The health workforce crisis in Europe is no longer a looming threat – it is here and now. The Bucharest Declaration charts a way forward.

Newly adopted Declaration spells out how political action can protect, support and invest in health workers across Europe and Central Asia

BUCHAREST, 22 March 2023

Representatives from 49 out of 53 Member States in WHO’s European Region have joined health workers, their unions and associations, along with academics and experts in adopting a bold declaration urging political action and commitment to protect, support, and invest in health and care workers across Europe and Central Asia.

Adopted at a landmark regional meeting in Bucharest co-organized by WHO/Europe and the Romanian Ministry of Health, the Bucharest Declaration comes against the backdrop of a serious crisis affecting health workers across the Region, including through strikes and industrial action.

“The health workforce crisis in Europe is no longer a looming threat – it is here and now. Health providers and workers across our Region are clamouring for help and support,” said Dr. Hans Kluge, WHO Regional Director for Europe. “The COVID-19 pandemic has revealed the fragility of health systems and the importance of a robust and resilient health workforce. We cannot wait any longer to address the pressing challenges facing our health workforce. The health and wellbeing of our societies are at stake – there is simply no time to lose.”

During the past year, Europe has seen a mounting number of strikes among healthcare workers citing challenging working conditions and insufficient resources. In France, for example, doctors and nurses held a nationwide strike in November 2022, with over 100,000 healthcare workers participating. In September 2022, more than 6,000 nurses in Ireland went on strike over concerns about low pay and poor working conditions. Similarly, in Germany, thousands of healthcare workers participated in a nationwide strike in August 2022, for similar reasons. And in the UK, strikes and walkouts by doctors, nurses and ambulance staff have severely impacted the health system for months. 

“This industrial action clearly reflects the growing frustration and concern among healthcare workers across our Region, further highlighting the urgent need for multi-pronged action to support and invest in the health and care workforce,” Dr Kluge explained.

A regional report published by WHO/Europe in September last year warned of a “ticking timebomb” threatening health systems in Europe and Central Asia. With the Region witnessing a fast-ageing population and ageing health workforce, a surge in chronic illnesses, and the effects of the COVID-19 pandemic, the report warned of imminent collapse in key areas of countries’ health systems unless quick, concrete political actions tackled these issues—starting with the health workforce.

The report highlighted that in 13 out of the 44 countries providing data, 40% of medical doctors are already aged 55 years or older, which poses a significant challenge to the sustainability of the workforce. At the same time, labour markets are changing with increasingly complex worker mobility and migration. As a result, some countries are finding it increasingly difficult to attract and retain young people in the health and care professions.

Despite historically high numbers of health and care workers across the European Region, national health systems are struggling to keep up with the rising demand for healthcare, exacerbated by service backlogs caused by the COVID-19 pandemic, rising expectations from patients, and the health risks posed by climate change and emergencies. 

The COVID-19 pandemic has only heightened these issues, leading to stress, burnout, and violence among workers, many of whom have left their jobs. During the first wave of the pandemic in March 2020, the Region saw a staggering 62% increase in health worker absences. Mental health issues have been reported in almost all countries in the Region, and in some countries, over 80% of nurses have reported some form of pandemic-related psychological distress. In addition, WHO/Europe received reports that 9 out of 10 nurses had declared their intention to quit their jobs.

In response to these challenges, the Bucharest Declaration calls for political action to

1) improve the recruitment and retention of health and care workers

2) improve health workforce supply mechanisms,

3) optimize the performance of the health and care workforce,

4) better plan the health and care workforce, and

5) increase public investment in workforce education, development, and protection.

The Declaration recognizes the links between these priorities and the need for collaboration with all stakeholders, including health and care workforce representatives, their employers, national ministries of finance and education, and international non-profit organizations, trusts, and foundations.

“Ignoring the challenges facing the health and care workforce is no longer possible,” said Dr Natasha Azzopardi Muscat, WHO/Europe’s Director for Country Health Systems and Policies. “Healthcare workers are the backbone of healthcare systems, and their dedication and hard work must be recognized and supported now. This will pay rich dividends in individual and collective health and wellbeing, both for healthcare workers and those they serve, and better prepare countries and our Region as a whole to handle the health emergencies we know lie ahead, as well as strengthen health systems to provide essential, everyday services.”

NOTE TO EDITORS

• The Bucharest Declaration is the main outcome of the meeting, co-organized with the Romanian Ministry of Health on 22-23 March 2023, which brought together nearly 300 participants from health ministries, government agencies, academia, along with policy experts, health workers and their unions and associations to discuss health workforce challenges and agree on concrete actions to tackle them.
• Please email Ramy Srour (srourr@who.int) to receive the full text of the Bucharest Declaration.

Additional resources:

• WHO/Europe Regional meeting on the health and care workforce: Time to act: https://www.who.int/europe/news-room/events/item/2023/03/22/default-calendar/who-europe-regional-meeting-on-health-and-care-workforce–time-to-act
• Health and care workforce in Europe: Time to act https://apps.who.int/iris/handle/10665/362379
• The health workforce crisis in Europe is also a gender equality crisis https://www.bmj.com/content/380/bmj.p554

MEDIA CONTACTS

Bhanu Bhatnagar: bbhatnagar@who.int 
Ramy Srour: srourr@who.int 
WHO/Europe press: eupress@who.int