According to the World Health Organization, 40 million new health and social care jobs must be created globally by 2030 to meet Sustainable Development Goal 3 of universal health coverage. At the same time, global youth unemployment reached 71 million in 2016, according to International Labour Organization data. Could the two problems be used to solve each other?
Director of the Health Workforce Department at the WHO Jim Campbell believes they could. He says it’s time to “join the dots” between the shortage of health care workers and young unemployed people. Campbell told Devex that development practitioners need to approach the solution in a non-traditional way, and create new training models for the next cohort of skilled health professionals.
It is already happening in some countries, he says. Afghanistan and Ethiopia have both created accelerated training programs to help get more young people into health care. And while there may not be specific pots of money available for health training for youth, he points out that many international funding organizations have marked out job creation or health and education as priorities.
Yet many medical and youth-focused organizations working in developing countries have expressed doubts, and point to a lack of primary education, poor public interest in key geographies and short funding cycles as potential obstacles.
Overcoming the barriers
Many schemes already exist to help train young people for the job market. United Kingdom charity Y Care International delivers enterprise and employability program to unemployed 15 to 30 year olds around the globe, usually in partnership with local organizations and vocational training colleges. The young people YCI supports often go on to train in manual roles, such as plumbing, welding or food production, or are helped to establish their own microbusinesses.
Interim Director of International Programmes Susannah Taylor says the organization would be open to supporting young people into health care work — but it might not be easy.
“Training for medical professionals is a long-term, very sophisticated course that’s going to require funds and a high level of education,” she told Devex. “It would be a beneficial option for young people, and if it was provided by vocational centers then that’s something we would consider. Our aim is to provide young people with safe, decent and sustainable work, so it could be a great option. It just tends to not be something that’s offered through vocational services.”
Other practitioners argue that unemployed youths simply do not have the basic education necessary to start training for a health care role.
“It doesn’t make me feel good that we’re only working with people who are already at the top of the tree, but then it’s doctors or no doctors.”— Marcus Wootton, Project Manager, Global Links
U.K. charity Health Poverty Action’s Programmes Development and Quality Advisor Nicole Tobin says indigenous languages are often a barrier to young people taking up even voluntary roles.
“The language they speak is different from those in the education system,” she says. “As much as there’s interest in youth volunteers, those who tend to be unemployed are often coming from different literacy and language backgrounds that mean it’s very difficult to train them in the eyes of most of the trainers.”
The U.K. Royal College of Paediatrics and Child Health's Global Links program sends trainee and consultant paediatricians to work in resource-poor health settings and provide training and capacity building. But Project Manager Marcus Wootton told Devex the health care workers they support come from the educated working population.
“Training time for a doctor is seven years and you have to be pretty educated before you start,” he says. “If you screw up primary school education, you don’t get a lot of doctors at the end of it.”
He says it’s a “big ask” to try and turn a poorly educated teenager into a health worker. Even in the U.K., he points out, it’s rare that unemployed youths are directed toward medical training. “It doesn’t make me feel good that we’re only working with people who are already at the top of the tree, but then it’s doctors or no doctors,” he says.
Taylor added that getting a young person back into work is not just about education — they also need to learn life-skills. These include basic numeracy and literacy, interpersonal and communication skills.
Breaking traditional training models
“In Afghanistan the government has taken a three-year graduate program for midwives and delivers that same curriculum within 21 months.”— Jim Campbell, director of the health workforce department at the WHO
However, Campbell says development professionals and governments need to look at new models of teaching the next generation of doctors and technical or lower-skilled health workers, such as options offered by digital learning. He wants them to overcome barriers posed by poor basic education and break the “elitism model that only the best of the best get into health care.”
“In Afghanistan the government has taken a three-year graduate program for midwives and delivers that same curriculum within 21 months to the same competency standards,” he says, adding that this is achieved by students studying six days a week, and not having long vacations.
“There’s a public subsidy,” he continues. “Training doesn’t take four years like it might in some countries. Have they got exactly the same competencies? Invariably not the pedagogical training and research exposure. But they’re in a supervised practice and will be able to acquire those skills and competencies through repeat behavior very quickly.”
He says Ethiopia has similarly reduced the time it spends training its physicians. And he points to Ghana, where last year the country’s Youth Employment Agency began a campaign to recruit 20,000 young unemployed people to train as community health workers over two years.
“It’s being done,” he emphasises. “It can’t be done if you approach the solution and the challenge in the traditional way.”
The models Campbell describes all aim to shorten the amount of time it takes to complete health training. Taylor says time is a key element in lifting young people out of unemployment. The training YCI supports can take two to three months, or up to two years, depending on the country. This is in addition to the time it may take to prepare a young person to start training, break down cultural or gender barriers, and get their family on board to support the decision. During that time, young people may have to give up a daily labor job — which might be less sustainable but from which they are nonetheless earning a wage to support them and their family — in order to train.
“It’s something we struggle with in terms of how funding is provided, because it’s time-limited,” says Taylor.
But Campbell says in the era of the SDGs, it is time for development professionals to have a “15-year horizon at minimum.” He says local governments must be involved in delivering health training to young unemployed people, as in many countries health services are public-led.
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“Within the next five years, which is a very short cycle in terms of the global macro-economic perspective, I would hope to see the scale of this with IMF, World Bank, African Development Bank, and Asian Infrastructure Investment Bank coming to fruition,” he says. “The money is there.”
Reaching out to young people
Even with the right training models in place however, youth-focused NGOs say young unemployed people will need to be encouraged to take up health worker roles. People and performance director at U.K. charity Restless Development, Kate Muhwezi, told Devex that in some countries and regions, such as West Africa, young people have a dim opinion of the health sector. For example, in post-Ebola Sierra Leone, trust in health services is at an all-time low.
“While it’s stronger in eastern or southern Africa, what you still have is a government-led sector at the health worker level, and quite often governments pay low salaries,” says Muhwezi. “A lot of young people we see accessing education are striving to go to university to get higher paid jobs.”
Her colleague, Public Relations Senior Coordinator Bobby Dean, says governments and medical organizations looking to recruit young unemployed people into medical training should work alongside youth-based organizations to “build trust and make that sector youth friendly, attractive and accessible.”
“Empowering people to understand and take care of their health at community level is a key part of coping with the global shortage of health workers.”— Clive Ingleby, lead health advisor for Voluntary Service Overseas
U.K. charity Voluntary Services Overseas' lead health advisor, Clive Ingleby, agrees that supporting young people to understand their health rights in developing countries is an important step toward achieving better health services.
“Empowering people to understand and take care of their health at community level is a key part of coping with the global shortage of health workers,” says Ingleby. “There is every chance that young people who have been motivated by their role as a peer educator may eventually seek to become a health care worker, but this requires proper training, support and supervision from qualified health educators.”
Whatever happens, young people must be part of the solution to the health care worker crisis, he added. “The global shortage of health care workers will only be resolved if sufficient numbers of young people are motivated and encouraged to take up a career in health care,” he says.
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