The world is still coping with the havoc created by the COVID-19 pandemic. This is true where health and care workers are concerned, too. The pandemic underlined the importance of their work and brought the problems they are dealing with to the fore. A recent roundtable hosted by Medicus Mundi International (MMI) discussed violations of the rights of workers and the role of the World Health Organization (WHO) in empowering them. The speakers also pointed towards the need to involve the International Labor Organization (ILO) and health and care workers unions in the negotiations of the Pandemic Treaty led by the WHO.
The World Health Assembly (WHA) adopted a technical document on human resources for health in May 2022. Since then, a negotiating body of the WHO is looking into strengthening existing international legal norms, and developing new ones, to protect health and care workers in health emergencies. This is happening in a situation of chronic and global scarcity of skilled workers, who are risking their lives to provide essential care to people.
According to the first working draft of the WHO Pandemic Treaty published in July 2022, the health workforce is one of the specific fields to be addressed. However, the draft does not address the need to protect health and care workers, provide them with decent working conditions, and enable them to defend their rights. During the roundtable, Michelle Acorn from the International Council of Nurses (ICN) said that the needs of nurses still remain unmet and neglected even as they continue to shoulder growing workloads. Obtaining the necessary mental health support for them is more difficult due to the stigma associated with mental illness, and they continue to suffer workplace safety issues such as violence.
Local experiences to international actions
The speakers at the roundtable discussed the expectations for international solidarity and support as well as the experiences and actions of health workers on a national level. National legal frameworks and institutions for the protection of health workers’ rights are completely missing in Georgia due to deregulation, pointed out Sopiko Japaridze of Solidarity Network, an independent health and care worker union. According to Japaridze, the primary strategy for defending rights of health workers in Georgia is applying pressure from below. In order for this to lead to systemic change, it is necessary to establish international cooperation and partnerships to rebuild labor rights infrastructure. Yet, at the moment, health workers and trade unions in Georgia are locked out from international arenas where negotiations take place. This means that they have very little say about the content that makes it into the final guidance, raising questions about unequal distribution of power and representation in international settings.
Another segment that needs strengthening in order to better protect health workers is the stability of health systems. Musa Lumumba El-Nasoor talked about the recent Ebola outbreak in Uganda, which has already claimed the lives of five healthcare workers. According to him, there wasn’t enough personal protective equipment (PPE), and health workers had to pressure the government in order to change this. Both health workers and the government were caught off guard because the outbreak occurred in an area outside the Ebola belt, which led to additional complications in the response. Although the government is making efforts to control the outbreak, it is dependent on donations because of insufficient funding – pointing to the fact that adequate budgets are needed in order to secure essential rights of health workers.
Baba Aye from Public Services International (PSI) noted that the trade union organization invests a lot of effort on building international-level advocacy building upon their members’ local experiences. In addition to communicating directly with the WHO and the ILO, PSI is also attempting to debunk arguments that are used to naturalize inadequate funding for health systems and the health workforce in particular, such as tax justice.
Bringing together local experiences of defunding of health systems and other factors impacting health workers with international analysis should lead to more informed documents and legislation. Osahon Enabulele from the World Medical Association agreed with this, and illustrated the possibility of sharing their work on the national level and international efforts to develop a joint memorandum with the WHO, demanding the protection of health workers’ rights.
Beyond technical guidance
Jim Campbell, director of the WHO Health Workforce Program, pointed out that WHO member states have already decided that the agency should provide support over and above technical guidance. According to Campbell, WHO’s members are asking for better instruments to be developed by the agency, which would also help them in performing their duty of protecting the right to health. With the adoption of a resolution on health workers at this year’s WHA, WHO members outlined a number of priorities for the WHO, including investment in more employment and protecting the health workforce.
On the other hand, Maren Hopfe from the ILO presented how existing policies and guidelines can be used to improve the position of health workers at the national level. The Nursing Personnel Convention is being promoted as a way to increase professional retention and retraining while also improving the working conditions in the sector. According to Hopfe, we should note the role unions play in advocating for the ratification of these conventions.
Eric Friedman from Georgetown Law stressed that the WHO Global Compact was a good starting point for building protection for health workers on the international level, as it encompasses a wide range of actions. A lot of its content is based on instruments which have already been ratified, which should make it easily implementable.
Soosmita Sinha from Health Law Institute agreed that the guidance provided by international organizations has to be enforceable. But after seeing the blatant violation of health workers’ rights during the pandemic, measures to safeguard the health workforce should be agreed upon in the broader context of the United Nations rather than at the WHO alone. The absence of such a framing means that the current guidance focuses on the need to have adequate skilled workers for the delivery of services, without the consideration of protecting their fundamental rights. The nurses’ duty to themselves should be balanced with their duty to the patient’s health, said Sinha.
Baba Aye opined that in order to develop international norms which would put health workers at the center, trade unions, health workers, and their allies should wage the struggle on several fronts. He emphasized that the context of neoliberalism must be confronted at all levels, both national and international. Otherwise, health workers would be fighting for a little concession here and there. There is a need for a new economic, political, and environmental order, he stressed.
People’s Health Dispatch is a fortnightly bulletin published by the People’s Health Movement and Peoples Dispatch. For more articles and subscription to People’s Health Dispatch, click here.