Spotlight Interview
With Juan Somavia Conducted March 2008
Juan Somavia is the Director-General of the International Labour Organization (ILO). He is an advocate of social justice and decent work for people around the world. ICHRN spoke to Mr Somavia about the need for decent work for the global health workforce, and the ILO's view of the Positive Practice Environments Campaign.
	ICHRN: What is the ILO's latest information on the state of the global health workforce?
Juan Somavia: From an ILO perspective the health workforce has to be viewed from two angles: health care workers play a key role in maintaining the health of people in the world of work, as well as their families, thereby contributing to workplace productivity and social and economic development. This is why it is very important that health care work be decent work. The people who care for others require care for themselves, in the form of adequate working conditions and income, safety and health in the workplace and a social safety net. We must recognise that providing decent work for the health care workforce is increasingly important as demographic changes and advances in health care over the past three decades have spurred huge growth in the number of persons working in the health professions. Yet just as employment growth worldwide has lagged behind economic growth, the health care work force hasn't been expanding fast enough to meet the ever-growing demand for health services. Four million more health workers are required globally to meet people's essential health care needs. Addressing this issue will be challenging, not in the least because the majority of the health care workforce is female and requires special attention in employment.
	ICHRN: You are a strong advocate of “decent work”. What, in fact, is decent work?
Juan Somavia: Decent work sums up the aspirations of people in their working lives. It involves a fair opportunity at a decent and productive job, security in the workplace, social protection for families and freedom for people to express their concerns, organise and participate in the decisions that affect their lives. Very significantly for the global health care workforce, it also involves equality of opportunity and treatment for women and men. The idea that we needed to provide a brief summing up of what the ILO and its constituents stand for first emerged when I became Director-General of the ILO. Decent Work captures the essence of our mandate and our hopes in two short words. Though it started as an expression of our own goal, it has now become a global one. Decent work has received wide support from governments, employers, trade unions, civil society, parliamentarians and leaders from the United Nations, the G8, the European Union, and the African Union as well as in Asia and the Pacific, the Middle East, Latin America and the Caribbean.
	ICHRN: ICN and its core partners are launching a Positive Practice Environments Campaign to improve the health workplace and organisational climate in order to improve patient outcomes and workers' well-being. How do you see ILO supporting this initiative?
Juan Somavia: The ILO recognises the important role of decent working conditions in quality health care. The performance of health workers depends on the work environment, properly equipped and well organised facilities, training and education and adequate support from management and policy makers. The ILO can support this initiative in many ways. First, it fosters a meaningful social dialogue between governments, employers' and workers' organisations to address issues of concern to health workers. The ILO contributes to decent work in the health sector through its technical advice and ILO labour standards, recommendations and guidance materials. The best example is the Nursing Personnel Convention, 1977 (No. 149) and its accompanying Recommendation (No. 157). These standards establish basic policy principles for this sector including the participation of nursing personnel, education and training, practice of the nursing profession, career development, remuneration, working time and rest periods, occupational health protection and social security. 1
	ICHRN: What are some of the priority labour issues for the health workforce? Can you provide some examples of how these priorities are being addressed by ILO?
Juan Somavia: As a tripartite organisation, we hold continuous social dialogue. Labour issues in the health sector are regularly reviewed by ILO constituents, including governments, employers and workers. In the last few years, a major concern in the health sector has been working conditions and terms of employment in the context of public service reforms. These reforms are important and necessary as a means of adapting to changing needs in the health care sector, as well as improving performance, responsiveness and the quality of health services. But in many countries, the deterioration of working conditions in the health sector has been observed as an unintended consequence of public sector reforms. Concerns include low wages in many developing and transition countries where health workers are paid at or below minimum wages. Long hours due to overtime, shift-work and unsocial working time make it difficult to combine work and family life. And the lack of professional development opportunities combines with these concerns to reduce the perception that the health profession is an attractive career choice. Altogether, poor working conditions contribute significantly to the critical health workforce shortages worldwide. This has serious consequences on the quality of services and can entail negative social consequences, such as unequal access to health care. The ILO addresses these issues in various ways. We conducted a joint research project together with WHO, ICN, PSI and DSE 2 resulting in a practical tool to assist policy makers in designing and implementing public service and health sector reforms in the most effective and sustainable way, taking into account human resource policies. 3
	ICHRN: In your view, how does the ILO Nursing Personnel Convention No.149 contribute to the health, safety and personal well-being of nurses?
Juan Somavia: The Convention and the accompanying Nursing Personnel Recommendation, 1977 (No. 157) are intended to strengthen the rights of nursing personnel and guide governments, workers and employers representatives in planning and implementing policies within the framework of a country's overall health policy. An essential element of the Convention is giving nursing personnel a voice. For example, the Convention establishes the principle of the participation of nursing personnel in developing nursing policies and services. The Convention calls on ILO Member States to adapt laws and regulations on occupational safety and health to the special nature of nursing work and environment. It also stipulates that nursing personnel should enjoy conditions at least equivalent to those of other workers regarding decent working conditions, including hours of work, weekly rest and annual leave, maternity protection, sick leave and social security.
	ICHRN: Can you briefly describe the types of activities ILO is undertaking to address workplace violence in the health sector and the prevention of HIV in the workforce?
Juan Somavia: Research has produced strong evidence that cases of violence directed against health care workers are alarmingly high – around one quarter of all violence in the world of work. Joint Programme partners developed two practical tools to address this: (1) framework guidelines on the development, implementation and evaluation of workplace policies aimed at preventing violent incidences at work, protecting health workers and caring for victims of violence; and (2) an accompanying training manual, which is a tool for management and health workers to address aggressive behaviour and violence in their workplaces. With regard to HIV/AIDS, the health services sector has the unique feature of having a population of workers who, in addition to providing care to patients suffering from HIV/AIDS, are at risk of contracting HIV/AIDS because of their professional responsibilities. We also developed and adopted the Joint ILO/WHO guidelines on health services and HIV/AIDS. They provide wide-ranging and practical approaches to protection, training, screening, treatment, confidentiality, prevention, the minimizing of occupational risk and the care and support of health care workers. The guidelines also address the essential role of social dialogue among governments, employers and workers in meeting the challenges posed by the HIV/AIDS epidemic in the sector.
The International Labour Organization is the tripartite United Nations agency that brings together governments, employers and workers of its member states in common action to promote decent work throughout the world. ILO is devoted to advancing opportunities for women and men to obtain decent and productive work in conditions of freedom, equity, security and human dignity. Its main aims are to promote rights at work, encourage decent employment opportunities, enhance social protection and strengthen dialogue in handling work-related issues. www.ilo.org
1 Other relevant ILO instruments include for example the Labour Relations (Public Service) Convention (No. 151) and Recommendation (No. 159), 1978; the Medical Care Recommendation (No. 69), 1944; the Night Work Recommendation, 1990 (No. 178). The relevant ILO codes of practice and guidelines (for example on workers' health surveillance, HIV/AIDS, and occupational safety and health OSH management systems) provide not only models for regulations but also concrete examples of good practice in building healthy and safe working environments. 2 World Health Organization (WHO); International Council of Nurses (ICN); Public Services International (PSI); German Foundation for International Development (DSE) 3 WHO, ILO, ICN, PSI (2001). Public service reforms and their impact on health sector personnel – Critical questions: A tool for Action; available from http://www.ilo.org/public/english/dialogue/sector/papers/health/pserv-ref.pdf