Overload of health workers cannot be the “new normal”, highlights CRIS/Fiocruz seminar

In the International Year of Health and Care Workers, this workforce is depleted. They have been the targets of applauses and assaults, seen old problems worsen, and become victims of the very COVID-19 they help fight. This panorama was outlined during the webinar Human Resources in Health in a Pandemic, promoted by the Fiocruz Global Health Center (CRIS/Fiocruz), on August 4th. With Francisco Eduardo Campos mediation, a public health and human resources specialist, the seminar showed that it is also necessary to prepare for the post-pandemic, so that the current situation of overload does not become a “new normal”.

“Of the 570,000 Brazilians who died in the pandemic, many were health workers, visible and invisible, a group of professionals that includes drivers, stretcher bearers, cleaning professionals...,” said Campos, a member of Fiocruz Brasilia and the Federal University of Minas Gerais (UFMG). The researcher also highlighted the shortage of health professionals in certain regions, a problem that does not only affect weaker states, and recalled the time required for the training of these professionals. “If a factory is built in two or three years and a vaccine is developed, an issue involving training cannot be solved in a short period of time. No fruits are reaped in the current management.”

Gender inequalities

Jim Campbell, director of the Health Workforce Department at the World Health Organization (WHO), pointed out that the problems of professionals distribution and inequities were exacerbated by the pandemic. “These inequities in the health care system are also related to the gender issue. Almost 70% of the healthcare workforce is made up of women. And we still see challenges in equal pay, decent working conditions, and leadership opportunities,” he described.

Campbell pointed out that around the world 150,000 health care workers may have died contaminated with COVID-19, many of them due to lack of protective equipment. He stressed the need to recruit more people to work in vaccination campaigns, so that the displacement of professionals does not increase shortages or overload. The strenuous working conditions are affecting mental health, something revealed in signs of stress, depression, and insomnia. “We have to protect the workers who are protecting us in the pandemic”, he said.

Expanded concept

Maria Helena Machado, a researcher at the National School of Public Health Sérgio Arouca (Ensp/Fiocruz), in turn, focused on the impact of COVID-19 on the health workforce in Brazil. She used as a basis two surveys she develops with health professionals and the so-called invisible professionals, a contingent that totals about 3 million people, of which about 40,000 participated in the study in all states.

The researcher pointed out that the situation of these professionals, which was already precarious before the pandemic, has worsened: they report low salaries, temporary loss of vacations, cut of unhealthy additional, overtime, work overload, with no financial, psychological, or emotional reward. “It's a depleted workforce”, she summarizes. “Of these, 70% are women. In nursing, it's as high as 85%.”

Of the COVID-19 victims in Brazil, 3,500 are health care workers, a number that could be much higher, since it includes the so-called “invisible” ones. These make up more than 60 categories that should be incorporated into health workers, explains Maria Helena. As an example, she cites the North Region, which has only 4.5% of the health workforce in the country, but concentrated most of the deaths in the sector. “Many of the 'invisibles' had to go to court to get individual protection equipment and vaccine.”

For her, it is necessary to think about the policy for the sector in the post-pandemic period. “It is necessary to review and broaden the concept of health worker, review the process so that it has a more stable situation. I would say that the extenuating service, where you do the work of two or three due to sick leave or death, seems to be establishing itself as the new normal in Brazil”, she pointed out.

Role of Universities

Argentine sociologist Hugo Mercer, from the National University of San Martin (Unsam, acronym in Spanish), highlighted the academic institutions' contributions in the fight against the pandemic in Latin America. Mercer, who has served as a consultant to the World Health Organization (WHO) in Geneva and Washington, pointed out that distance education became widespread in the pandemic and highlighted the “bridge” that academic institutions made with communities. “Universities worked closely with health professionals facilitating access to unprotected groups, building rapid information and alert systems regarding the impact of public policies”, he said.

He also told of partnerships with the private sector, such as in research on a vaccine developed by Unasam and the Pablo Cassará Laboratory that could be available by 2022, as well as others involving the production of “super masks” and testing for COVID-19. “In Argentina, this has been particularly productive. Agile mechanisms were created for universities to participate in generating information to face the pandemic. There was also the development of epidemiological, social, and environmental warning systems associated with the pandemic”, he said.

Networked Information

The CRIS researcher Sebastián Tobar brought the experience of structuring networks as a strategy for educating the workforce on the pandemic, of which the Foundation itself is a part. Many of them emerged in the Unasur framework, with their work in Latin America then extended overseas through the Ibero-American General Secretariat (Segib, acronym in Portuguese). “The pandemic allowed an intensification of networking”, Tobar noted.

Tobar highlighted the three of them performance strengthening. The Network of Public Health Schools and Training Centers, for example, has already produced four webinars, one of them coordinated by Fiocruz, and its institutions have developed a tool to measure the social impact of the pandemic that is already in use in Brazil, Argentina, Portugal, and Mexico. With 122 institutions in 20 countries, the Health Technician Education Network has established a lecture series to discuss practices and suggest recommendations. All the material produced is made available on a website. And the National Institutes of Health Networks have been active in monitoring the virus and advising authorities in their countries on decision making. “The increased use of virtual meetings has allowed great opportunities to address common problems. We need to work together to overcome both pandemic and workforce problems, he said.

Seminars

During the webinar, Paulo Buss, coordinator of the Fiocruz Global Health Center, pointed out that this was the 15th Advanced Seminar of the center this year. Co-sponsored by CRIS/Fiocruz and the Latin American Global Health Alliance, it had simultaneous translation into English and Spanish. All seminars can be accessed at Fiocruz website. The bi-weekly reports produced by the center can be found in the Arca repository.