12th October 2023, Geneva – 1 in 3 frontline health and care sector workers around the world have seen patients in their care die due to a lack of adequate staff, according to a survey of over 2000 workers by Public Services International (PSI).

The findings were unveiled by PSI ahead of its World Congress in Geneva. Health workers attending the event 'hung up their uniforms' in protest, placing lines of empty scrubs in front of the United Nations headquarters symbolising the shortfall of medical staff around the world and the need for rapid new employment and improved conditions.

More than half of respondents to PSI's survey said they regularly think about quitting, raising concerns about how to sustain and improve health services. Three quarters of respondents (drawn from 50 countries) said they felt increasing pressure to accomplish more tasks with fewer resources. 4 in 5 are working over capacity, and nearly a quarter working double their expected workload. 

Responding to the PSI research, Director General of the WHO Tedros Adhanom Ghebreyesus said:

“Health and care workers protect us day in and day out. Whether in local health centres, care facilities, fighting disease outbreaks, or in emergency responses to conflict and climate-related disasters, they face major challenges that demand a major response.  We owe them our gratitude and duty of care.”  

The WHO estimates the world currently faces a daunting 15 million health worker deficit. Professionals are leaving en masse from developing nations. Africa in particular faces dire shortages with only 1.55 healthcare workers per 1,000 people, a number starkly below the WHO’s recommended minimum of 4.55. Such figures expose the danger of current health workforce strategies such as in OECD countries where the number of migrant health workers has increased by 60%. 

Other findings of PSI’s survey include:

• Well over two-thirds of healthcare workers (71.5%) have seen patients experience unnecessary pain or suffering because of staff shortages. 

• 75% reported a lack of well-enforced policy on ratios between patients and staff

• Three quarters had more patients than they could deal with on an average shift.

The survey found the reasons for workers wanting to leave their roles are diverse, but the main drivers were insufficient pay (selected by 58% of respondents as a factor) and staff shortages leading to increased hours (49%).

An overwhelming majority of respondents said stronger public investment from government, rather than market-based or private provision, was key to creating better conditions in the sector. 

PSI also issued a letter to WHO member states’ health and finance ministers, calling for governments to set out tangible steps to implement improved employment conditions and increase investment in public sector healthcare services, to prevent a dangerous potential mass resignation.

Daniel Bertossa, Public Services International Assistant General Secretary said: 

“Just a few years ago, we celebrated our health workers as heroes. Now, the vast majority of these professionals feel betrayed by their leaders. Insufficient public investment in our healthcare systems is creating life threatening risks for both patients and staff. 

Skilled workers like these take time to train - we are perilously close to not having enough skilled staff to train the new staff we need. As shortages become more profound, the failures of band-aid solutions will become  more acute.” 

Health workers and union leaders from around the world shared their testimonies of understaffing in the sector

Haruki Hirayama, Director of the Health Care Workers Council of Jichiro (All Japan Prefectural and Municipal Workers Union):

"Japan's medical and care frontlines are tormented by chronic shortages of personnel and harsh working conditions. In order to provide high quality medical and care services, securing personnel is an unavoidable issue. To achieve this, it is essential to improve wages and working conditions commensurate with responsibilities and job descriptions."

Masahiko Uema, President of the Japan Health Care Workers' Union:

"In order for healthcare workers to work with responsibility and pride, working conditions must be greatly improved in order to alleviate the shortage of labour.”

Gita Devi Thing Paudel, Community Health Worker, Kathmandu and President of the Nepal Health Volunteer Association: 

“Health workers have to be on standby 24/7. We have no balance of family and personal life. It is a pity that our work doesn’t get the recognition it deserves. I’ve struggled  to deliver care because our health infrastructure is poor and medicine supply is insufficient. My patients have waited for doctors but there are no doctors there, only auxiliary nurses.”

“Understaffing has had a personal impact on me. I lost my brother to COVID-19. I couldn’t get him a bed at the hospital, and he died in my arms. I had to tell my relatives, as a community health worker, I simply cannot save him. It is our health system that isn’t working."

Fernanda Boriotti, Biomedical healthworker, Rosaria, Argentina

“Our health centre in the city of Rosario [Argentina] has been without water for more than a month. We workers really can't continue to provide health care in this way. We are exhausted. We are disappointed with the lack of response. 

The perception of the work is negative and there is a lot of concern about the wear-and-tear of our work clothes. The provincial and national governments are not providing adequate budgets to ensure the health of the population and quality working conditions for the half million workers in our public health sector.”

Bill Muriuki, Medical Doctor, Nyeri, Kenya 

I have seen both staff and patients suffer due to the extreme shortage situation in the country. I was the only doctor in the casualty and emergency department of the biggest facility in the region and this would lead to situations for example where critically ill patients would come at night and would have to wait for me to report to work in the morning or on Monday if they came on the weekend. This says nothing about the ones who never made it and hence I never got to see them.

We would also run out of supplies from time to time when a patient would come and I would need to send their relatives back into town to run around and get us the medicine, bandages and dressings that we would need to help their loved ones.

I have also seriously considered quitting my job time after time often after feeling that I was really not able to do enough for my patients.