Health workers in Sweden demand workforce policies that do not rely on international recruitment

Nina Bergman from the Swedish Association of Health Professionals talks about the working conditions of health workers in Sweden and the trade union’s support for the struggles for workers’ rights in the Global South

September 23, 2023 by Peoples Health Dispatch
The Karolinska University Hospital, where over 15,000 health professionals work. Photo: Holger.Ellgaard, CC BY-SA 4.0 , via Wikimedia Commons

In a recent meeting of trade unions affiliated with Public Services International (PSI), community health workers launched a campaign aimed at securing equal rights within the health care sector. This meeting, which saw the participation of health care workers from many South Asian countries, also welcomed trade union representatives from the Global North. Some of the trade unions’ representatives used the opportunity to share a call for governments in high-income countries to develop alternative strategies for health workforce strengthening, moving away from the practice of international recruitment.

Nina Bergman, a trade union organizer from the Swedish Association of Health Professionals, shared more on the matter during a conversation with the People’s Health Dispatch. She highlighted Sweden’s ongoing struggle with a serious shortage of healthcare workers. Despite the shortage impacting the work routines in the sector, the trade union remains convinced that international recruitment is not the solution for Sweden’s challenges. Bergman emphasized that even if the number of health workers in the public health system were to increase through international recruitment, it would be insufficient to ensure the universal right to health in Sweden amid the global deterioration of health conditions.

“When I attend the World Health Assembly, one of the issues there is always that they say each country has a responsibility to build up their own health care workforce, and not to take health workers from each other. So I think it’s really important that we care about other countries, because that way we also care about ourselves and our patients,” said Bergman.

Beyond their involvement in initiatives to support health workers in the Global South, Bergman’s organization grapples with unresolved issues at the local level. Sweden’s apparently stable health system, Bergman noted, owes much to its structure, funded predominantly by public resources and designed to respond effectively to diverse regional health needs. While the private sector is gradually establishing itself in Sweden, its reach remains limited.

However, both the public and private sectors in Sweden face vacancies at all levels. The existing workers are overwhelmed by the workload, an experience that makes it even more difficult to find people willing to work in health care. Bergman commented, “When we engage with healthcare workers, including midwives, nurses, biomedical scientists, and radiologists in my union, we hear their perspective. They talk about the burdensome workload and, most significantly, the shortage.”

The extent of the problem became even more evident during the COVID-19 pandemic when the workload became unbearable. Bergman explained that while the pandemic was a significant challenge for Sweden, it provided the trade union with additional grounds to advocate for a stronger strategy for training healthcare workers, particularly nurses, within the country. The importance of maintaining adequate staffing levels, achieved through increased training and improved working conditions, is also evident from data on patient safety and the quality of care. 

Currently, the situation is far from ideal, with health workers facing excessive overtime and unpredictable working schedules on a regular basis. Bergman shared the experience of an emergency clinic worker whose assumed schedule is 8 in the morning to 8 in the evening but who practically “never knows when they will be going home.”

Workers in the clinic remain until the last patient receives care, which means that one day they may leave at 1 am and the next at 8 pm as initially planned. 

Addressing the issues of shortages and excessive overtime solely through a ratio-based approach is unlikely to provide a resolution, Bergman told the People’s Health Dispatch. She stressed that focusing exclusively on nurse-to-patient ratios might obscure other critical elements essential for ensuring high-quality care. According to her, it is equally crucial to ensure the presence of interdisciplinary teams working collaboratively with patients.

Bergman elaborated, “We also had concerns that a ratio could become a ceiling. We aim to organize care in the best possible way for patients, which might require more nurses than set ratios allow, hence our caution with ratios.”

The primary focus remains on building a workforce tailored to local needs while extending support and solidarity to other nations, particularly those in the Global South. Bergman emphasized that recognizing the shared root causes of health worker challenges, including cuts in public expenditure and austerity policies, should motivate workers to take actions that benefit everyone.

“We have to work together for health and see that health is really treated as a fundamental human right,” says Bergman. The feeling that there is widespread consciousness about the importance of the shared condition of health workers gives her the hope that joint efforts will lead to that outcome.

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