Law and Policy Areas

Health and care workers are foundational to the ability of health systems to deliver universal access to quality care. However, countries worldwide struggle with the education, employment, retention, and migration of health and care workers. WHO estimates that by 2030, there will be a global deficit of 10 million health professionals alone, to the detriment of improving health service coverage and realizing the right to the highest attainable standard of health. The COVID-19 pandemic deepened both public and government recognition of the importance of health and care workers, and of the importance of meeting their needs. In light of the unprecedented challenges health and care workers faced during the pandemic, in 2021 the 74th World Health Assembly (WHA) requested WHO to develop a Global Health and Care Worker Compact (the “Compact) to help improve the conditions of work.

The Compact itself details the robust international legal framework that exists for supporting health and care workers and safeguarding their rights. The Compact articulates the norms and standards that apply to issues including occupational health and safety, access to health services, protection against violence and harassment, equal treatment and non-discrimination, enabling work environments, and freedom of association. However, significant gaps in coverage in domestic law and policy exist, and challenges in implementation remain. There is a lack of existing research that analyzes national laws and policies that apply to health and care workers, and assesses the variation across countries.

Ten indicator questions, benchmarked against the 10 elements of the Compact, were developed to measure compliance between national law and policy environments and Compact standards. Indicators were identified that would be valid and meaningful, sensitive to the underlying legal standards being measured, easily interpretable, and to allow for international comparison and consistency over time. There are hundreds of types of laws, policies, and other measures that fall within the scope of the Compact and relate to the rights of health and care workers — the indicators chosen are intended to represent this broader context.

This section lists and summarizes the 10 areas of the global compact and describes the indicators from each specific area

1. Protection from Occupational Hazards

The health and safety of health and care workers should be protected within an overall approach of prevention, risk assessment, and implementation of control measures, and broader occupational safety and health principles and frameworks.

Indicator

• Does the country have national policy instruments/laws for occupational health and safety that cover all health workers and require all health workers to have access to protective equipment or supplies?

2. Health Services for Health and Care Workers

Quality, accessible, affordable, acceptable, and confidential health care must be available for all health and care workers. Free services and support should be available for diseases, injuries, and other conditions resulting from their work.

Indicator

• Does the country have policies/laws that allow for a national package of health services for health workers that includes mental well-being?

3. Protection Against Violence and Harassment

All health and care workers should be protected from violence, sexual abuse and exploitation, and harassment in the world of work.

Indicator

• Does the country have national policies/laws for the prevention of attacks against all health workers?

4. Protection Against Attacks in Fragility, Conflict, and Violence

The Geneva Conventions and Additional Protocols, as well as customary international law binding on all countries, require that all parties to a conflict respect and protect health and humanitarian workers and their transport, including ambulances, and their supplies and equipment. The protections, including prohibitions on violence, attacks, and killing, apply to both military and civilian medical personnel. Patients are also protected. Parties to a conflict must not use medical facilities or ambulances as shields against attack. If they do, strict conditions apply when those objects may be legitimately targeted due to the military objectives, including issuing warnings and not attacking if the civilian harm would exceed the military benefit. Health workers must also be protected to act according to medical ethics, including not being punished for acting in accordance with these ethics and not being compelled to act against medical ethics.

In situations of fragility, conflict, and violence, it is imperative that all States Parties fulfill obligations in international humanitarian law with respect to health and care work.

Indicator

• Does the country have laws and policies that incorporate all of Geneva Convention protections of health and humanitarian workers, health facilities, transport, and patients during armed conflict into national law?

5. Equal Treatment and Non-Discrimination

All health and care workers merit equal treatment and should be protected against discrimination on all internationally protected grounds, including the facilitation of women’s economic inclusion in the health and care economy.

Internationally protected classes include “race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth, … disability, age, nationality, marital and family status, sexual orientation or gender identity, health status, place of residence, and economic/social situation” as defined by United Nations Committee on Economic, Social and Cultural Rights in interpretive guidance of binding international law in General Comment 20. General Comment 20 makes it clear that the coverage of non-discrimination on the basis of nationality does not make distinctions based on legal, immigration, or documentation status. 

Indicator

• Does the country have a law that prohibits discrimination in the workplace, on internationally protected grounds, that includes all health and care workers?

6. Fair and Equitable Remuneration

It is important to ensure just and fair remuneration for all health and care workers, including community health, at levels comparable to other workers and professionals of similar/equivalent qualifications, responsibilities, workload, and risk with consideration to the cost of living.

Indicator

• Does the country have national policies/laws covering health workers that:
  • regulate working hours and conditions, and
  • regulate a minimum wage?

7. Social Protection

Social protection mechanisms should be available for all health and care workers including health benefits, pregnancy benefits, disability benefits survivor benefits, paid maternity leave, parental leave, childcare leave, unemployment benefits, and older age benefits.

Indicator

• As a tracer for social protection mechanisms, does the country have national social protection policies/laws that, at minimum, provide parental leave to all health workers?

8. Enabling Work Environments

Enabling work environments for all health and care workers reflects rights to safe and healthy working conditions and the right to the enjoyment of the highest attainable standard of health. Enabling work environments encompass effective human resource management and training for managers, supportive supervision or feedback, or clear job responsibilities and pathways for progression.

Indicator

• Does the country have policies/laws for a national system of professional development for health workers that includes:
  • Access to continuing professional development, and
  • In-service training for the health workforce?

9. Freedom of Association and Collective Bargaining

Health and care workers have the right to freedom of association, including the right to form and join trade unions of one’s choice, and the effective recognition of the right to collective bargaining for all health and care workers.

Indicator

• Does the country have policies/laws that protect the right to join an independent union or similar workers’ organization that apply to some health workers?

10. Whistleblower Protections and Freedom from Retaliation

It is important to protect whistleblowers – those who report and expose malfeasance in the workplace – and all health and care workers from retaliation for seeking to exercise their rights, safeguard their health and safety, and follow their professional ethics.

Indicator

• Does the country have policies/laws providing whistleblower protections that include freedom from retaliation and guaranteed confidentiality to all health workers?

Sources

• See World Health Organization, The World Health Report 2006: Working Together for Health (2006); see also World Health Organization. Global Strategy on Human Resources for Health: Workforce 2030 (2016).

• Mathieu Boninol et al., The Global Health Workforce Stock and Distribution in 2020 and 2030: A Threat to Equity and ‘Universal’ Health Coverage, BMJ Global Health (2022).

• World Health Assembly Resolution 74.14, Protecting, Safeguarding and Investing in the Health and Care Workforce (2021).

• World Health Organization, Global Health and Care Workers Compact (2022).

• Friedman EA, Bickford R, Bjork C, et al The global health and care workers compact: evidence base and policy considerations BMJ Global Health 2023;8:e012337. https://gh.bmj.com/content/8/7/e012337

• Brown D. Good practice guidelines for indicator development and reporting. In: Third World Forum on Statistics: knowledge and policy. Busan, Korea: 2009. 27–30.