Spain has a problem with the precariousness of its toilets


Lourdes Velasco |

Madrid (EFE).- Spain, like most neighboring countries, has a problem with its health system that is of great concern to the World Health Organization (WHO): the big task is to plan human resources and improve the conditions of health workers, as assured in an interview with EFE the regional adviser for human resources in health of the WHO in Europe, Tomás Zapata.

Zapata, who took part this week in Madrid in a conference on primary care organized by the Ministry of Health, told EFE of his concern about the consequences of the precarious working conditions of Spanish professionals.

“During the pandemic, workers have been exposed to high workload levels, high stress, anxiety (…) Now there is a feeling of fatigue, exhaustion and at the same time to see that the working conditions in many countries in Europe are not as they should be in terms of workload, work flexibility and reconciliation”, he explains.

A worker attends to a patient at a health center in Madrid. EFE / Marshal

This adviser to the body that oversees global health recalls that a 2019 collegial survey revealed that up to 40% of doctors in Spain had a fixed-term contract.

The organization will conduct a comparative study with the salaries of doctors and nurses in different countries. For the moment, Zapata is only arguing that in Spain health expenditure – in relation to gross domestic product (GDP) – is relatively “cheap or efficient compared to other systems”, and one of the causes is wages.

Zapata, who precisely trained as a family doctor in Madrid, believes that the main problem lies in primary care, where family doctors, pediatricians and nurses are overworked.

“If we have health workers who are on leave due to depression, exhaustion or burnout, we ultimately cannot provide the services that are needed,” explains this WHO adviser.

Toilets rested in front of Hospital de Igualada, Barcelona, ​​in the early months of the pandemic
A toilet rested in front of the Hospital de Igualada, in Barcelona, ​​in the first months of the pandemic. EFE/Susanna Saez

The challenge of attracting young people, especially for nursing

Zapata assures us that we are at a “critical moment” in general in Europe, but believes that there are countries which are “doing better”, which means that they have very good long-term planning which allows them to project what the need for toilets will be in the next 10 or 15 years.

Spain, he said, is also making progress. He cites a report from the Ministry of Health in which a projection is made for the years 2028 and 2035 of the different medical specialties and the needs that there will be.

This planning is important, he says, so as not to produce an “excess” of toilets as happened 30 years ago in Spain, nor to run out of them. A first short-term measure, according to Zapata, is to “hold back those we have”.

And the second is to attract new people, especially young people, to specialties such as nursing, because Spain is below the European average not only in the number of active professionals but also in training.

Demonstration of nurses and nurses in Madrid last April
Demonstration of nurses in Madrid last April. EFE/ JJ Guillen

“There also needs to be a consideration regarding the role and role that nurses play in service delivery,” Zapata asks.

The WHO adviser is the author of a report on the situation of human resources in 53 countries of the European region which offers devastating data: in one in three countries, at least 40% of doctors are over 55 , that is, he retires in ten years.

However, the data manipulated by the WHO does not corroborate the exodus of professionals that certain headlines are alerting. “What we are seeing is that around 300 or so doctors have emigrated in 2020”, explains Zapata, who recalls that our country is a “net receiver of doctors”.

“That doesn’t mean that (the exodus) can’t increase in the future, especially with younger generations arriving prepared to speak different languages,” he said.

The greatest staff shortage is in the primary

In Spain, the greatest staff shortage occurs in primary care. “We have to start taking measures now (…) if we want to replace all the family doctors who are going to retire in the next 15 or 20 years.”

It’s a core specialty for the World Health Organization because, he says, health systems that invest in primary care “achieve good health outcomes and very efficiently”.

Spain invests 14% of its total health expenditure in primary education, one point above the 53 countries of the European region, but the data – he points out – is “very bad”, below what would be desirable.

In our country, says Zapata, funding for hospital care has continued to increase while primary care has grown much less, that is, the gap is widening.

The consequences of not investing in primary care, warns the WHO expert, are already being felt: emergencies are saturated, and it is not an “effective” way to treat patients. Additionally, Zapata predicts that in a few years it will also impact hospital care.

Incentives to bring doctors to unpopulated areas

Another of the difficulties that Spain faces, according to the WHO, is attracting health professionals to work in rural areas.

Several people are waiting their turn to enter the primary care center in the town of Allariz (Ourense).EFE/Brais Lorenzo

Economic incentives, improving working conditions, equipping homes with good facilities and fast internet connections are some of the measures the organization recommends so that rural areas are not deprived of doctors.


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