Health workers: Ethical aspects and dimensions

Health workers’ rights and working conditions

Christiane WiskowIndependent Specialist International Public Health

Global – Gerecht - GesundInternational Conference, Berlin, Germany 17-18 September 2010

Why the work environment matters

Competitive labour markets• Poor work environments compromise HW supply

& contribute to early exits• Challenge of recruitment and retention

Work environments & quality of care• Poor work environments compromise quality of

care• Challenge to support effective performance

Health workers’ right to health:Occupational health protection

The issues• High level of exposure to occupational risks • May lead to premature exits or reduced

work ability • Many occupational diseases/accidents are

preventable

Example: Infection through sharp injuries

Estimated occupational infection rates annually:

HBV 66’000 HW

HCV 16’000 HW

HIV 200-5000 HW

Source: Prüss-Üstün et al, 2005

Example workplace violence: health workers most at risk

% of surveyed health workers experienced workplace violence in the past 12 months (%)

Case studies ( 2001)

Verbal abuse Bullying/mobbing

Physical violence

Bulgaria survey 32 % 31 % 7%

Portugal (health centre)

51% 23 % 3%

South Africa (public sector)

60% 21% 17%

Thailand 47% 11% 10 %

Brazil 39% 15 % 6%

Source: Di Martino, 2002 (Country case studies of ILO/ICN/WHO/PSI Joint Programme on Workplace Violence in the Health sector

Health workers’ right to fair working conditions

Example remuneration

Country Percentage of workforce

paid at or below the minimum wageArmenia 30%

Bulgaria 25% (20% in 1996)

Georgia 90% (public sector)

50% (private sector)Latvia 2.3% (public sector)

13.9% (private sector)Poland 70%

Russian Federation 0%

Source: adapted from Afford, 2002

Percentage of workforce paid at or below the minimum wage, selected CEE/CIS countries ( 2001)

Health Workers’ right to participate and have a voice

• Consultation regarding their employment and working conditions

• Participation in the planning of health services • Professional autonomy

Social dialogue• Positive association with improvement of work

environment• Capacity building to strengthen social dialogue

Creating attractive, supportive work environment

• Incentive to enter health professions - and to stay• Enabling health workers to perform effectively

Goal: Quality health care services

What is an attractive & supportive work environment?

Quality of work environment: dimensions and elements

Source: adapted from the job quality model of Munoz de Bustillo et al, 2009

Vision: Universal Declaration of Human Rights (1948)

Everyone has the right to ….

Article 23.(1) work, to free choice of employment, to just and favourable conditions of work(…).(2) equal pay for equal work.(3) just and favourable remuneration ensuring for himself and his family an existence worthy of human dignity, (…)(4) form and to join trade unions for the protection of his interests.

Article 24.• … rest and leisure, including reasonable limitation of working hours and periodic

holidays with pay.