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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

time to talk about health systems and governance-a comparative assessment of nine countries in the WHO European region
Authors: Kuhlmann, Ellen; Falkenbach, Michelle; Brînzac, Monica Georgina; Correia, Tiago; Panagioti, Maria; Rechel, Bernd; Sagan, Anna; +4 Authors

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

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.

Keywords

Medicine (General), Health Personnel, Primary Health Care/organization & administration, European region, World Health Organization, a call for evidence and analysis papers on causes, impacts, and solutions ; Comparative assessment ; Health Personnel [MeSH] [Policy implementation ; Europe [MeSH] ; Delivery of Health Care/organization ; Governance ; Humans [MeSH] ; Health systems ; Health Workforce/organization ; World Health Organization [MeSH] ; Primary Health Care/organization ; European region ; Healthcare workforce crisis ; Health Policy [MeSH] ; Health workforce policy ; Research ; Primary healthcare ; The primary care medical workforce crisis in the European region], Health systems, R5-920, SDG 3 - Good Health and Well-being, Healthcare workforce crisis, Humans, Health Workforce, Delivery of Health Care/organization & administration, Governance, Primary Health Care, Research, Health Policy, Health Workforce/organization & administration, Policy implementation, Europe, Comparative assessment, Health workforce policy, Public aspects of medicine, RA1-1270, Primary healthcare, Delivery of Health Care

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    selected citations
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    This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    7
    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 10%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Average
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
    Top 10%
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
7
Top 10%
Average
Top 10%
Green
gold