1. Health workers: Ethical aspects and dimensions Health workers’ rights and working conditions Christiane Wiskow Independent Specialist International Public Health Global – Gerecht - Gesund International Conference, Berlin, Germany 17-18 September 2010

2. Why the work environment matters Competitive labour markets Poor work environments compromise HW supply & contribute to early exits Challenge of recruitment and retention Work environments & quality of care Poor work environments compromise quality of care Challenge to support effective performance

3. Health workers’ right to health: Occupational health protection The issues High level of exposure to occupational risks May lead to premature exits or reduced work ability Many occupational diseases/accidents are preventable

4. Example: Infection through sharp injuries Developed regions Developing regions 40-65% HBV & HCV More burden of occupational infections HBV: 10% HCV: 8-27% Estimated occupational infection rates annually: HBV 66’000 HW HCV 16’000 HW HIV 200-5000 HW Source: Prüss-Üstün et al, 2005

5. Example workplace violence: health workers most at risk % of surveyed health workers experienced workplace violence in the past 12 months (%) Case studies ( 2001) Verbal abuseBullying/mobbi ng Physical violence Bulgaria survey32 %31 %7% Portugal (health centre) 51%23 %3% South Africa (public sector) 60%21%17% Thailand47%11%10 % Brazil39%15 %6% Source: Di Martino, 2002 (Country case studies of ILO/ICN/WHO/PSI Joint Programme on Workplace Violence in the Health sector

6. Health workers’ right to fair working conditions Adequate education & training Ethical recruitment Adequate remuneration Manageable workloads Reasonable hours of work CPD & Career prospects Social protection

7. Example remuneration CountryPercentage of workforce paid at or below the minimum wage Armenia30% Bulgaria25% (20% in 1996) Georgia90% (public sector) 50% (private sector) Latvia2.3% (public sector) 13.9% (private sector) Poland70% Russian Federation 0% Source: adapted from Afford, 2002 Percentage of workforce paid at or below the minimum wage, selected CEE/CIS countries ( 2001)

8. Health Workers’ right to participate and have a voice Consultation regarding their employment and working conditions Participation in the planning of health services Professional autonomy Social dialogue Positive association with improvement of work environment Capacity building to strengthen social dialogue

9. Creating attractive, supportive work environment Incentive to enter health professions - and to stay Enabling health workers to perform effectively Goal: Quality health care services

10. What is an attractive & supportive work environment? Quality of work environment: dimensions and elements Work environment quality Employment quality Wages Type of contract Working hours (incl. work schedules & family-work balance) Social benefits Participation Professional development (training & skill development ) Work quality Work autonomy Work organization (incl. division of work and staffing) Organizational culture and trust Safety and health Pace of work Social work environment Source: adapted from the job quality model of Munoz de Bustillo et al, 2009

11. Vision: Universal Declaration of Human Rights (1948) Everyone has the right to …. Article 23. (1) work, to free choice of employment, to just and favourable conditions of work(…). (2) equal pay for equal work. (3) just and favourable remuneration ensuring for himself and his family an existence worthy of human dignity, (…) (4) form and to join trade unions for the protection of his interests. Article 24. … rest and leisure, including reasonable limitation of working hours and periodic holidays with pay.