrimination in the health and care workforce:
The gender pay gap; the burden of unpaid care work; gender-based violence; and the fact that women account for almost 7 in 10 of all health and care workers, but hold less than 1 in 4 senior positions.
We have also heard loud and clear the voices of Small Island Developing States, many of whom face the twin threats of noncommunicable diseases and climate change.
Neither of these threats can be met without a strong health and care workforce.
In those low-and middle-income countries with the greatest shortages, it is necessary and feasible to double the number of health workers in the next 10 years.
Of course, every country’s context is different. There is no one-size fits all approach.
And we all have a role to play to protect, invest, together.
First, protect.
We call on all countries to implement the commitments they have made in the Working for Health Action Plan for 2022 to 2030, to ensure that every country has the national workforce capacity for public health, universal health coverage and health emergencies.
It’s important these actions are aligned with negotiations on the pandemic accord, amendments to the International Health Regulations, and discussions over a global health emergency corps.
At the national level, parliaments can play a key role, by addressing gender pay gaps through legislation, by approving budgets to fund the health sector, and by providing oversight.
At the international level, we call on all countries to respect the Global Code of Practice on the International Recruitment of Health Personnel, and in particular to protect the 55 countries on the recently updated Support and Safeguards list.
I welcome the proposal from some high-income countries to develop a process for agreeing on additional actions to implement the code.
WHO will support you in any way we can, and I am willing to engage personally if I can help.
To assist WHO and our Member States, I will also establish a multi-sectoral advisory group of experts that will provide me with the evidence for action in support of national health policy and workforce priorities.
This advisory group will comprise government and partner expertise from education, finance, gender, economy, health and labour, and will report to WHO’s Global Policy Group, which includes me and the six Regional Directors.
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Second, we all have a role to play to invest.
Two regions, Africa and the Eastern Mediterranean, account for almost three-quarters of the projected shortage of health workers.
The estimated investment needed to expand the education supply in these two regions is less than one half of one percent of their combined GDP.
Let me put that into context:
It’s less than 1% of global military expenditure;
And it’s around 2% of the International Monetary Fund’s annual lending.
Investment in education is essential, but it’s not enough. Once they graduate, health workers need decent jobs with decent pay and decent working conditions.
The adoption of the Health Workforce Investment Charter by countries in the African Region is an important step to build on.
Unions, professional associations and civil society have a key role to play in advocating for investment, in keeping governments and donors accountable for their commitments, and in advising where investments should go for the greatest impact.
And as a major provider of health services and health products, private sector investments are essential, especially through partnerships for public purpose.
Increased investment is important, but as we heard today, it’s also vital that investments are aligned with national priorities; that they serve to stimulate further investment; and that they are sustainable over the long term.
These are all your words, by the way ̶ what you have said over the last three days.
I will therefore engage with Heads of State, regional economic bodies, Ministers, heads of the international financing institutions and others in the various international fora this year to identify how we realize these investments through domestic, international and philanthropic funding.
We also plan to make workforce a cross-cutting priority in our next General Programme of Work for 2025-2029, and we will increase the internal allocation of our budget to strengthen our work in this area.
Already we have committed to increasing funding to our country offices, enabling them to better support Member States, including on workforce issues.
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Third, together.
The challenges we face manifest at the local level, but they have global and multisectoral causes that can only be addressed with a global and multisectoral response.
Migration is not a standalone issue: it results from labour market conditions and requires labour market solutions, and market failures should be addressed head on.
Likewise, education and training for health and care workers cannot be addressed in isolation from wider education and training strategies.
Improving gender equity, addressing gender-based violence and engaging youth are not issues for the health sector alone, and can only be properly addressed as part of a whole-of-society response.
These are complex issues, but they are not insurmountable.
It takes clear vision, strong leadership, evidence-informed policy, smart investments, good data and relentless advocacy.
As we have heard from so many countries this week, it can be done, and it must be done.
Because the simple truth is that there is no health without health and care workers.
Health information does not communicate itself;
Vaccines do not administer themselves;
Wounds do not dress themselves;
Caesarean sections do not perform themselves;
Diseases do not diagnose themselves;
Medicines do not prescribe themselves;
And care, compassion and kindness do not deliver themselves.
They all require a person – and not just any person – they require a health or care worker.
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Excellencies, dear colleagues and friends,
Thank you all once again for your hard work this week, and for your commitment to strengthening the health and care workforce in every country.
I began my remarks on Monday by telling you the story of Lucy Nyambura, a health promotion officer in Mombasa City, Kenya.
Let me finish by telling you about Dr Gantsengel Purev, an intensive care specialist at the Central Military Hospital in Ulaanbaatar, Mongolia.
During the pandemic, health and care workers at the hospital were on a roster where they worked for 14 days straight, almost 24 hours a day.
Then they stayed in a quarantine facility for seven days, followed by 14 to 30 days at home. Complete prisoners.
This is what Dr Purev said about one of his 14-day shifts:
“During my first shift, I lost my grandmother to COVID-19. She died in my arms. During my last shift, three people died in an hour. My patients are no different to my grandmother and grandfather. Many patients recover and leave the hospital. What keeps me going is two words from them: thank you.”
Those two words are among the most powerful in any language. By the way, I learned to say "Thank you" in many languages when I was doing my masters at the London School of Hygiene and Tropical Medicine in London in 1991. It's like a melting pot, everybody comes from all over the world. So I like to say thank you in many different languages.
They are important words, but health and care workers deserve more than thanks.
They deserve quality education and training;
They deserve safe working conditions;
They deserve decent pay;
And they deserve respect.
They deserve our every effort to protect, invest, together.
I thank you.