The geriatric workforce in Romania: the need to improve data and management

Facing severe under-funding and significant workforce maldistribution, the health system in Romania is challenged to provide adequate care for the ageing population. The aim of this article is to connect health labour market data of the geriatrics workforce in Romania with individual perceptions of front-line workers in geriatrics in order to better understand the ‘human’ factors of effective health workforce development. Comprehensive health workforce data are not available; we therefore used a rapid scoping review and interviews to combine quantitative and qualitative data sources, such as the ‘Healthcare Facility Activity Report’, policy documents and available reports. They show that despite a consistent increase in the overall number of geriatricians, their majority is based in Bucharest, the capital city. The initial review points to possible geriatrician burnout, caused in part by high workload. The geriatrics workforce in Romania is poorly developed. Significant efforts are still needed to create policies addressing inflows and outflows, training, maldistribution and inefficiencies related to their practice. Addressing burnout by improving teamwork and collaboration is vital for maintaining and improving the workforce morale and motivation. Two major policy recommendations emerged: an urgent need for better health workforce data in Romania and development of more effective workforce management.

2.G. Workshop: The health labour market and the human face of the health workforce: analysis, advocacy and action

Background Health workforce research and data have significantly improved over recent years. Many countries have stepped up efforts to establish more complex health workforce monitoring and planning systems, to increase the stock of care workers, and to introduce new education and training programs. There is now also greater attention to skill-mix and task-shifting models. However, major policy problems and knowledge gaps remain. Health systems across countries have largely failed to respond adequately to the globalisation of health labour markets and the growing mobility. Furthermore, research on needs and demands of the health workforce is still poorly developed. Health policy largely ignores the 'human being' behind every single healthcare worker. Objectives This workshop connects health labour market data (macro-level) with the 'human face' of the health workforce (micro-level) and brings a global approach (transnational level) to the analysis, with a focus on Europe. It aims to identify gaps in health workforce policies and to highlight a need for a public health approach, which moves beyond nationally-defined health workforce policy of 'faceless numbers' of health professionals and carers. The workshop relates to ethical, cultural and social aspects of the health labour market. It also builds on the research that has revealed the connections between working conditions, staff turn-over, job satisfaction and quality of care. It acknowledges that we have a European labour market for health workers, but very little common policies developing the European health workforce. The workshop introduces novel results drawn from major international data sources (WHO, OECD, EUROSTAT), from a European primary care survey, cross-country comparative research and in-depths country case studies. Next to the nursing, medical and primary care workforce, specific attention is paid the long-term care and geriatric sectors. A particular area of concern are the threats of labour market migration to the individual professional and the sending countries. Two major policy recommendations are emerging from the research: (1) to move beyond national health labour market policy and develop a transnational regulatory framework to reduce growing inequality in Europe and globally caused by health workforce shortage and labour market migration; (2) to bring the 'human face' of the health workforce into data analysis and policymaking. The workshop will stimulate critical debate and improve knowledge exchange across countries and between researchers and international data holders. It will strengthen public health advocacy and action for future health workforce governance with a 'human face' to create a sustainable workforce and support the implementation of the SDGs. Key messages Analysis must connect health labour markets with the ‘human face’ of the health workforce. Action is needed to develop a global regulatory framework for effective and ethically responsibile health workforce governance.

Health labour markets: an overview of some human factors that influence demand and supply

Background The global demand for health workers is expected to double by 2030 and it is estimated that if need is taken into account, there will be a deficit as high as 18 million according to the World Health Organization's Global Strategy on Human Resources for Health: Workforce 2030. Combined with inequities in the access to qualified health workers, this impedes progress towards the achievement of universal health coverage, global health security and the SDGs. This paper addresses health labour market deficiencies. It aims to provide guidance for a comprehensive analysis of health labour market dynamics, including the political and social factors that, in addition to economic ones influence the behaviour of health workers and of employers. Methods This paper uses the material of the WHO Health Labour Market Analysis Guidebook, which is based on the most recent literature on the demand and supply of health workers and on factors that affect them. It also draws from empirical analysis conducted recently by WHO in four regions of the world. Results On the supply side, the paper illustrates how social norms, such as those related to gender, influence the decision to become a health professional, the choice of a specialty, the choice of a practice location, and labour market participation. As to demand, examples are given of how professional interest groups' political actions (councils, trade unions) influence the division of tasks and which types of jobs will be offered. Conclusions The analysis of the dynamics of health labour markets must include human factors to achieve a better understanding of the forces that drive health worker shortages and surpluses, skills-mix and geographical imbalances, and suboptimal performance and to develop effective policies to address these issues.

The geriatric workforce: is there anybody out there to care in Romania?

Background Demographic changes - such as population ageing - pose great challenges to health systems around the world. For the Romanian health system, challenges might be particularly difficult to address. Facing a severe under-funding and significant workforce maldistribution, the health system in Romania is called to care about both the ageing population and the workforce taking care of the elderly. The aim of this paper is to apply the health labour market framework to the geriatric workforce in Romania. Methods The paper describes the composition and distribution of the geriatrics workforce in Romania based on data in the Healthcare Facility Activity report, policy documents and available reports. Results Geriatric care is provided in Romania mainly by geriatricians employed by public hospitals. The team around geriatricians is limited to nurses only, with other professions - such as psychologists, physiotherapists and social workers - almost absent. Even though the number of geriatricians has increased country-wide over recent years (from 149 to 242), there are significant differences in their distribution at a county level. Eleven counties out of the 41 reporting to have only 1 geriatrician for populations of hundreds of thousands. Training curricula for geriatrics residents fall short of addressing team work and inter-professional collaboration. Reports show growing concern over geriatrician burnout, caused in part by inadequate team work. Faced with burnout risk, many of them report considering changing specialties, which would further aggravate the lack of comprehensive elderly care. Conclusions The geriatrics workforce in Romania is poorly developed, and significant efforts are still needed to develop policies addressing geriatrics production, inflows and outflows, and maldistribution and inefficiencies. Moreover, addressing burnout by improving teamwork and collaboration is vital for maintaining and improving the workforce morale and motivation.

Migrant carers in Europe: double jeopardy of labour market exploitation and hostile environments

Background Many health systems have responded to growing population needs and expanded long-term care services for older people (LTC). However, no country managed to adequately increase the human resources for health. A large group of transnationally mobile migrant carers fill the gaps and mitigate policy failure. This study aims to explore the connections between health labour markets, migrant care workers and populism and to reveal blind spots in the governance of the LTC workforce. Methods An explorative comparative approach was applied, which draws on a rapid review of the literature, public statistics and document analysis. A novel analytical framework was developed, which is informed by transsectoral governance and combines four major dimensions: LTC system (e.g. cash benefits, public responsibility), health labour market situation (supply-demand) in the LTC sector, labour migration policies relevant for LTC, and the role of populist parties. Five EU countries were selected which represent different conditions in LTC: Austria, Denmark, Germany, Italy and Poland. Results Typologies of sending and receiving countries are no longer sustainable, but transnational mobility flows still impact differently in healthcare systems and national labour markets. Undersupply coupled with cash-benefits and a culture of family responsibility are predicting high inflows of migrant carers, who are channelled in low-level positions or in the informal care sector. These conditions can often be observed in countries with strong populist movements. Conclusions Health labour markets, LTC systems, culture and political factors combine to create a double jeopardy for migrant carers, exploited as labour market subjects and exposed to hostile social environments as individual citizens. Action has to be taken to improve public health advocacy for migrant carers and to establish effective European health labour market regulation and transnational health workforce governance.

Robotics and AI in the European Union: opportunities and challenges

The development of AI will bring with it a plethora of new economic and social opportunities. Areas that are as distinct as agriculture and health will be inevitably changed. However, this “new” technology also brings with it fundamental challenges and a new reality that our current legal framework is not yet prepared to deal with. In this paper, we will study the opportunities that AI brings to the European Union, the difficulties of regulating it, the current state of affairs, and theinitiatives currently being drawn up to guarantee that the EU can keep up and even become a leader in this area. Our focus will be on the areas of health, labour market, liability rules and the challenges for the integration of robots in our daily lives.