Regulation of employment and working conditions

5.6.2 Analysis of results

107. Employment characteristics and

working conditions are major drivers of attractiveness of employment, performance and productivity, and retention of the health workforce. The Global Strategy on Human Resources for Health: Workforce 2030 calls for upholding “the personal, employment and professional rights of all health workers, including safe and decent working environments and freedom from all kinds of discrimination, coercion and violence”. To assess this dimension, six indicators related to regulation of employment characteristics and working conditions were examined (Figure 5.11).

It should be noted that three indicators (regulation on working hours and conditions, nursing council, existence of advanced nursing roles) are specific to nursing: the rest apply to the health workforce as a whole, including nurses.

108. Of the responding countries, more than 80% reported having regulation on

working hours and conditions, social protection and minimum wage, and having a nursing council or equivalent, but fewer responding countries (53%) had advanced nursing roles. A total of 55 countries responded to the indicator on the existence of measures to prevent attacks on health workers, of which just over a third (37%) said that such measures were in place.

109. Table 5.9 indicates that countries in the Eastern Mediterranean Region reported higher levels of employment regulations for nurses examined for this report: over 70% of countries responded positively to all six indicators. The South-East Asia and Eastern Mediterranean regions were the only two regions in which the majority of countries reported having measures in place to prevent attacks 5.6.1 Key findings

The African, American, European and Eastern Mediterranean regions reported high levels of existence of regulatory mechanisms relating to working conditions for nurses.

Some countries, mostly in the South-East Asia and Western Pacific regions, but also in the African Region and South America, reported lower levels of these regulations.

Just over a third of countries (37%) reported having in place measures to prevent attacks on health workers, mostly in the South-East Asia and Eastern Mediterranean regions.

The existence of an advanced nursing role (reported by 53% of the 95 responding countries) is more frequent in countries with a low density of medical doctors, suggesting that more professional autonomy for nurses might be a policy response to mitigate the shortages of medical doctors.

Map of regulation of working conditions score

Figure 5.12

1 or no 2 3 4 5 6

not reported not applicable

Note: Combining working condition capacity questions, raw score from 0 to 6.

Source: NHWA 2019.

WHO REGION

Regulation on working hours and conditions

Regulation on minimum

wage

Regulation on social protection

Measures to prevent attacks on health

workers

Existence of advanced

nursing roles Nursing council

Africa 90% 90% 85% 41% 74% 78%

Americas 97% 85% 94% 37% 55% 91%

South-East Asia 75% 50% 50% 67% 50% 80%

Europe 98% 92% 100% 26% 30% 96%

Eastern Mediterranean 85% 100% 92% 73% 75% 85%

Western Pacific 100% 86% 57% 30% 52% 78%

Global 94% 89% 91% 37% 53% 86%

Source: NHWA 2019, and State of the world’s nursing 2020 specific indicators for the last factor. Latest available data reported by countries between 2013 and 2018.

Percentage of countries responding on existence of nursing regulations on working conditions, by WHO region

Table 5.9

Regulation on working hours and conditions (133 yes out of 42)

Regulation on social protection (125 yes out of 37)

Regulation on minimum wage (119 yes out of 134)

Nursing council (141 yes out of 164)

Existence of advanced nursing roles (50 yes out of 95)

Measures to prevent attacks on health workers (20 yes out of 55)

Percentage of countries reporting yes

0% 20% 40% 60% 80% 100%

94%

53%

86%

37%

89%

91%

Source: NHWA 2019.

Figure 5.11 Percentage of countries with regulatory provisions on working conditions

on health workers, probably reflecting the relatively high incidence of such attacks in these regions.¹⁰ The African, American and European regions also reported positively on most indicators tracked; only 30% of responding European countries, however, reported having advanced nursing roles and 26%

reported having measures in place to prevent attacks on health workers.

110. High proportions of countries in the Western Pacific Region reported having regulation on working hours and conditions and a minimum wage, and a nursing council or equivalent.

However, they reported lower levels of existence of the other three regulation mechanisms. The South-East Asia Region reported the lowest rate of positive responses to indicators assessing the regulatory environment, although half of

10 Surveillance System for Attacks on Health Care: https://publicspace.who.int/sites/ssa/SitePages/PublicDashboard.aspx.

the countries in this region responded positively to each of the six indicators.

As noted in section 5.4, these regional variations may to some extent reflect different perceptions of the meaning of these indicators, as well as the different reporting rates across regions. The data collected do not provide information on the adequacy of regulations or the level of implementation of the relevant provisions.

111. Data for the six indicators were used to derive a composite “regulation of working conditions” score for each country using a similar methodology to that used in section 5.4, and with methods described in Annex 2. Figure 5.12 reinforces the finding that, as for the education system analysed in section 5.4, the regulatory environment was reported to be relatively stronger in

Map of regulation of working conditions score

Figure 5.12

1 or no 2 3 4 5 6

not reported not applicable

Note: Combining working condition capacity questions, raw score from 0 to 6.

Source: NHWA 2019.

North America, sub-Saharan Africa, and the European Region.

112. Advanced nursing roles were found to be more frequent in countries with lower density of medical doctors, as shown in Figure 5.13.

Figure 5.13 Percentage of countries with advanced nursing role by level of density of medical doctors per 10 000 population

Medical doctors density per 10 000 population

Percentage of countries with advanced nursing role

80%

60%

40%

20%

0%

<5 5-19 20+

65%

59%

43%

Source: NHWA 2019.

© AKDN/Christopher Wilton-Steer