Abstract

Abstract Background Healthcare workers face high pressures and new threats during the COVID-19 pandemic, and health systems and governance are key to improve preparedness and protection. This study aims to introduce a tool for rapid assessment based on an integrated multi-level governance approach and to empirically explore preparedness and protection. Methods The study is explorative in nature and applies a comparative approach. The assessment tool comprises four major dimensions of governance: system, sector, occupational and sociocultural issues (focus on gender issues and migrant healthcare workers) of protection and preparedness. Secondary sources and expert information serve the empirical exercise, using material from Denmark, Germany, Portugal and Romania. Results We revealed similar developments across countries: action has been taken to improve physical protection, vaccination of healthcare workers and digitalisation, while social and mental health support programmes were poor or lacking. Developments were more diverse in relation to occupational/ organisational preparedness: some ad-hoc transformations of work routines and tasks were observed in all countries, yet skill-mix innovation and collaboration were strong in Demark and weak in Portugal and Romania. We are able to identify major governance gaps in relation to integration of education and health systems, social and mental health support programmes, gendered issues of health workforce capacity, integration of migrant healthcare workers, and comprehensive surveillance and monitoring. Conclusions There is a need to step up efforts and make health systems more accountable to the needs of healthcare workers during global public health emergencies.

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