Health sector has a key role in rebuilding from the COVID-19

Ms. Dagmar Walter, Director ILO DWT/CO-New Delhi, spoke at the inaugural session of Virtual Conference: Healthcare During and Beyond Covid organized by CII

Statement | New Delhi, India | 28 October 2020
Thank you Dr Kapur;

Distinguished members on this virtual dias, all protocols observed;

Members of CII;

Esteemed participants;

Namaskar and Good Morning to you all!

It is indeed a great pleasure and privilege for me to speak at this CII event on a topic that is most pertinent in the current times. Let me upfront salute the efforts made by the Indian health sector, in particular health workers who have not spared their efforts to stand up to and tackle the COVID-19 challenge posed to the world.

In my presentation, you will see that several points resonate with what speakers before me have mentioned.

The International Labour Organization was among the first to identify that the COVID-19 pandemic is not just a health crisis, but a social and economic one too. It has disturbed the economy and labour market situation globally. In a way, the ancient saying ‘health is wealth’ has been yet again proven right.

The ILO was quick to build on its 100 years of experience, which includes dealing with previous emergencies and economic depressions, to respond to the fallout caused by this pandemic.
The ILO regular Monitors on COVID-19 and the World of Work, periodically estimate the impact on income and employment. Besides, it also provides policy recommendations to deal with the situation under four pillars, which are to:
  1. Protect workers at the workplace;
  2. Stimulate economic and labour demand;
  3. Support employment and incomes; and
  4. Use social dialogue between government, workers and employers to find solutions.
All these pillars equally apply to the health sector. The sector is a critical enabler for accelerating economic growth of the country. It is also one of the fundamental sectors for the society ensuring sustainable and inclusive development. It is now playing a key role in recovery and rebuilding from the COVID-19 pandemic.

The 2030 Agenda for Sustainable Development acknowledges the pivotal role of Universal Health Care Coverage and ensuring its access and quality. It promotes physical and mental health and well-being, as well as the extension of life expectancy for all. The ILO endorses the fundamental principles of the human right to health and social protection. It is a necessary means to achieve full and productive employment, and Decent Work for All as enshrined in SDG 8 on Decent work and Economic Growth.

In the rapidly changing world of work, complex drivers and trends have been creating both challenges and opportunities globally for health service delivery. Globally healthcare investment is increasing, populations and the health workforce are ageing in many countries; but also technology promises to radically reshape the health sector in ways yet to be imagined. Despite many achievements however, persistent health inequities remain a major concern.

Unfortunately, the global shortages and unequal distribution of qualified health personnel are another major constraint in providing universal access to health care. Many emerging economies, including India, are facing similar challenges at national level. While wide-spread reforms of health systems are continuously changing the employment environment for health care workers, more is called for.

We all are aware that skilled employees are at the core of competitive economies. It infuses the agility and resilience into enterprises and enables them to effectively respond to market changes. The health sector needs a skilled and trained workforce more than any other sector as it has direct bearing on the well-being of people.

The world definitely didn’t need COVID-19 to underpin the importance of this sector. COVID-19 has however amplified the need to invest in this sector, necessitating technology based service models for delivery of healthcare services in non-contact mode.

While India’s efforts in up hauling its health care delivery system through National Rural Health Mission and Ayushman Bharat Yojana is laudable, more is desirable to plug the quantity and the quality gaps.

A stark reality is that though an estimated 70% of the Indian population lives in villages and towns, only 40% of India’s total health care workers work in rural India. Increasing workforce may take more time, however developing the skills to address the quality gaps can be done immediately. This calls for innovative models on skilling, upskilling, and re-skilling, including introduction of concepts such as Barefoot doctors similar to Barefoot engineers introduced in rural programmes such as MGNREGA, in addition to telemedicine.

I would also like to emphasize on a few more solutions. Firstly, employers should review various possibilities, such as improving the occupancy of hospital beds, capital equipment and other resources; improving staffing patterns in relation to day-to- day fluctuations in workload and patient dependency; and adjust the distribution of resources, for example between tertiary, secondary and primary care.

Secondly, ensuring decent work for health workers. Health services are unique and complex work environments with inherent challenges that do not only need skilled workers but good working conditions as well. The ILO supports improvement of working conditions and labour relations in the health sector through sectoral labour standards and by promoting social dialogue. We collaborate with the World Health Organization (WHO) to promote supportive, enabling and healthy work environments for the health workforce.

A disturbing trend observed in the sector is increased reliance on non-standard forms of employment such as contractual staff. Further, the cadre of ASHA workers who are doing an essential job on the ground face challenges of limited opportunities for career progression and get low wages.

Thirdly, the ILO argues that a cheaper skill mix, such as by substituting more expensive nurses in favour of less paid care assistants, may not be necessarily cost-effective because of the various hidden costs associated with skill dilution. Various studies provide evidence of higher levels of unproductive time, less autonomy and possible risk to patients through such practices.
This pandemic points at the importance of having social partnerships between employers and workers organizations. ILO is working closely with Governments, workers and employers in combating the outbreak, ensuring the safety of individuals and the sustainability of businesses and jobs.

Among other we are supporting the employers’ organization in South Asia to design a health service model programme with focus on building a cadre of occupational health and hygiene trainers. They can provide professional support on operating safely while the COVID-19 risk is around.

Another important aspect the pandemic has underlined is the need for investing in the development of OSH professionals and services due to the nature of the health risk. ILO has developed several practical policy briefs and guidelines to help enterprises towards safe and peaceful return to work through its dedicated COVID-19 web-portal: The ILO is also working extensively with ESIC to improve its institutional capacity and coverage, especially to the informal sector.

In conclusion, while the pandemic has probably prompted us to revisit the skilling needs in the healthcare sector, it is important to realise for optimal results, the human software needs to be matched with investment in working conditions and infrastructure as well; coupled with the expansion and consolidation of social security. This will go miles ahead in reducing the high health care cost burden on many who are reeling under it in the country, a major cause of indebtedness, alongside curtailing loss of work-days and reducing the care burden on women, in a country which has among the lowest female labour force participation rates.

I wish all of you very fruitful deliberations during this event.

Thank you for your kind attention!