Health system resilience and health workforce capacities: Comparing health system responses during the COVID‐19 pandemic in six European countries

Abstract

Background The health workforce is a key component of any health system and the present crisis offers a unique opportunity to better understand its specific contribution to health system resilience. The literature acknowledges the importance of the health workforce, but there is little systematic knowledge about how the health workforce matters across different countries. Aims We aim to analyse the adaptive, absorptive and transformative capacities of the health workforce during the first wave of the COVID‐19 pandemic in Europe (January‐May/June 2020), and to assess how health systems prerequisites influence these capacities. Materials and Methods We selected countries according to different types of health systems and pandemic burdens. The analysis is based on short, descriptive country case studies, using written secondary and primary sources and expert information. Results and Discussion Our analysis shows that in our countries, the health workforce drew on a wide range of capacities during the first wave of the pandemic. However, health systems prerequisites seemed to have little influence on the health workforce's specific combinations of capacities. Conclusion This calls for a reconceptualisation of the institutional perquisites of health system resilience to fully grasp the health workforce contribution. Here, strengthening governance emerges as key to effective health system responses to the COVID‐19 crisis, as it integrates health professions as frontline workers and collective actors.

Healthcare workers’ perceptions and medically approved COVID-19 infection risk: understanding the mental health dimension of the pandemic. A German hospital case study

“…Similarly, minimum requirements of nurse staffing levels in intensive care and geriatric care were suspended between March and August 2020 and for high-maintenance areas until end of 2020 to help hospitals (47) These policy changes may have increased pressures on HCWs to ensure quality of care with less well educated staff. Policy efforts focussed on structural resources and technical equipment, including ensuring appropriate personal protective equipment (PPE) and surveillance measures especially for the hospital sector (12,39). The governance attempts towards strengthening HCW protection were nested in a system of high-quality hospital hygiene, infection control and regulatory frameworks of occupational health in the hospital sector (56).…”

“…Our findings reveal a strong mismatch between technical measures and individual perceptions of HCWs. Applying a ‘dual pandemic’ approach to COVID-19 (9) opens new opportunities to explore this mismatch in more detail and develop governance approaches, that respond more effectively to health workforce needs and resilience (2,8,12,39). Notwithstanding the importance of country-specific contexts and the privilege of a high-resourced healthcare system and low-risk setting, we believe that our case study may support much needed investment in the health workforce and help build back better and fairer after the pandemic.…”

“…It spends a greater proportion of its GDP on health (11.7%) than any other EU country (47: p.3) and health workforce staffing levels are among the highest in OECD countries (3: Figure 3.1). During the first wave of the pandemic health workforce capacity was scaled-up through a number of measures (39,47), yet HCW shortage still remained a major problem. Köppen et al concluded from their review, that health workforce planning was limited in the pandemic response plan and 'actions during the peak of the pandemic varied considerably across states' (54).…”

“…Policy efforts focussed on structural resources and technical equipment, including ensuring appropriate personal protective equipment (PPE) and surveillance measures especially for the hospital sector (12,39). The governance attempts towards strengthening HCW protection were nested in a system of high-quality hospital hygiene, infection control and regulatory frameworks of occupational health in the hospital sector (56).…”

“…The recommendations highlighted that ‘more detailed information on the impact of COVID-19 on health workers’ wellbeing’ is ‘crucial to designing better support measures’ (3:p.31). Similarly, the European Union Expert Panel (38), as well as scholarly debate into building back better after the pandemic mentioned the important role of the health workforce for health systems (4,30,39,40,41,42,43).…”