PHSSR Policy Roadmaps for Acting Early on NCDs Synthesis Report 2025

80 Acting early on NCDs The Partnership for Health System Sustainability and Resilience8 Workforce capacity and development Healthcare workers translate all other health system investments into patient care, making workforce capacity fundamental to NCD prevention and management. Yet NCDs demand different workforce competencies than acute care, emphasising prevention, behaviour change, care coordination, and long-term relationship building. The rising prevalence of patients with MTLCs requires workers comfortable managing complexity and uncertainty rather than following single- disease protocols. This chapter examines healthcare workforce preparedness for NCDs, analysing overall supply and distribution, skill mix and professional roles, education and training, and strategies for addressing shortages. It covers both traditional health professions and emerging roles, the potential for task- shifting, and the critical challenge of making primary care and prevention attractive career choices when health systems systematically undervalue these fields. Workforce supply and distribution No studied country has developed adequate workforce planning that fully addresses future NCD care requirements, creating systematic imbalances that threaten health system sustainability. The absence of comprehensive planning manifests in severe mismatches between workforce composition and population health needs. Quantitative shortages and imbalances Greece exemplifies the workforce imbalance with the EU’s highest physician density at 6.6 per 1,000 population coexisting with the lowest nursing density at 3.9 per 1,000 (OECD, 2019; OECD/European Commission, 2024a; OECD/European Union, 2014). This inverted skill-mix forces physicians to perform tasks that nurses undertake in other countries, reducing system efficiency and increasing costs without improving outcomes. The imbalance reflects historical emphasis on medical education without corresponding investment in nursing programmes, creating structural distortions that persist despite their recognised inefficiency. Japan faces absolute shortages with only 2.6 physicians per 1,000 population, well below OECD averages, when its rapidly ageing population requires intensive chronic disease management (OECD, 2023a). The country’s physician shortage is particularly acute in primary care and geriatrics, specialties essential for managing complex multimorbidity in ageing populations. Since 2008, regional quota medical school admissions and phased increases in admissions have generated approximately 3,500-4,000 new physicians annually (MHLW, 2022c). Despite these efforts to address workforce shortages, regional and specialty disparities will require targeted interventions beyond simply increasing overall supply. Poland confronts some of the EU’s most severe constraints with 3.5 doctors and 5.7 nurses per 1,000 population, levels insufficient to meet current needs let alone rising future demand (OECD, 2023a). The country has responded with dramatic action, increasing medical school admissions by 92.3% and introducing regulatory frameworks for 15 new medical professions including prevention specialists through its Act of 17 August 2023 (Kupis et al., 2024). However, these increases will take years to translate into practicing clinicians, and quality concerns arise from rapid expansion without corresponding investment in educational infrastructure.