20 Addressing the Global Health Crisis: Universal Health Protection Policies
Often countries decide to use a mix of financing mechanisms. The reasons for using mixed financing mechanisms are often linked to the desire to generate sufficient
funds from different sources and to make best use of the respective advantages of the different mechanisms, such as large risk pools, generation of stable revenues and reaching
out to populations in remote areas. An overview of observations on some aspects of performance of key financing mechanisms towards sustainable development is provided in
table 3.
Table 3: Performance of selected financing mechanisms towards sustainable development
Favourable factors Unfavourable factors
Tax-based health protection: National health services
Risks are pooled for the whole population Potential for administrative efficiency and
cost control Redistributes high and low risk and high and
low income in the population covered Risks of unstable funding and often
underfunding due to competing public expenditure
Inefficient due to lack of incentives and effective supervision
Contribution-based social and national health insurance schemes
Generates stable revenues Often strong support from the population
Provides access to a broad package of quality services
Involvement of social partners If subsidized, coverage of the poor
Requires administrative effectiveness and efficiency which might have to be
developed
Premium-based private health insurance
Preferable to out-of-pocket expenditure Increases financial protection and access to
health services for those able to pay Encourages better quality and cost-
efficiency High administrative costs
Ineffective in reducing cost pressures on public health systems
Inequitable without subsidized premiums
Requires administrative and financial infrastructure and capacity
4.3. Making services available through decent work for all
The health workforce is crucial to ensure sustainable development based on the availability and thus accessibility of quality health care services for all in need.
Based on ILO calculations, to achieve universal health protection and equitable access to needed health care, the world needs about 26 million physicians, nurses and
Addressing the Global Health Crisis: Universal Health Protection Policies 21
midwives. However, of the 26 million needed health workers in 2014, as much as 10.3 million health workers are globally missing: The urban areas of the world are short of 3
million health workers, and the rural areas are short of 7 million.
Currently, these workers are not trained and not employed to provide urgently needed quality services. This crisis needs to be urgently addressed in order to realize the
right to health for all that is heavily depending on the service delivery through skilled doctors, nurses and midwives.
The health worker crisis is rooted in failure of paying attention to the most valuable asset of health systems: Those who care. Addressing the global shortage requires
an action plan consisting of multiple measures ranging from training and recruiting a sufficient number of health workers and distributing them in an equitable way within
countries to providing them with decent working conditions.
Providing decent working conditions can considerably increase retention rates and thus reduce the very high turn-over rates in some countries and especially among rural
areas. This includes adequate wages that are necessary to ensure quality health care and to prevent health workers from migrating to countries where better conditions are offered.
In this context it is also important to address wage disparities across regions, and between general practitioners and specialists. Public authorities need to be exemplary
employers and procurers. Thus, expenditure of public funds and any contract for health- care provision must include clauses ensuring decent wages.
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At the same time, non- financial incentives are needed to increase work motivation and reduce turn-over rates, e.g.
through recognition, career development, and further qualification. Key instruments to achieve the necessary conditions include laws and regulations,
collective agreements and other mechanisms for negotiation between employers’ and workers’ representatives, and arbitration awards. The right to organize and bargain for all
health-care workers is crucial. Collective bargaining is the best way to negotiate workplace arrangements that attract the necessary number and quality of health-care workers.
Finally, with regard to migration of health workers, bilateral and multilateral arrangements are needed with a view to compensate for training costs and avoiding brain
drain. Upholding decent work conditions is particularly important in times of economic
and financial crises, when the demand for health care services and the workload are usually increasing.
In general terms, decent working conditions for health workers, universal health protection and sustainable development go hand in hand. It leads to reduced absenteeism
and create spill over effects to the whole economy.
4.4. Providing financial protection for equity in access
