Tools and Guidelines
WHO, the International Labor Organization, and other organizations have developed valuable guidance material thatcovers all areas of the Global Health and Care Worker Compact (Care Compact). Governments, program planners, employers, and health and care workers themselves, among others, can use this material to support their efforts to follow through on Care Compact recommendations and underlying commitments and obligations. With their concrete recommendations and detailed approaches that could inform people and organizations advocating for full Care Compact implementation, these could also be valuable documents for health and care workers, their unions and other associations representing them, and civil society organizations. The material includes a mix of guidelines – specific, actionable steps – and tools, like checklists and step-by-step guides.
A separate set of summaries includes key conventions, UN and WHO resolutions, and other international legal instruments that contain state obligations and other commitments, as well as recommends, that collective establish a mix of legally binding- and non-binding norms regarding state action that underlies the Care Compact. While those legal instruments provide the “what” of states should do, the tools and guidelines included are resources that pathways to how states can implement these norms.
These guidance documents are arranged here by Care Compactissue area. Each document including element. Most documentsinclude a link and a short summary for reference and use in implementing the Compact. At the end of this list are additional guidelines and tools, without summaries. This latter material is generally older or specific to a particular region or even country, but nonetheless remains pertinent, or may be a valuable resourcein other regions. Some of this unsummarized material is also specific to a single disease, like COVID-19.
1. Preventing Harm
1.1 Occupational HAZARDS
Systems, Programs, Equipment, and Facilities
Caring for Those Who Care: Guide for the Development and Implementation of Occupational Health and Safety Programmes for Health Workers (2022). World Health Organization.
Developed by WHO and the ILO, this guide outlines the crucial elements to creating effective occupational health and safety programs for health workers, including improving the quality and safety of care, safeguarding the health workforce, and promoting environmental sustainability in the health sector. Specific guidance is offered not only for facility programs but also at the national and sub-national levels of governance. The guide also provides specific recommendations about how policymakers can work with health workers to create and improve occupational health and safety outcomes.
Caring for Those Who Care: National Programmes for Occupational Health for Health Workers: Policy Brief (2020). World Health Organization.
A joint document between WHO and ILO, this policy brief emphasizes the need for national occupational health and safety policies to protect the well-being of both health workers and the people they care for. The brief provides information and recommendations on the wide variety of occupational risks that health workers face, encouraging state actors to urgently develop comprehensive occupational health and safety policies to address these issues.
Occupational Safety and Health in Public Health Emergencies: A Manual for Protecting Health Workers and Responders (2018). International Labour Organization.
Jointly developed by WHO and ILO, this manual outlines the main occupational health and safety (OHS) risks faced by emergency responders during disease outbreaks and other emergencies such as natural disasters, chemical incidents, radiological emergencies, and emergencies involving and within conflicts. The manual places particular focus on needs in low-resource settings, and is intended to assist organizations and workplaces to better prepare and respond to such events, by providing technical guidance on best practices in establishing systems that can do the following:
i. Reduce occupational exposures, injury, illness, and death among response workers;
ii. Decrease stress and reduce fears; and
iii. Promote the health and well-being of health and care workers.
Protection of Health and Safety of Health Workers: Checklist for Healthcare Facilities (2020). World Health Organization.
This checklist, developed by WHO, is a helpful tool for healthcare facilities to assess the comprehensiveness of their occupational health and safety policies. This checklist is the first step in identifying and prioritizing areas of action for improving the protection of health and safety of health workers and is designed to be filled out in collaboration with management, responsible officers for occupational health, environmental health, infection prevention, and control, human resources and representatives of workers in the health facility. It asks straightforward yes-or-no questions, with space for an assessor to write notes about existing measures that are in place as well as recommendations about how an existing (or absent) measure can be improved. Although the checklist is designed to be used internally, it can also be utilized by external parties (NGOs, governments, etc.) to review existing practices.
Prevention of Entry of Weapons Into Health Facilities. International Committee of the Red Cross.
Developed by Health Care in Danger (a multidisciplinary initiative of the International Red Cross and Red Crescent Movement), this digital toolkit aims to reduce the presence of weapons in healthcare facilities. To do this, it explores some of the reasons people bring weapons into healthcare facilities and provides alternatives that keep weapons outside these facilities, through long-term behavioral change techniques like messaging, re-design of the environment, and training. The tool itself is flexible, and designed to take the user through a series of interconnected stages that build knowledge to generate effective interventions tailored to their context.
HealthWISE – Work Improvement in Health Services – Action Manual and HealthWISE – Work Improvement in Health Services – Trainers’ Guide (2014). International Labor Organization and World Health Organization.
Jointly developed by WHO and ILO, this action manual and its accompanying Trainers’ Guide aim to help initiate and sustain changes to improve the quality of health facilities and encourages managers and staff to work together to promote safe and healthy workplaces. The action manual uses a checklist as a workplace assessment tool, which is designed for prioritizing areas of action to improve occupational safety and health for health workers.
COVID-19 and Health Facilities: Checklist of Measures to Be Taken in Health Facilities (2020). International Labor Organization.
This checklist applies the ILO-WHO HealthWISE participatory, action-orientated approach to prevent COVID-19 infection in health facilities and protect health workers.
Occupational Safety and Health in the Health Services Sector (2015). International Labor Organization.
This checklist includes codes of practices, such as on HIV/AIDS in the world of work, and guidelines, such as the joint ILO/WHO/UNAIDS guidelines on health workers’ access to TB and HIV prevention, treatment, care, and support.
Guidelines on Occupational Safety and Health Management Systems (2001). International Labor Organization.
These voluntary guidelines provide a unique international model, compatible with other management system standards and guides. They reflect ILO’s tripartite approach and the principles defined in its international occupational safety and health instruments, particularly the Occupational Safety and Health Convention, 1981 (No. 155) and Recommendation (No. 164). Their purpose is to assist organizations (enterprises/workplaces) and competent institutions in the achievement of continual improvement in occupational safety and health performance.
Infection Prevention and Control
Guidelines on Core Components of Infection Prevention and Control Programmes at the National and Acute Health Care Facility Level (2016). World Health Organization.
This guide, developed by WHO, outlines the necessary components of infection prevention and control (IPC) measures in order to reduce the rates of healthcare-associated infections. Although the primary goal of the guide is to safeguard patient health, it provides guidance on how proper IPC measures can indirectly safeguard the health of healthcare providers. The guide is aimed at a wide variety of groups, including leaders at the facility level, policymakers at the government level, and NGOs.
Minimum Requirements for Infection Prevention and Control Programmes (2019). World Health Organization.
These WHO-developed guidelines lay out the minimum requirements for infection prevention and control (IPC) programs to effectively safeguard the health of both health and care workers as well as visitors. To help managers and policymakers at healthcare facilities achieve these minimum requirements, this guide outlines a 5-step improvement strategy that involves self-assessment, the creation and execution of an action plan, and continuous monitoring of the impact of these plans.
Preventing Disease Through a Healthier and Safer Workspace (2018). World Health Organization.
This report from WHO reviews the landscape of occupational risks for health workers. It provides data on the current impact that occupational risks have on death, injury, and disease amongst both health workers and the general population. It then estimates how much of this impact could be reduced by effective policies limiting occupational risk, providing general guidance on risk reduction as well as selected examples of interventions that successfully improved health by reducing occupational risk.
Optimizing Community Health Worker Programmes for HIV Services (2021). World Health Organization.
This guide, developed by the WHO, describes the optimal design and delivery of community health worker (CHW) programs for enhanced and sustainable HIV/AIDs service delivery. The resource builds on key elements of WHO normative guidelines on CHW programs with the needs of HIV interventions in mind.
Hazard Education
Occupational Hazards in the Health Sector. World Health Organization.
This WHO tool is a hub for health workers to access educational information about many different types of occupational hazards. This database links to many additional resources related to occupational hazards in health. The topic areas that can be accessed are occupational infections, unsafe patient handling, exposure to hazardous chemicals, exposure to radiation, occupational stress, violence, and harassment, risks in the ambient work environment, occupational injuries, and environmental health hazards.
Work Hours – Nursing
Decent Working Time for Nursing Personnel: Critical for Worker Well-being and Quality Care (2018). International Labor Organization.
Developed by ILO, this guideline focuses on the rights of nursing personnel and describes the detrimental impact that an overworked nursing workforce has on patient health. It particularly condemns problematic work structures, such as night shifts and on-call scheduling, and prescribes limitations on the hours that nurses can work in a given day or week. The brief advocates for the ratification of the Nursing Personnel Convention (ILO C.149), and provides insights on how State and relevant stakeholders can best implement core principles of decent work in the nursing sector.
Association of Working Hours and Patient Safety Competencies with Adverse Nurse Outcomes: A Cross-Sectional Study (2019). International Journal of Environmental Research and Public Health.
This study explores the relationship between nurses’ working hours and patient safety competencies with adverse nurse outcomes. The study found that, out of the 346 participants, most worked over 40 hours per week. The results also indicated that working hours had the strongest association with adverse nurse outcomes and low perceived patient safety competencies and frequently reporting patient safety accidents were correlated with adverse nurse outcomes. The study illustrates the need for nursing leaders to facilitate working environments that discourage working overtime and prioritizes patient safety competencies, as well as the need for healthcare managers to formulate policies that secure nurses’ rights.
Nurses’ Shift Length and Overtime Working in 12 European Countries (2014). Medical Care.
This study explores and describes the shift patterns of nurses in Europe and investigates the relationship between shift length and working overtime to the quality of care delivered to patients. The study found that those working shifts of 12 hours or more (15% of respondents) and those working overtime were more likely to report poor or failing patient safety, poor/fair quality of care and more care activities left undone. Overall, the study documents evidence regarding the need to balance shift length and overtime policies with optimizing both the rights of nurses as well as patient needs and care.
1.2 Health Services
Worker Health Care
Implementation Guide for Vaccination of Health Workers (2022). World Health Organization.
This WHO guide summarizes contemporary recommendations for health worker safety from occupational infections around the world. It emphasizes the need for a strong policy and program that ensures all health workers can be vaccinated before they enter the workforce and can receive regular vaccinations to protect themselves and their patients from vaccine-preventable diseases. The target audience for the guide includes policymakers in government health offices as well as health facility managers.
Occupational Stress, Burnout, and Fatigue. World Health Organization.
Developed by WHO, this guide aims to assist employers of health workers to mitigate the onset and impacts of occupational stress, burnout, and fatigue for their employees. The guide outlines nine preventative measures that employers can take to protect against occupational burnout and links to additional resources within as well. Preventative measures include the provision of work-focused consultations to staff who are experiencing job stress, and the optimization of shift lengths to avoid fatigue.
Mental Health at Work (2022). World Health Organization.
This document focuses on the importance of mental well-being in the world of work. It discusses the relationship between work and an employee’s mental health and highlights how employers can promote mental health. It also provides an overview of the risks to mental health at work, how to prevent work-related mental health conditions, and how to support people in need of mental health support to engage and thrive at work.
Statement on Physicians Well-Being (2015). World Medical Association.
Within, the World Medical Association provides an overview of the threats, barriers, and opportunities for physician well-being, them being professional roles and expectations, working environment, and illness. To break down these barriers, the statement recommends that National Medical Associations (NMAs) recognize and (where possible), actively address 12 areas. These include the need for workplaces to promote conditions conducive to healthy lifestyles (including access to healthy food choices, exercise, nutrition counseling, and smoking cessation support), along with the need for medical staff to undergo training in recognizing, handling, and communicating with potentially violent persons.
1.3 Violence/Harassment
Workplace Violence/Harassment – General
Statement on Workplace Violence in the Health Sector (2022). World Medical Association.
This World Medical Association (WMA) statement condemns violence against health workers, with special attention to the detrimental impact it has both on the workers and the care they provide. It urges decision-makers at all levels to collaborate in addressing this issue. To help stakeholders reduce workplace violence, the statement provides policy recommendations in a variety of areas, including finance, training, communication, security, and data collection.
Prevention and Management of Workplace Violence (2017). International Council of Nurses.
This position statement from the International Council of Nurses (ICN) outlines the landscape of workplace violence against nurses, emphasizing their often-heightened exposure to bullying, sexual assault, and gender discrimination, as well as the threatening environments that lead them to underreport such issues. The statement provides sets of recommendations on how to reduce violence, including measures such as prevention strategies, training for healthcare professionals, and “facts not faults” investigations. These recommendations are specifically tailored, with distinct guidelines offered for nurses’ associations, employers, individual nurses, and clinicians, along with researchers.
Violence and Harassment (2023). World Health Organization.
This WHO tool aims to assist employers of health workers to mitigate the onset and impacts of violence and harassment in the workplace, including “work-related abuse, threats or assaults among health workers including physical, sexual, verbal and psychological abuse and workplace harassment.” The guide outlines eight preventative measures that these employers can take to achieve this, including the provision of security measures, and ensuring a confidential complaint or grievance procedure is established as part of organizational practice. These preventative measures are set out in more depth in WHO’s Framework Guidelines for Addressing Workplace Violence in the Health Sector.
Safe and Healthy Working Environments Free from Violence and Harassment (2020). International Labor Organization.
This ILO report supports the implementation of the Violence and Harassment Convention (No. 190) and its accompanying Recommendation (No. 206) by highlighting how a comprehensive OSH framework at both the national and workplace levels can address violence and harassment in the world of work. This includes the incorporation of provisions related to violence and harassment into occupational safety and health laws along with codes of practices and guidelines to support the implementation of programs and preventive workplace measures.
Violence and Harassment at Work – An Employers’ Guide (2022). International Labor Organization.
This ILO guide provides employers with a toolkit on how to address, prevent and respond to violence and harassment in the world of work. The guide is designed to be easily adaptable to national circumstances and reflects local laws, policies, and situations. It is aimed at staff responsible for managing hazards, risks, and workforce safety and health – such as those working in human resources, occupational safety and health, employee relations, and staff-wellbeing roles.
Violence Against Health Care: Current Practices to Prevent, Reduce or Mitigate Violence Against Health Care (2022). International Council of Nurses, International Committee of the Red Cross, International Hospital Association and World Medical Association.
This report provides the survey results about perceptions of violence amongst healthcare workers. It also offers recommendations on ways to prevent, reduce, and mitigate violence in ways that are receptive to the countries and health workers involved. These recommendations center on five focus areas for anti-violence policy: security, work environment, mental health, and well-being, communication, and coordination. The specific survey questions used in the creation of this report are also provided, allowing healthcare facilities to internally assess how their workers struggle with violence. The report also include several national case studies that highlight good practices.
HealthWISE – Work Improvement in Health Services – Action Manual (2014). International Labor Organization.
This tool from WHO and ILO is designed to assist health facilities in improving the quality of occupational safety and health, personnel management, and environmental health for health workers. The tool recommends that managers and health and care workers collaborate on implementing the best practices outlined in the tool. It is broken into eight, nonsequential modules, each focusing on a specific area of improvement such as musculoskeletal hazards, HIV and TB, working time, and supply storage. This approach allows healthcare teams to address their areas of greatest concern first.
Need for Guidelines on Prevention of Abuse in the Health-Care Sector (2022). Bulletin of the World Health Organization.
This journal article examines the implementation of WHO guidelines for addressing workplace violence in the healthcare sector, specifically those about workplace harassment. In doing so, it highlights both successes and challenges in implementing the guidelines as well as discussing areas for improvement or change. Other recommendations explored include an enhanced monitoring framework, how to prevent and treat technology-driven forms of harassment, and modernizing communication systems through the better use of user-friendly social media platforms.
Sexual Harassment/Gender-Based Violence
Sexual Harassment in the World of Work (2019). International Labor Organization.
This resource, developed by the ILO to advance the Violence and Harassment Convention (No. 190) and its accompanying Recommendation (No. 206), focuses on sexual harassment in the world of work. It provides an overview of sexual harassment in the workplace, draws attention to vulnerable groups, and causes of violence, along with its adverse impact on the world of work. The guide also discusses measures for prevention, and how the legal or policy interventions can be used to address the issue.
Ending Sexual Violence and Harassment of Women Health Workers (2022). Women in Global Health.
This report, created by the non-profit Women in Global Health initiative, utilizes interviews of over two hundred women health and care workers around the globe to draw attention to the sexual violence and harassment that such workers face. The report offers recommendations to health facilities and managers on ways they can combat sexual violence and harassment against women health workers, including making work facilities safer for women, offering trauma support to survivors, and collecting more robust data on the issues.
Marco Clari, Alessio Conti, Alessandro Scacchi, et al. Prevalence of Workplace Sexual Violence against Healthcare Workers Providing Home Care: A Systematic Review and Meta-Analysis (2020). International Journal of Environmental Research and Public Health.
This systematic review explores the prevalence of sexual violence (encapsulating both sexual harassment and abuse), towards home care workers by their clients. Overall, the study highlights the particular risk home care workers face due to their relatively uncontrolled work environment when compared to other health workers such as those in clinical settings, and the need for health management officials to consider interventions to prevent and reduce the risk of home care workers from being subjected to sexual violence.
Policy on Preventing and Addressing Sexual Misconduct (2023). World Health Organization.
These guidelines were created by WHO to set out best practices in addressing sexual violence and harassment within its staff and apply to all WHO collaborators, centers, and partners. The guidelines cover the entire process of addressing sexual violence and harassment, from initial disclosure to formal proceedings. WHO assigns specific duties to its workers, including protection, training, and transparency. It also outlines its guiding philosophy for supporting workers who come forward with allegations, a human rights-based approach that focuses on ideas such as “do no harm,” confidentiality, and non-discrimination.
Training about Preventing Violence
De-Escalating Violence in Health-Care Settings. International Committee of the Red Cross.
Developed by Health Care in Danger (a multidisciplinary initiative of the International Red Cross and Red Crescent Movement), this training package aims to prevent violence in healthcare settings by providing education on to identify potentially violent situations from the outset and appropriately defuse them before they escalate. Specifically, the training focuses on the improvement of communication skills and teaching key behaviors for reducing and de-escalating tension. The training package includes a combination of presentations, discussions, and role-playing exercises across three substantive online components. Portions of the training package can be downloaded from the website.
1.4 Attacks in Situations of Fragility, Conflict, and Violence
Prevention/Response to Violence in Conflict – General
Protection of Health Workers, Patients and Facilities in Times of Violence (2023). Johns Hopkins Bloomberg School of Public Health.
This resource provides an overview of discourse and recommendations generated by a group of experts convened by the Center for Public Health and Human Rights at Johns Hopkins University to discuss the situation of attacks against health and humanitarian workers in fragility, conflict, and violence in the 2020s. The report summarizes current international initiatives, identifies what can be better integrated or aligned with domestic measures, and gaps in knowledge, protection, monitoring, and accountability. The report also identifies key actions States, international organizations, NGOs, and professional health organizations can take to promote respect for and protection of, health care in times of armed conflict and violence.
Protecting Health Care: Guidance for the Armed Forces (2016). International Committee of the Red Cross.
These guidelines from the ICRC are uniquely targeted at military and other weapon-carrying actors, not those involved in health care. The guidelines have an overarching focus on encouraging armed forces to account for the safety of health and care workers in their operations, with nine specific focus areas that emphasize guidelines on civil-military cooperation, MEDEVAC, and military operations in medical facilities.
Respecting and Protecting Health Care in Armed Conflicts and in Situations Not Covered by International Humanitarian Law (2012). International Committee of the Red Cross.
This ICRC advisory document provides an overview of how international humanitarian law does or does not apply in a variety of situations that may impact health and humanitarian workers operating in an armed conflict or other emergency.
Unrelenting Violence: Violence Against Health Care in Conflict (2021). Safeguarding Health in Conflict Coalition.
This report discusses the financial costs associated with attacks on healthcare systems in conflict settings through case studies and analysis. It emphasizes the need to hold conflict parties accountable for such violations and makes three key recommendations – end impunity, strengthen prevention, and strengthen global and domestic leadership.
Protecting Health Care from Violence: Legislative Checklist (2021). International Committee of the Red Cross.
Developed by the International Committee of the Red Cross (ICRC), this checklist provides legislative guidance and recommendations on how to ensure a country’s laws and regulations adequately protect health care from violence in times of armed conflict and other emergencies. Specifically, it helps stakeholders assess whether a domestic normative framework complies with international obligations and adequately protects health care delivery.
Ethical Principles of Health Care in Times of Armed Conflict and Other Emergencies (2016). International Committee of the Red Cross (and others).
Jointly developed by the World Medical Association (WMA), the International Committee of Military Medicine (ICM), The International Council of Nurses (ICN), the International Pharmaceutical Federation (FIP), and the IRC, this document contains an overview of ethical principles of health care applicable in times of armed conflict and other emergencies. The principles are divided into three categories: general principles, relationships with patients, and protection of healthcare personnel.
Institutional Health Care in Danger Strategy. Protecting Health Care from Violence and Attacks in Situations of Armed Conflict and Other Emergencies (2020). International Committee of the Red Cross.
Developed by Health Care in Danger (a multidisciplinary initiative of the International Red Cross and Red Crescent Movement), and the ICRC, this document sets out the organization’s strategy to protect health care from violence and attacks in situations of armed conflict and other emergencies. In doing so, it sets out its overarching vision and context, its desired strategic direction, and implementation strategies, including influencing and coalition building.
The Implementation of Rules Protecting the Provision of Health Care in Armed Conflicts and Other Emergencies (2017). International Committee of the Red Cross.
This ICRC report draws upon the recommendations that emerged from a workshop jointly ran by ICRC, the Belgian Intermenstrual Commission for Humanitarian Law, and the Belgian Red Cross, which looked at concrete domestic legislative measures that can be established to implement the existing international legal framework for protecting the provision of and access to health care in armed conflicts and other emergencies. Accordingly, this document serves as a practical tool to support States in their efforts to develop effective domestic legal frameworks, implementation measures, and appropriate sanctions to uphold their international obligations in this space.
Ambulance and Pre-Hospital Services in Risk Situations (2015). International Committee of the Red Cross.
Developed by Health Care in Danger (a multidisciplinary initiative of the International Red Cross and Red Crescent Movement), this publication summarizes the most significant results of the expert workshop on ambulance and pre-hospital services in risk situations (jointly organized by the ICRC and Mexican Red Cross). This workshop focused on understanding the concrete challenges healthcare personnel faced when providing ambulance and pre-hospital services in risky situations.
Ensuring the Preparedness and Security of Health-Care Facilities in Armed Conflict and other Emergencies (2015). International Committee of the Red Cross.
Developed by Health Care in Danger (a multidisciplinary initiative of the International Red Cross and Red Crescent Movement), this publication provides an overview of issues relevant to the security of healthcare facilities located in contexts prone to, or during, armed conflict and other emergencies. It promotes key preventive measures for consideration during the early stages of designing a healthcare facility to increase its resilience to all kinds of major risks and presents general recommendations about measures to enhance the preparedness and security of healthcare facilities to mitigate the risk of disruption in healthcare delivery.
Domestic Normative Frameworks for the Protection of Health Care (2015). International Committee of the Red Cross.
Developed by Health Care in Danger (a multidisciplinary initiative of the International Red Cross and Red Crescent Movement), this report summarizes the results of research on domestic legislative and regulatory measures that could be established by States to implement the existing international legal framework for protecting the provision of and access to, health care in armed conflicts and other emergencies. Accordingly, this document serves as a practical tool to support States in their efforts to discharge their obligations in terms of implementation of the international legal framework for protecting the provision of health care and guaranteeing more effective protection of healthcare services.
Letter Dated 18 August 2016 from the Secretary-General Addressed to the President of the Security Council (2016). United Nations.
This UN letter provides important information and context to the issue of insecurity of medical care in armed conflict and provides several recommendations on how to prevent acts of violence, attacks, and threats against the wounded and sick, medical personnel, and humanitarian personnel exclusively engaged in medical duties, their means of transport and equipment, as well as hospitals and other medical facilities, and to better ensure accountability and enhance their protection.
Critical Condition: Violence Against Health Care in Conflict 2023 (2024). Safeguarding Health in Conflict Coalition and Insecurity Insights.
This report details health acts of violence against health care in 2023 in 20 countries and territories. That year saw a record number of recording attacks on health care – nearly 2,500, killing nearly 500 health workers. The report also offers proposals to reduce these attacks, among them: ending impunity, including through national prosecutions under universal jurisdiction laws, and country-level monitoring; strengthening prevention including by ratification of the Arms Trade Treaty and donor funding for programs ensuring safe and accessibility of health services in war-torn countries; expanding data collection; strengthening of the national, regional, and global leadership; and support and safeguarding health workers, including by providing security and psychosocial support and expressing solidarity with colleagues under attack.
Emergency (Non-Conflict) Settings
Protection of Health Care and Law Enforcement: Case Studies and Proposed Guidelines for the Improved Interaction Between Law Enforcement Agencies and Health-Care Providers in order to Protect and Facilitate Access to Health Care in Emergencies other than Armed Conflicts. International Committee of the Red Cross.
This resource from the ICRC combines open-source information review, expert interviews, and case studies from a variety of countries to provide guidelines for how law enforcement officials and health and care workers can fulfill their respective goals in harmony. This assessment examines several specific common interactions between law enforcement and health workers, such as providing care for injured protestors and law enforcement’s presence in emergency departments, with the case studies serving as positive examples of best practices. The report concludes by outlining guidelines in five specific areas of law enforcement-health worker intersection, including the safety of first-aid providers, patient dignity and autonomy, and immigrants’ access to health care.
Occupational Safety and Health in Public Health Emergencies: A Manual for Protecting Health Workers and Responders (2018). International Labor Organization.
These occupational safety guidelines, jointly developed by WHO and ILO, aim to prepare health organizations to protect the health and safety of their workers during public health emergencies. Guidance is offered for how to handle both natural public health emergencies, such as disease outbreaks, and man-made emergencies, such as chemical spills. Though helpful to all health organizations, these guidelines are particularly useful for organizations that have low resources or operate in countries with higher risks of public health emergencies.
Collection of Data – Attacks on Health Care in Conflict or Other Emergency Settings
Surveillance System for Attacks on Health Care (2023). World Health Organization.
This tool from WHO allows for a quick and easy search for data regarding violence against health and care workers around the world. The search engine allows users to select particular date ranges, countries, and types of attacks. It also provides overall statistics for the year’s healthcare attacks as well as a log of recent attack reports.
Toolkit: Evidence that Protects Health Care (2021). Johns Hopkins Bloomberg School of Public Health (and others).
This virtual toolkit contains a collection of resources that can be utilized for documenting, analyzing, and advocating for the ending of violence against healthcare in conflict. Information on how to develop a method of surveying the impact of violence against health care and help collect data on health-related security incidences in the context of an armed conflict are included. The toolkit was jointly developed by the Center for Public Health and Human Rights at Johns Hopkins University, Insecurity Insight, the International Rescue Committee, and Physicians for Human Rights. The toolkit is particularly useful for stakeholders committed to protecting healthcare in conflict, including (but not limited to) humanitarian organizations, human rights actors, and researchers.
Impunity Remains: Attacks on Health Care in 23 Countries in Conflict (2018). Safeguarding Health in Conflict Coalition.
This report, developed by the Safeguarding Health in Conflict coalition, aims to provide a global overview of the prevalence of attacks against health care in conflict and its impacts on health delivery in humanitarian situations. The report also outlines a series of recommendations for numerous stakeholders, including all parties to the conflict, the UN Security Council and Secretary-General, along with non-state armed groups.
Gathering Evidence-Based Data on Violence against Health Care (2021). International Committee of the Red Cross.
Developed by Health Care in Danger (a multidisciplinary initiative of the International Red Cross and Red Crescent Movement), this literature review aims to explore the prevalence of violence against health and care workers across numerous jurisdictions. The results of the study found that 15% – 97% of health workers had experienced physical, sexual, or psychological harm whilst performing their duties. The forms of violence experienced were varied and included beating, stabbing, threat of physical force, and verbal abuse. The literature review identified four common sources of violence – including groups such as junior personnel, women, those working in evening shifts, or the emergency department as particularly vulnerable to experiencing violence.
Trainings about Preventing Violence
De-Escalating Violence in Health-Care Settings. International Committee of the Red Cross.
Developed by Health Care in Danger (a multidisciplinary initiative of the International Red Cross and Red Crescent Movement), this training package aims to prevent violence in healthcare settings by providing education on to identify potentially violent situations from the outset and appropriately defuse them before they escalate. Specifically, the training focuses on the improvement of communication skills and teaching key behaviors for reducing and de-escalating tension. The training package includes a combination of presentations, discussions, and role-playing exercises across three substantive online components. Portions of the training package can be downloaded, free of cost, from the website.
2: Inclusivity
2.1 Equal Treatment/Non-Discrimination
General
Joint United Nations Statement on Ending Discrimination in Health Care Settings (2017). United Nations.
This statement from the UN strongly condemns healthcare discrimination in all its forms. Primarily aimed at national governments and policymakers, the statement proceeds to urge these actors to take specific actions to reduce discrimination in the health sector, including providing discrimination education, robust methods for redressing discriminatory action, and legislative measures. The action urged in the last category involves not only passing laws that expressly prohibit discrimination in healthcare settings but also repealing laws that punish individuals for things such as gender expression, same-sex conduct, or drug use.
Race
Organizational Strategic Plan to Embed Racial Justice and Advance Health Equity 2021-2023 (2021). American Medical Association.
These guidelines from the American Medical Association lay out a three-year plan to begin dismantling racism and improving equity within the United States healthcare system. The statement articulates five general goals, including embedding racial and social justice throughout the AMA system and building alliances with historically marginalized and minoritized physicians. Although focused on the United States healthcare system, these guidelines can be a useful reference point to any health and care system looking to combat and undo racism.
Gender
10 Key Issues in Ensuring Gender Equity in the Global Health Workforce (2019). World Health Organization.
This online resource developed by WHO summarizes the 10 key points emerging from the report at the Commission on the Status of Women. This report discusses the social and economic determinants of the underrepresentation of women leaders in global health and makes a call for action to urgently address this gender inequity. Some of the main points outlined in this online resource are that women comprise 70% of the health workforce but only a quarter of them hold senior roles and that oftentimes gender norms and stereotypes of jobs can affect the healthcare roles that women occupy, which is a significant contributor to the gender pay gap.
Improving Personal Protective Equipment (PPE) for Women Health & Care Workers (2021). Women in Global Health.
Developed by the nonprofit Women in Global Health, this report aims to document the challenges faced by women health workers around the fit and design of personal protective equipment (PPE), which are usually made based on the male body despite women forming the majority of the health and care workforce.
Delivered by Women, Led by Men (2019). Women in Global Health.
This analysis, produced by the nonprofit Women in Global Health with the support of the WHO, shares the conclusions from a review of over one hundred and seventy studies on gender and equity in the global health workforce. The analysis offers many conclusions about both the causes and impacts of gender inequity in the health and care workforces, breaking down its findings by category, assessing occupational segregation, discrimination, harassment, gender pay gaps, and gender parity in leadership. The analysis offers recommendations on changing the narrative around women in the global health and care workforce, introducing policies aimed at combating gender inequity and shifting the focus of health research to more greatly emphasize gender and intersectionality impacts.
The State of Women and Leadership in Global Health (2023). Women in Global Health.
Developed by the nonprofit “Women in Global Health”, this report aims to examine the gendered leadership gap among health workers. It does this by drawing on both global data and individual country case studies and sets out guidance for how to promote gender equity in the health and care workforce.
Health Workers
“We are Not the Virus”: Stigmatization and Discrimination against Frontline Health Workers (2021). Journal of Public Health.
This study outlines the numerous forms of stigma and discrimination faced by (among others) frontline health workers. The study makes several recommendations on how the Philippine government and the public alike can create safety guidelines by drawing upon insights from relevant national and international laws. While the study focus is on the Philippines, the findings and subsequent recommendations are relevant for all contexts.
Employment and Working Conditions of Nurses: Where and How Health Inequalities Have Increased during the COVID-19 Pandemic? (2021). Human Resources for Health.
This study aims to explore how employment relations, along with employment and working conditions may be negatively impacting nurses’ health in countries including Brazil, Croatia, India, Ireland, Italy, México, Nepal, Spain, and the United Kingdom. The study explores the inherent vulnerability of nurses, and how this can be exacerbated by gender inequalities, as well as factors such as ethnicity, age, and migrant status. It also showcases evidence of how during the COVID-19 pandemic, employment and working conditions are associated with poor physical and mental health. The study recommends the establishment of national and international enforceable standards in conjunction with economic and health policies to improve employment and working conditions for nurses.
Perceived COVID-19-associated Discrimination, Mental Health and Professional-turnover Intention among Frontline Clinical Nurses: The Mediating Role of Resilience (2021). International Journal of Mental Health Nursing.
This study examines the relationships between Philippine frontline nurses’ perceptions of COVID-19-associated discrimination and their resilience, mental health, and professional-turnover intention. The 259 frontline nurses’ results indicated that they perceived a moderate level of COVID-19-associated discrimination and that those who perceived a higher level during the COVID-19 pandemic reported poorer mental health and higher professional-turnover intention. The results also indicated that resilience acted as a mediator and reduced the impacts of COVID-19-associated discrimination on nurses’ mental health and their intention of professional turnover. Based on these findings, the study recommends that proactive measures to reduce the negative impacts of COVID-19-associated discrimination, along with efforts to foster resilience in frontline nurses be undertaken as a high priority by hospital and nursing administrators.
Count CHWS: Making the Case for Community Health Worker Master Lists (2023). Community Health Impact Coalition.
This statement from the nonprofit Community Health Impact Coalition urges the need to adequately count community health workers so that governments can properly create national public health plans and pay community health workers. The statement provides specific 7-step guidelines for creating a community health worker master list (CHW), the key characteristics of an effective CHW, and the benefits of utilizing CHWs.
Migrant Health Workers
Promoting Decent Work Across Borders: A Project for Migrant Health Professionals and Skilled Workers (2014). International Labor Organization.
This brief statement from the ILO outlines a European Union-funded pilot project aimed at improving and streamlining the system allowing nurses to be employed in countries to which they migrate and to be re-employed if they return to their home countries. Although the project is ongoing and thus does not have any hard conclusions, it provides guidelines for how nations can collaboratively engage their governments, trade unions, and employers to create networks and programs that facilitate migrants in their work across borders. Several specific examples of ongoing efforts within the project are detailed as well.
WHO Global Code of Practice on the International Recruitment of Health Personnel (2020). World Health Organization.
This WHO report details their assessment of WHO Global Code of Practice on the International Recruitment of Health Personnel. The report provides four recommendations to fill the gaps it found in the implementation of the Code, including calling for broader adoption of the Code by WHO member states and urging leading destination countries to provide multi-year fund commitments towards migrant worker programs
The International Platform on Health Worker Mobility: Elevating Dialogue, Knowledge, and International Cooperation (2017). International Labor Organization (and others).
Jointly developed by the ILO, OECD, and WHO, this online resource provides an overview of health worker mobility and its escalating scale and complexity and highlights the importance of better understanding and managing this issue. In doing so, it sets out the relevant global governance instruments such as the WHO Global Code of Practice on the International Recruitment of Health Personnel, and sets out recommendations made by the High-Level Commission on Health Employment and Economic Growth. This includes establishing a dialogue between relevant stakeholders on health worker mobility to advance knowledge and cooperation.
The Workforce for Health in a Globalized Context – Global Shortages and International Migration (2014). Global Health Action.
This study examines the phenomenon of health worker migration (particularly migration from low to high-income countries) and the internal and external factors that fuel it. With reference to the WHO Global Code of Practice on the International Recruitment of Health Personnel, this resource discusses current practices for the migration of health workers and presents best practices in policy and governance for solving this issue.
International Labour Migration in the Health Sector: A Manual for Participatory Assessment of Policy Coherence (2023). International Labor Organization.
The manual constitutes a step-by-step practical guide to support labor and employer organizations, governments, and other stakeholders at country level in designing more effective health and labor migration policies with respect to migrant health workers. The manual covers the policy development cycle from a preparatory phase through monitoring and evaluation, and encourages policies that are ethical and support the rights of health workers, along with the population’s health.
Labour Rights
Global Estimates of Modern Slavery: Forced Labour and Forced Marriage (2022). International Labor Organization.
This report from the ILO provides data regarding global estimates of forced labor and forced marriage around the world. The report then provides specific recommendations on how to end these two harmful systems, with the goal of eradicating them entirely by 2030.
Maternity Rights
Maternity Protection Resource Package. International Labor Organization.
This tool from the ILO provides specific learning and teaching modules about maternity protection and maternity leave for health and care workers. The modules are broken up into 3 parts, covering background, the core and basic elements of maternity protection, and the actions that can be taken to improve maternity protections at the national and organizational levels. This tool can be utilized by any individual for self-education and also provides the teaching structure necessary for governments, employers, and NGOs to use the modules to educate others.
Maternity and Paternity at Work: Law and Practice Across the World (2014). International Labor Organization.
These guidelines, published by the ILO and other international partners, outline the required entitlements and safety policies for pregnant workers, recent mothers, and others who are involved with early child rearing in some way. The guidelines include discussions of breastfeeding arrangements at work, parental leave, and minimizing exposures to environments harmful to a pregnancy. Although focusing directly on Indonesia, the guidelines draw most of their substance from international agreements, treaties, and other legal frameworks that Indonesia has adopted, so these guidelines can be a useful reference for advancing issues related to maternity and paternity protection.
Protecting Pregnant Health Care Workers From Occupational Hazards (2011). Professional Practice.
This article reviews the mechanisms currently in place to protect pregnant health workers in the United States, Canada, and the European Union (EU) and provides further recommendations to better protect the health and safety of pregnant occupational health nurses in particular.
In 38 Countries, Women Can Still Be Fired for Being Pregnant (2021). World Bank Blogs.
This resource, published by the World Bank, shines a light on the fact that many pregnant workers do not have legal recourse in cases of unlawful termination, and can be fired for simply being pregnant. In doing so, it presents a case as to why explicit legal prohibitions against this practice will serve as a useful stepping stone to a fairer and safer working environment for all pregnant workers.
Maternity Leave Legislation in Support of Breastfeeding – Case Studies Around the World (2019). World Health Organization.
Jointly developed by the WHO, UNICEF, and the Global Breastfeeding Collective, this report focuses on the ILO Maternity Protection Convention No. C183 and its corresponding Recommendation No. R191 – which called for countries to provide new mothers with at least 14 weeks of maternity leave, paid at no less than two-thirds of previous earnings through compulsory social insurance or public funds. The report explores the implementation of this Convention and Recommendation along with associated challenges through country case studies.
Maternity Protection: Compliance with International Labour Standards (2019). World Health Organization.
This resource, developed by WHO within the Nutrition Landscape Information System, provides indicators and additional implementing guidelines for maternity protection standards as set out in the ILO Maternity Protection Convention, 2000 (No. 183) and its accompanying ILO Maternity Protection Recommendation, 2000 (No. 191). This includes maternity leave duration, amount of maternity cash benefits, source of such benefits, and details as they relate to the right to continue breastfeeding a child after returning to work.
It Shouldn’t Be a Heavy Lift: Fair Treatment for Pregnant Workers (2013). National Women’s Law Center.
This report details best practices in the workplace for pregnant workers. It focuses on supportive measures, and challenges that may occur in implementation when pregnant workers seek temporary modifications to their job duties due to pregnancy, such as avoiding heavy lifting, staying off high ladders, or being permitted to sit down during a long shift. The report also details the recommendations for laws and policies that best protect the right to reasonable accommodations for pregnant workers.
Disability Rights
The Right of Persons with Disabilities to Work (2022). United Nations.
This learning module, created by the UN, provides an overview of the labor rights held by persons with disabilities. It covers the specific provisions of the Convention on the Rights of Persons with Disabilities (CRPD), then details actions that can be taken to promote inclusion and eliminate discrimination based on ability status. This teaching tool is intended for governments, NGOs, researchers, universities, and labor organizations, as well as anyone else who may benefit from greater knowledge of labor rights for individuals with disabilities.
International Standards on the Right to Physical and Mental Health. United Nations.
This UN resource outlines all standards relating to the right to physical and mental health. These include the UN Declaration of Human Rights (UDHR) and the International Convention on the Protection of the Rights of All Migrant Workers and Members of their Families (ICMW). These standards are first ordered in hierarchical order (starting with the UDHR), then are grouped into six categories, including core international human rights treaties, standards for specific groups, and international humanitarian law.
Decent Work for Persons with Disabilities: Promoting Rights in the Global Development Agenda (2015). International Labor Organization.
This extensive report on the rights of disabled persons, published by the ILO, outlines the history of international legal frameworks protecting and promoting the labor rights of persons with disabilities. In addition, the report outlines an agenda for improving the effectiveness of existing protections and the advancement of employment rights and opportunities for persons with disabilities. This agenda includes passing more laws guaranteeing equal opportunity for people with disabilities, encouraging employers to hire people with disabilities, and developing national disability strategies. These guidelines are helpful for governments, NGOs, and employers.
Achieving Equal Employment Opportunities for People with Disabilities through Legislation: Guidelines (2014). International Labor Organization.
These ILO guidelines provide key insights and standards in improving the effectiveness of national laws concerning the training and employment of disabled persons across all work sectors.
Trade Union Action on Decent Work for Persons with Disabilities. International Labor Organization.
This ILO report captures and summarizes trade union action on disability from over 50 countries including developed, emerging, and developing economies. This report offers a new perspective to trade unions who have not worked in the disability space and provides insights into ways for policymakers and unions to further develop their work.
Legislation on Disability and Employment: To What Extent are Employment Rights Guaranteed for Persons with Disabilities? (2022). International Journal of Environmental Research and Public Health.
This study aims to understand how legislation in seven Latin American countries (Bolivia, Costa Rica, Chile, Colombia, Ecuador, Mexico, and Peru) has defined and enabled the inclusion of people with disabilities in the labor market. A thematic analysis of legal and/or policy documents found that despite the fact all seven countries have enacted legislation that promotes the employment rights of people with disabilities, barriers continued to exist. The authors provide important context on rights-affirming legal and policy frameworks, as well as insights on how to best implement measures to promote the labor market inclusion of disabled populations and counter the association of disability with notions of inability to work.
Situation of Wage Employment of People with Disabilities: Ten Developing Countries in Focus. Handicap International.
This report analyzes the concept of decent work for persons with disabilities, with a focus on countries “where specialized resources are rare and inclusive policies remain in their infancies.” The report analysis provides insights through a qualitative study and also provides contextual information for each country of focus including how disability is defined in relevant legislation and the prevalence of disability.
3: Providing Support
3.1 Fair/Equitable Remuneration
General
Compensation Models for Community Health Workers: Comparison of Legal Frameworks Across Five Countries (2021). Journal of Global Health.
This research study examines the legal frameworks for the compensation of community health workers in five countries: Brazil, Ghana, Nigeria, Rwanda, and South Africa. Each country utilized a different payment model, and the study outlines the pros and cons of each model. The study concludes that a legal framework is a necessary first step in the effective compensation of community health workers, and its findings can be a helpful starting point for governments around the world hoping to implement a payment model for community health workers.
Gender
The Gender Pay Gap in the Health and Care Sector: A Global Analysis in the Time of COVID-19 (2022). World Health Organization.
Jointly developed by WHO and ILO, as the first global sectoral gender pay gap report by international organizations, presents findings of gender pay gaps in the health and care sector, for it to be utilized in pay parity advocacy. The evidence in the report illustrates significant variations in gender pay gaps in health and care across countries and sets out a path forward for targeted action to close these. This path includes improving the collection and analysis of targeted gender-disaggregated wage data for the health and care sector, pay transparency and legal instruments against pay discrimination, and facilitating the transition of workers from the informal to the formal economy.
Subsidizing Global Health: Women’s Unpaid Work in Health Systems (2022). Women in Global Health.
This report, authored by the nonprofit Women in Global Health, provides data on and examines the root causes of unpaid and underpaid health and care work, the majority of which is provided by women who are community health workers. The report articulates six broad conclusions, including an explanation of the differences in the types of unpaid work in the health and care sector and the negative economic impact that this work has on women’s economic potential, with several sub-conclusions within each category.
Health and Social Care’s Gender Pay Problem (2022). World Economic Forum.
Written by the World Economic Forum (WEF) this article summarizes the key findings of the joint WHO and ILO report “The Gender Pay Gap in the Health and Care Sector: A Global Analysis in the Time of COVID-19”. The key points raised include that the average pay for women is about 24% lower than men in the health and care sector (and 20% less overall), and the gender pay gap is exacerbated for mothers raising families.
Equivalent Position/Work
Closing the Leadership Gap (2021). Women in Global Health.
This report, jointly authored by WHO and the nonprofit Women in Global Health, is a follow-up to the “Delivered by Women, Led by Men” report. This analysis provides data indicating that women hold a disproportionately-low percentage of leadership positions in the health and care field despite providing most of the labor. Because the first report, “Delivered by Women, Led by Men,” was published before the COVID-19 pandemic hit, this report expands upon how COVID-19 has worsened the gender inequities that were already plaguing the health and care systems. The report explores why these inequities exist and also articulates four general recommendations, each with many sub-recommendations, on how to remove systemic barriers so that women have more opportunities for leadership positions. These recommendations include building the foundation for equality and addressing social norms and stereotypes.
Situation of Wage Employment of People with Disabilities: Ten Developing Countries in Focus. Handicap International.
This report details the results of a study conducted by the nonprofit Handicap International (now Humanity & Inclusion) that examined wage employment of people with disabilities in low- and middle-income countries. The study highlights ten country-specific examples of successful wage employment for people with disabilities, which can be used as a guide for other countries (and organizations) when assessing their disability policies and landscape. The report also offers particularized recommendations for policymakers, businesses, NGOs, and job training centers.
New Reports Reveal Nurses are Underpaid, Undervalued and Face Larger Gender Pay Gap than Other Sectors (2022). International Council of Nurses.
This resource by the International Council of Nurses (ICN) summarizes the key findings from two reports – “The gender pay gap in the health and care sector: a global analysis in the time of COVID-19” by WHO and ILO and “Subsidizing Global Health: Women’s Unpaid Work in Health Systems”, by nonprofit Women in Global Health. ICN focuses on the gender pay gap between women in the health and care sector when compared to their male counterparts. Additionally, ICN discusses how more than six million women worldwide are subsidizing health systems with their unpaid or underpaid labor, including the nursing profession.
Extra Responsibilities (OT, hazard pay, remote areas)
Compensation and Hazard Pay for Key Workers During an Epidemic: An Argument from Analogy (2020). Journal of Medical Ethics.
This study, published in the Journal of Medical Ethics, concludes that the no-fault and hazard pay compensation schemes offered to military service members placed in dangerous environments should be extended to health and care workers operating during a pandemic.
3.2 Social Protection
Worker Benefits
Health Workforce Requirements for Universal Health Coverage and the Sustainable Development Goals (2016). World Health Organization.
This study, published by the WHO, assesses the trajectory of the health workforce landscape and outlines the steps necessary to create a health workforce that can meet the WHO’s Sustainable Development Goals by 2030. The study concludes that in many parts of the world, the gap between the health and care needs of the population and the workforce available will increase or fail to improve without intervention. The study offers several recommendations, including greater reliance on mid-level providers and community health workers and greater investment in the health workforce.
3.3 Enabling Work Environments
Management, Structure, and Responsibilities
Guideline on Health Policy and System Support to Optimize Community Health Worker Programmes (2018). World Health Organization.
These WHO guidelines outline the best practices for designing, implementing, and evaluating community health worker (CHW) programs in service of working towards providing universal health coverage. The guidelines offer fifteen different recommendations regarding the integration of CHWs into the larger health workforce, ranging from the training and certification of CHWs to remuneration and the availability of supplies. These guidelines are intended primarily for governments and policymakers, but also for international and national NGOs and other health organizations.
Health Policy and System Support to Optimize CHW Programmes for HIV, TB and Malaria Services: An Evidence Guide (2021). World Health Organization.
Developed by the WHO, this evidence guide pulls together existing guidelines and bodies of evidence in conjunction with recommendations from WHO experts to provide a “first-ever” evidence base for national governments and their partners to design, implement and sustain effective and cost-effective HIV, TB, and malaria programs.
Workload Indicators of Staffing Need: WISN (2010). World Health Organization.
Developed by the WHO, this user guide provides an overview of the Workload Indicators of Staffing Need (WISN) – an analytic tool for recording, analyzing, and reporting data related to staffing status and needs at health facilities. The tool is intended to support a full and informed decision-making process for ensuring an adequate and strong health workforce at the facility and governance levels.
How to Create an Attractive and Supportive Working Environment for Health Professionals (2010). World Health Organization.
Jointly developed by the WHO, European Observatory on Health Systems and Policies, and the Health Evidence Network, this policy brief sets out the different policy approaches that can be employed to help create positive environments for health workers in hopes to improve the recruitment and retention of health professionals and facilitate health service quality. Whilst the brief focuses on policy approaches for physicians and nurses in particular (as they represent the largest constituents of the health workforce), the findings from this brief are intended to be widely applied across the health and care workforce sector.
Working for Health 2022-2030 Action Plan: Protection and Performance (2023). World Health Organization.
Developed by the WHO, this thematic brief examines policy considerations on the protection and performance of the health and care workforce. Topics include the relevant policy landscape, key challenges, and future directions.
Sustain and Retain in 2022 and Beyond (2022). International Council of Nurses.
Commissioned by the International Centre for Nurse Migration (ICNM), this brief provides a global assessment of how the COVID-19 pandemic impacted the nursing workforce – with a specific focus on how changing patterns of nurse supply and mobility challenges the sustainability of the global nursing workforce. The brief also recommends a path forward to ensure workforce sustainability is supported, and that health system responsiveness and resilience in the face of pandemic threats is improved.
Recover to Rebuild: A Roadmap for Nursing and Health (2023). International Council of Nurses
This report aims to guide discussions on protecting and supporting the nursing workforce during the COVID-19 pandemic as countries work to recover and rebuild health systems affected by COVID-19. It emphasizes the need for recovery in global health systems, noting that many nurses had to acquire new skills and adapt to different roles, creating challenges for organizations and patient care. Therefore, safeguarding the nursing workforce is essential for recovery and should be integrated into broader strategies for ensuring its long-term sustainability. It presents an action agenda for rebuilding the nurse workforce, with both country-level and international actions, such as conducting a national nurse workforce impact assessment and investing in safe staffing levels domestically, and internationally, committing to early vaccination access for all nurses and ethically managing the global supply of nurses.
The Global Mental Health Nursing Workforce: Time to Prioritize and Invest in Mental Health and Wellbeing (2022). International Council of Nurses.
This report points to the need to increase investments in nurses who specialize in mental health and substance use, i.e., mental health nurses, as many countries have significant shortages. It covers undergraduate and advanced education for mental health nurses, clinical placements, preparation for specialization, and post-graduate education. It also addresses key factors affecting retention in mental health nurses. Throughout, the report offers strategies for improvement.
Continuous Training
Working for Health 2022-2030 Action Plan: Education and Employment (2023). World Health Organization.
Developed by the WHO, this thematic brief sits alongside the Working for Health 2022-2030 Action Plan (link) to inform Member States, non-state actors, and other stakeholders of the Action Plan on topics such as health education and employment, the relevant policy landscape, key challenges, and future directions. The Brief also expands upon the themes outlined in the Action Plan and reflects on the topical issues and considerations that shaped its design – including issues identified in the World Health Assembly Resolution WHA74.14 (link) to protect, safeguard and invest in the health and care workforce.
Education and Training (2016). World Health Organization.
Developed by the WHO, this technical document provides a collection of information regarding the safe and adequate provision of primary health care. In doing so, it avoids a “one-size-fits-all” approach, recognizing that primary care is organized in different ways across and within different countries. The nuanced recommendations mean that this technical document can be utilized by relevant stakeholders across an array of diverse health systems globally.
Transforming and Scaling Up Health Professionals’ Education and Training (2013). World Health Organization.
These WHO guidelines set out targets to scale up health professionals’ education and training. This is defined as the “sustainable expansion and reform of health professionals’ education and training to increase the quantity, quality, and relevance of health professionals, and in doing so strengthen the country’s health systems and improve population health outcomes. In doing so, these guidelines provide policy and technical guidance in the area of pre-service education (particularly for countries experiencing a shortage of doctors, nurses, midwives, and other health professionals), and guide countries on how to integrate continuing professional development (CPD) as part of the education of health professionals.
Declaration on Guidelines for Continuous Quality Improvement in Healthcare (2019). World Medical Association.
This statement from the World Medical Association reaffirms the need for healthcare professionals to maintain the highest standards of medical care. The statement emphasizes the key measures that must be taken to ensure this level of care is maintained. Continuing education is one of these points of emphasis, and healthcare institutions are encouraged to not only create their quality improvement systems but also to provide healthcare professionals with the adequate time and compensation needed to adequately maintain their levels of knowledge and skill. The statement also encourages individual physicians to continuously update their knowledge and skills in addition to any external modules or assessments they are required to do.
US and International Health Professions’ Requirements for Continuing Professional Development (2014). American Journal of Pharmaceutical Education.
This research article examines literature about continuing professional development (CPD) and continuing education (CE) practices in health professions – specifically pharmacy, medicine, nursing, ophthalmology, dentistry, public health, and psychology. The research compares and contrasts the variations that exist amongst these health professions, and recommends further steps to conceptualize CE and CPD within the health sector.
The Global Mental Health Nursing Workforce: Time to Prioritize and Invest in Mental Health and Wellbeing (2022). International Council of Nurses.
This report points to the need to increase investments in nurses who specialize in mental health and substance use, i.e., mental health nurses, as many countries have significant shortages. It covers undergraduate and advanced education for mental health nurses, clinical placements, preparation for specialization, and post-graduate education. It also addresses key factors affecting retention in mental health nurses. Throughout, the report offers strategies for improvement.
Core Competencies in Disaster Nursing: Competencies for Nurses Involved in Emergency Medical Teams (Level III) (2022). International Council of Nurses.
This guide underscores the critical importance of structured competencies within emergency medical teams (EMTs) to effectively support large-scale disasters. It outlines essential skills for nurses in EMTs, emphasizing the need for proper preparation and awareness of psychosocial effects post-deployment. The competencies are organized into eight domains: 1) preparation and planning, 2) communication, 3) incident management, 4) safety and security, 5) assessment, 6) intervention, 7) recovery, and 8) law and ethics. Descriptions of the competencies in each area are provided for generalized professional nurses (Level I), advanced or specialized nurses (Level II), and advanced nurses who are specialists in disasters (Level III).
Guidelines on International Health Nursing (2024). International Council of Nurses.
These guidelines describe mental health nursing – a nursing specialty involving caring for people at risk of and experience mental health conditions and substance use disorders – including a description of mental health nurses and characteristics and the scope of practice of these nurses. It covers key topics in and core competencies for mental health nursing undergraduate, post-graduate, and advanced practice education, as well as other key points for post-graduate education.
Strengthening Healthcare Systems
Health Workforce Support and Safeguards List (2020). World Health Organization.
Developed by the WHO, this technical document analyzes health workforce challenges related to universal health coverage and identifies countries with the most pressing health workforce needs. For example, WHO outlines and analyzes targets for a sufficient density of doctors, nurses, and midwives per population. This technical document also relates to the Global Code of Practice on the International Recruitment of Health Personnel as well.
Training Health Care Workers. Project HOPE.
Published by NGO Project Hope, this article outlines the global health worker crisis, how it has been exacerbated by COVID-19, and the various ways the civil society can support health workers – for example, by providing emergency housing for health workers who were displaced by the 7.8-magnitude earthquake in Turkey.
Global Strategy on Human Resources for Health: Workforce 2030 (2016). World Health Organization.
This statement, issued by the WHO, outlines all of the major health goals that WHO has set for itself to achieve by 2030. The statement categorizes its goals into four categories, although the overarching goal is ensuring universal health access. The statement provides a variety of policy options that member states can pursue to reach each of the enumerated objectives, with additional recommendations for how other international actors can help.
State of the World’s Nursing 2020: Investing in Education, Jobs and Leadership (2020). World Health Organization.
Jointly developed by the WHO, International Council of Nurses, and Nursing Now, this report provides the latest evidence on, and policy options for, the global nursing workforce, and presents a case for additional investment in nursing education, jobs, and leadership. The report further outlines policy options to strengthen the nursing workforce to achieve the health workforce targets within the UN 2030 Sustainable Development Goals.
Nurses: A Voice to Lead: Invest in Nursing and Respect Rights to Secure Global Health (2022). International Council of Nurses.
This report, developed by the International Council of Nurses (ICN), acts as a strategic toolkit that aligns well with key documents such as the WHO’s Global Strategic Directions for Nursing and Midwifery: 2021-2025 (SDNM) and State of the World’s Nursing (SOWN) report. The report examines the additional burden placed on health systems (particularly the nursing workforce) due to COVID-19 and outlines the required actions for the successful delivery and monitoring of the four key policy areas of the SDNM. Additionally, the report focuses on two “vitally important” strategic priorities that have come to the forefront due to COVID-19 – investing in and prioritizing the safety of health workers and caring for the health and well-being of nurses.
Nurses: A Voice to Lead: A Vision for Future Healthcare (2021). International Council of Nurses.
This report, developed by the International Council of Nurses (ICN) aims to outline the core features and levers required for a vision of future healthcare to be attained. In doing so, it illustrates how putting nurses in positions of influence and power will lead to a more people-centered and integrated approach to healthcare, and, as a result, more positive outcomes for the people and communities that nurses serve.
Community Health Worker Assessment and Improvement Matrix: A Toolkit for Improving CHW Programs and Services (2013). Community Health Impact Coalition.
This virtual toolkit, developed by CHW Central defines a set of key elements required for community health worker programs to function effectively. It operates by evaluating programs on specific criteria, including recruitment, equipment and supplies, and individual performance evaluation – and rating each criterion on a four-point scale ranging from “non-functional” to “highly functional.”
Community Health Worker Programming: Quality Standards for Design and Implementation for CHW Programme Models (2015). Community Health Impact Coalition.
This virtual resource, developed by CHW Central, features a community health worker (CHW) functionality matrix and information on CHW principles of practice, and quality standards for CHW functionality to be applied to a broad range of CHWs, irrespective of countries and contexts.
International Council of Nurses 2023 Report: Our Nurses. Our Future. (2023). International Council of Nurses.
This report introduces the ICN Charter for Change, which outlines ten essential policy actions that governments and employers must undertake to establish and maintain health systems that are safe, affordable, accessible, and responsive – and ones that value nurses. These actions include, for example, advancing strategies to recruit and retain nurses, ensuring safe and healthy working conditions, enabling nurses to work within the full scope of practice, engaging national nursing associations, and protecting vulnerable populations and upholding human rights. Discussions in each area further detailed needed actions and point to additional resources.
4: Safeguarding Rights
4.1 Whistleblowers/Freedom from Retaliation
Whistleblower Protection
Whistleblowing and Protection Against Retaliation (2015). World Health Organization.
This digital resource outlines the WHO’s whistleblowing and protection against retaliation policy and has three key aims. The first is to define “whistleblowing” and retaliation against whistleblowing by differentiating between wrongdoing that constitutes a risk of corporate significance and individual grievances that are administered through other established mechanisms. The second is to enhance the protection accorded to whistleblowers that fall within this definition, and finally, to clarify the responsibilities of actors such as line management and HR departments in these situations. Although the handout is particularized to WHO employees, it is a useful reference for other organizations or places of employment that are looking to implement or improve whistleblower protections.
Whistleblowing and Protection Against Retaliation Handout (2015). World Health Organization.
This handout from WHO is a helpful tool that articulates WHO policy on protecting whistleblowers. The handout provides a set of examples of conduct that whistleblowers should report and encourages them to come forward. It also defines and condemns retaliation. Although the handout is particularized to WHO employees, it is a useful reference for other organizations or places of employment that are looking to implement or improve whistleblower protections.
Speak Up for Health! Guidelines to Enable Whistle-Blower Protection in the Health-Care Sector (2021). United Nations.
Developed by the WHO, these guidelines provide a step-by-step process that an organization employing health and/or care workers can follow to establish internal policies and procedures that allow for the disclosure of allegations of wrongdoing whilst protecting the reporter from potential retaliation. In addition, the guidelines provide the necessary information for organizations to set up a fair and transparent reporting culture, that encourages people to speak up when they have concerns.
The Protection of Whistle-Blowers in the Public Service Sector (2022). International Labor Organization.
This report outlines the standards, and best practices, for promoting public-sector whistleblowing to increase transparency and accountability in line with relevant ILO instruments. The report defines corruption and its impact on decent work, and details policies and practices to best protect whistleblowing for public service employees, which would include any health or care worker employed in the public sector.
Conclusions of the Technical Meeting on the Protection of Whistle-blowers in the Public Service Sector (2022). International Labor Organization.
These conclusions cover challenges that countries face in protecting public service sector workers and people working in public sector oversight bodies with respect to their ability to disclose wrongdoing; effective laws and policies that countries been adopted to protect public service sector workers and people working in public sector oversight bodies from retaliation, harassment and violence for reporting wrongdoing, and lessons learned; and recommendations for future action. Recommendations include establishing effective laws and policies, ensuring equal access to protection mechanisms, and awareness-raising.
5: Governance and Policy
National/Local Action Plans
HealthWISE – Work Improvement in Health Services – Action Manual (2014). International Labor Organization.
This ILO action manual aims to help initiate and sustain changes for improvement by using a checklist as a workplace assessment tool, which identifies and prioritizes areas of action. The manual is split into eight modules addressing issues such as occupational hazards, workplace safety, physical and biological hazards, management and retention, working time, and personnel support. Each module includes sample action plans and checklists to guide the implementation of recommended practices.
HealthWISE – Work Improvement in Health Services – Trainers’ Guide (2014). International Labor Organization.
This ILO guide builds on the Work Improvement in Health Services Action Manual and contains necessary guidance and tools to deliver a training course on bettering work conditions and policies in the health sector. The guide is accompanied by resources such as a sample PowerPoint presentation for each of the training sessions.
Nurses: A Voice to Lead: Invest in Nursing and Respect Rights to Secure Global Health (2022).
This report, developed by the International Council of Nurses (ICN), acts as a strategic toolkit that aligns with key health workforce documents such as the WHO’s Global Strategic Directions for Nursing and Midwifery: 2021-2025 (SDNM) and State of the World’s Nursing (SOWN) report. The report examines the additional burden placed on health systems (particularly the nursing workforce) due to COVID-19 and outlines the required actions for the successful delivery and monitoring of the four key policy areas of the SDNM. Additionally, the report focuses on two “vitally important” strategic priorities that have come to the forefront due to COVID-19 – investing in and prioritizing the safety of health workers and caring for the health and well-being of nurses.
Health Policy and System Support to Optimize CHW Programmes for HIV, TB and Malaria Services: An Evidence Guide (2021). World Health Organization.
Developed by the WHO, this evidence guide pulls together existing guidelines and bodies of evidence in conjunction with recommendations from WHO experts to provide a “first-ever” evidence base for national governments and their partners to design, implement and sustain effective HIV, TB, and malaria programs.
Community Health Worker Assessment and Improvement Matrix: Updated Program Functionality Matrix for Optimizing Community Health Programs (2018). Community Health Impact Coalition.
This tool, jointly developed by the Community Health Impact Coalition, Unicef, and other health organizations, is a means of assessing the current functionality of community health worker (CHW) programs. The tool assesses ten different components of CHW programs, including recruitment, training, accreditation, and community involvement. Each component is assessed on a scale from one to four, with one being the lowest level of functionality (non-functional) and four being the highest level (highly functional). This tool can be used for both internal and external assessment.
Community Health Worker Assessment and Improvement Matrix: A Toolkit for Improving CHW Programs and Services (2013). Community Health Impact Coalition.
This virtual toolkit, developed by CHW Central, defines a set of key elements required for community health worker programs to function effectively. It operates by evaluating programs on specific criteria, including recruitment, equipment and supplies, and individual performance evaluation – and rating each criterion on a four-point scale ranging from “non-functional” to “highly functional.”
Nurses: A Voice to Lead: A Vision for Future Healthcare (2021). International Council of Nurses.
This report, developed by the International Council of Nurses, aims to outline the core features and levers required for a vision of future healthcare to be attained. In doing so, it illustrates how putting nurses in positions of influence and power will lead to a more people-centered and integrated approach to healthcare, and, as a result, more positive outcomes for the people and communities that nurses serve.
Community Health Worker Programming: Quality Standards for Design and Implementation for CHW Programme Models (2015). Community Health Impact Coalition.
This virtual resource features a community health worker (CHW) functionality matrix and information on CHW principles of practice, and quality standards for CHW functionality to be applied to a broad range of CHWs, irrespective of countries and contexts.
Global Strategic Directions for Nursing and Midwifery 2021-2025 (2021). World Health Organization.
Developed by the WHO, and in response to Decision WHA73(30) which requested updates to the Global Strategic Directions for Nursing and Midwifery, this report presents evidence-based practices and an interrelated set of policy priorities that can help countries ensure that nurses and midwives contribute optimally to achieving population health goals such as universal health coverage.
Christoph Aluttis, Tewabech Bishaw and Martina W. Frank. The Workforce for Health in a Globalized Context – Global Shortages and International Migration (2014). Global Health Action.
This study examines the phenomenon of health worker migration (particularly migration from low to high-income countries) and the internal and external factors that fuel it. With reference to the WHO Global Code of Practice on the International Recruitment of Health Personnel, this resource discusses current practices regarding the migration of health workers and presents best practices in policy and governance to comment on solving this issue.
6: Select Other Resources
6.1 Occupational Hazards
Keep Health Workers Safe to Keep Patients Safe. World Health Organization.
WHO/ILO Publish New Guide on Health and Safety of Health Workers (2022). Communitymedicine4all.
Joint ILO/WHO Guidelines on Health Services and HIV/AIDS (2005). International Labor Organization.
Infection Control Standard Precaution in Health Care (2006). World Health Organization.
COVID-19 and Health Facilities: Checklist of Measures to be Taken in Health Facilities (2020). International Labor Organization.
Rights, Roles and Responsibilities of Health Workers, Including Key Considerations for Occupational Safety and Health. World Health Organization.
The Joint WHO-ILO-UNAIDS Policy Guidelines on Improving Health Workers’ Access to HIV and TB Prevention, Treatment, Care and Support Services: A Guidance Note (2010). International Labor Organization.
Joint WHO/ILO Guidelines on Post-Exposure Prophylaxis (PEP) to Prevent HIV Infection (2007). International Labor Organization.
Guidelines on Occupational Safety and Health Management systems (2001). International Labor Organization.
6.2 Violence/Harassment
Framework Guidelines for Addressing Workplace Violence in the Health Sector: Joint Programme on Workplace Violence in the Health Sector (2002). World Health Organization.
Framework Guidelines for Addressing Workplace Violence in the Health Sector: The Training Manual (2005). International Labor Organization.
Workplace Violence in the Health Sector Country Cases Studies Research Instruments: Survey Questionnaire (English) (2003). World Health Organization (and others).
Management of Workplace Violence Victims (2003). International Labor Organization (and others).
6.2 Attacks on Healthcare in Conflict / Fragility
Guidelines on Investigating Violations of IHL: Law, Policy and Good Practice (2019). International Committee of the Red Cross.
Guidelines on Mental Health and Psychosocial Support (2017). International Committee of the Red Cross.
6.3 Inclusivity
Diversity and Discrimination in Healthcare (2023). Brandon M. Togioka; Derick Duvivier and Emily Young.
6.4 Providing Support
Accreditation Guidelines for Educational Training Institutions and Programmes in Public Health (2002). World Health Organization.
6.5 Country/Regional Specific Tools/Guidelines
Africa
CHW Incentives: Lessons Learned and Best Practices from Madagascar (2016). Community Health Impact Coalition.
Changing Behaviour: Tackling Violence Against Health Care in Niger, the Central African Republic and Nigeria (2018). International Committee of the Red Cross.
Workplace Violence in the Health Sector Country Case Study: South Africa (2003). World Health Organization (and others).
Asia
Second Asia-Pacific Regional Health Care in Danger Meeting Report (2021). International Committee of the Red Cross.
North America
Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers (2016). United States Occupational Safety and Health Administration.
Guidelines for Environmental Infection Control in Healthcare Facilities. United States Centers for Disease Control and Prevention.
Protecting Workers: Guidance on Mitigating and Preventing the Spread of COVID-19 in the Workplace. United States Department of Labor.
Safer Working Conditions for Emergency Department Staff (2021). American College of Emergency Physicians.
Federal Statutory and Regulatory Framework on Forced Labor in Healthcare and Public Health Supply Chains (2022). United States Department of Health and Human Services.
Policy on Pregnancy & Human Rights in the Workplace: What are the Roles and Responsibilities of Employees, Employers, and Unions? Canadian Human Rights Commission.
Multiple Geographic Areas