All countries have workforce issues

Despite their many differences, all countries in the WHO European Region are suffering from a shortage of healthcare workers, an issue that has been further exacerbated by the COVID-19 pandemic. The WHO is proposing collective long-term action.

Text: Dietmar Schobel

“Taken together, the challenges we are currently facing with respect to the health and care workforce represent a ticking time bomb. If left unaddressed, they are almost certain to lead to poor health outcomes across the board, long waiting times for treatment, many preventable deaths, and potentially even health system collapse.” It was with these dramatic words that Hans Kluge, WHO Regional Director for Europe, summed up the findings from the World Health Organization (WHO) report “Health and care workforce in Europe: time to act” during the presentation in September last year.

Tomas Zapata, Photo: WHO

Personnel shortages, unattractive working conditions, lack of strategic planning and insufficient investment in developing the workforce are just some of the issues he made reference to. Most have been known about for decades. But despite this, they have not yet been resolved, and it seems the situation in all 53 countries of the WHO European Region is similar. “There are quantitative and qualitative differences, of course. But generally speaking, each of our Member States is currently facing severe problems in ensuring that there are enough properly qualified staff available for healthcare and long-term care in the future as well,” emphasises Tomas Zapata. He is the Head of the Health Workforce and Service Delivery Unit in the WHO Regional Office for Europe, based in Copenhagen, Denmark, and played a leading role in preparations for the cited report.

Each of our Member States is currently facing severe problems.


Comprehensive data were collected for this report, and the fact that there is a staffing crisis in the healthcare sector may seem paradoxical at first glance when looking at the raw numbers. “The health and care workforce in the European Region has never been larger or more diverse in terms of available skills,” the WHO document states. In fact, the number of medical doctors, nurses and midwives in the WHO European Region increased by an average of ten percent between 2010 and 2020. Upon closer inspection, however, it becomes apparent that this growth on the “supply side” has been exceeded by an even greater increase on the demand side, ultimately leading to a shortage of personnel in all healthcare systems.

Four reasons for the staff shortage

Generally speaking, this development can be attributed to four reasons, explains Tomas Zapata:

*       Demographic changes, i.e. the proportion of elderly and old people in the population is increasing while the proportion of younger people is decreasing.

*       The increase in chronic diseases such as cardiovascular diseases, cancer, chronic respiratory diseases, musculoskeletal disorders, mental health issues and diabetes mellitus.

*       The increased expectations of patients with regard to the healthcare system and its representatives.

*       And last but not least, a backlog of routine examinations and therapies that were postponed due to restrictions during the COVID-19 pandemic.

Added to this is the fact that healthcare workers were pushed to their limits and often well beyond during the COVID-19 pandemic.

According to WHO estimates, no less than 50,000 health and care workers in the European Region have died as a result of COVID-19 infections. Furthermore, there will be a need to fill an especially large number of positions in the healthcare sector in coming years, as many members of the particularly large “baby boomer” cohort will retire. In 13 of the 44 countries that submitted data for the WHO report “Health and care workforce in Europe”, at least 40 percent of the doctors are over 55 and are therefore expected to retire in the next ten years. In Italy, for example, which heads up this statistic, the proportion is even higher at 56 percent.

And so there are more than enough reasons for the alarm bells to be ringing among policymakers – or at least they should be. When nurses, midwives, and doctors go on strike, as seen recently in England, healthcare staffing issues make it to the front pages of newspapers and news portals, thus attracting the interest of the general public. More money, more time off and greater appreciation are some of the remedies aimed at ameliorating the situation in the short term.

Immigration to countries with higher wages

Recruiting healthcare workers from other countries also appears to be a potential solution – but only for the destination countries. Within the European Union, this is facilitated by the right of establishment. Unsurprisingly, immigration primarily occurs from countries with relatively low average incomes to those with relatively high incomes. In the EU, this typically means from Eastern and Southern European countries to Western and Northern European Member States. In some countries, this has already led to a significant “brain drain” due to the emigration of highly qualified workers.

This makes finding collective ways of responding to the staffing problems that are common to all countries in the WHO European Region all the more urgent. The WHO held a meeting in Bucharest in March 2023. Fifty of the 53 Member States sent their responsible ministers and top officials to the conference in Romania and jointly adopted the “Bucharest Declaration”.

“The short-term focus is primarily on determining what we can do to ensure that healthcare workers remain in the healthcare system or return to it,” summarises Tomas Zapata. Other important steps include improving education, performance and planning processes, as well as increasing investment. The ten most important “actions to strengthen the health and care workforce in the European Region” are already included in the cited WHO report of September 2022 (see also box). It is to be hoped that they will also be taken into account and implemented in the short, medium, and long term. After all, one thing is clear: the structural problems that have existed in healthcare systems for decades will not be resolved within a few months. But taking the first steps towards a solution within a few months is all the more urgent. Ultimately, the goal is to defuse the “ticking time bomb” as quickly as possible.

10 actions to strengthen the health and care workforce

1       Align education with population needs and health service requirements

2       Strengthen continuing professional development to equip the workforce with new knowledge and competencies

3       Expand the use of digital tools that support the workforce

4       Develop strategies that attract and retain health workers in rural and remote areas

5       Create working conditions that promote a healthy work-life balance

6       Protect the health and mental well-being of the workforce

7       Build leadership capacity for workforce governance and planning

8       Strengthen health information systems for better data collection and analysis

9       Increase public investment in workforce education, development and protection

10     Optimise the use of funds through innovative workforce policies

Source: Health and care workforce in Europe: time to act. Copenhagen: WHO Regional Office for Europe; 2022