Flexible Learning Pathways into Healthcare Occupations

Previous work on anticipating skill needs by the OECD and the ILO, with the contribution of the WHO and with the support from the ILO-OECD-WHO Working for Health (W4H) Programme and Multi-Partner Trust Fund, has shown that labour and skill shortages, as well as mismatches, in the health and care workforce are pervasive, as discussed in Equipping Health Workers with the Right Skills: Skills Anticipation in the Health Workforce. Additionally, evidence from the Survey of Adult Skills (The Programme for the International Assessment of Adult Competencies, PIAAC) and from online job vacancies in several countries (e.g. Canada, the United States and the United Kingdom) shows shifts in the responsibilities and tasks that are required by professionals working in the healthcare sector, driven by the adoption of new technologies or the move towards integrated healthcare, which are further exacerbating skills gaps.

This report reviews policy initiatives in a select group of countries that are increasing flexible entry points into the health and care workforce. It covers policies in 19 OECD and low-and medium-income countries: Australia, Austria, Brazil, Canada, Denmark, Germany, Iceland, India, Japan, New Zealand, Norway, Philippines, Spain, South Africa, Tanzania, Thailand, the United Kingdom, the United States and Zimbabwe. The aim of the report is to identify innovative uses of flexibility in adult learning in the healthcare sector and highlight policy tools that are available to policymakers who wish to facilitate transitions to entry-level health and care occupations.

Skill gaps and shortages in the healthcare sector are costly, contributing significantly to unmet medical care needs. While increasing enrolment in comprehensive higher education programmes for doctors and nurses and introducing new technologies can help, they cannot fully close these gaps. This report explores pathways into entry-level health and care positions (which are defined as positions in the healthcare sector that require less than a bachelor’s degree, as healthcare assistant, therapy support worker and associate ambulance practitioner) and examines policies that help both adults without healthcare experience and those with some healthcare experience (such as long-term care workers often employed informally, or community health workers without formal health training) transition into the healthcare sector. Flexible career and training pathways into entry-level health and care professions offer an effective solution to help address these challenges and create opportunities for workers, particularly those with lower skill levels, while potentially alleviating some of the shortages faced in entry-level jobs as well as in higher-skilled health and care workers through task reallocation.

The limited offer of flexible training programmes is preventing many adults from participating in healthcare training. This is particularly true for entry-level occupations (such as for long-term care workers, nurse assistants and community health workers) where there are fewer flexible training programmes for adults wishing to take up these jobs, while there are more training options for workers already in the healthcare sector. This poses a challenge for entering the healthcare sector, as lack of time, financial reasons, and inconvenient training time and place are the main barriers to participation in training for adults. Comprehensive, full-length, full-time, formal education programmes take a long time to complete and might not attract enough adults to address the skill shortages and skill gaps observed in the healthcare sector. In this context, making adult learning provision more flexible is crucial, and needs to be paired with infrastructural investment and expansion of licenced positions, particularly at the community level. Flexible training can be provided in several ways:

• Modular learning and micro-credentials for entry-level health and care occupations are rare, but some countries have started implementing modularisation. Denmark’s Adult Vocational Training Programme (Arbejdsmarkedsuddannelser) in health and social work and the Philippines Ladderized Education Program in Health is now modularised, and participants can obtain certificates for smaller units of training that are recognised by the labour market and the education system at wide.

• A strong connection between adult education programmes and healthcare providers equips learners with enhanced career prospects and better prepares them for the real demands of the health labour market. These partnerships include elements such as job-related curricula, workplace learning, apprenticeships, and mentoring programmes to highlight the career pathway from training to employment. The examples of the Eixample Clinic Vocational Training Institute in Spain – where students are placed in public and private healthcare institutions under the supervision of an internship tutor – and the United Kingdom’s NHS apprenticeship programme – which offers adults the opportunity to gain qualifications through a blend of workplace learning and classroom training – demonstrate the benefits of a strong and flexible connection between education and healthcare sectors.

• Distance and online learning allow adults to participate from anywhere, reducing barriers related to physical attendance. Asynchronous learning, like pre‑recorded video lectures, reduces time barriers by allowing learners to study from home at their convenience. For example, the Health Education England’s eLearning for Healthcare platform delivers more than 400 eLearning programmes and is available for adults enrolled in the NHS Apprenticeship training programme (entry-level training), NHS employees (upskilling), and for learners enrolled in partnership programmes with the NHS. In India, the Project Extension for Community Healthcare Outcomes (ECHO) initiative leverages telemedicine and digital platforms to connect healthcare providers in remote regions with specialists in urban centres, facilitating real-time knowledge sharing and capacity building.

The recognition of prior learning including outside the healthcare sector is a key factor in making the skills and competences of workers visible, enabling formalisation, and boosting work mobility. By focussing on the individual’s prior experience, recognition of prior learning programmes can speed up the pace of an education programme through the certification of learning outcomes. Although recognition of prior learning can be used to validate candidates’ practical skills and theoretical knowledge, in the specific case of healthcare programmes, validation of practical skills tends to be more common. In relation to long-term care, where many often already experienced carers, particularly those working informally, have not gone through formal training, the recognition of prior learning can constitute an important incentive for workers to take‑up training to improve their skills. It also improves their working conditions and opens up new employment opportunities. In order to enable the use of recognition of prior learning, the skills and knowledge used in these jobs need to be mapped in occupational standards, for which candidates can be evaluated against. In South Africa, the RPL system is anchored in the National Qualification Framework as well as integrated into the South African Nursing Council’s policy. The Caregiving (Elderly) and Barangay NC II programmes in the Philippines offers Recognition of Prior Learning (RPL), enabling candidates with informal work experience in the care sector to have their skills assessed through practical demonstrations and interviews. New Zealand’s Careerforce is a multi-dimensional programme that utilises recognition of prior learning to shorten training pathways for adults working in the healthcare sector without qualifications. Finally, the recognition of prior learning and experience can be used as a more structural tool to strengthen training programmes and formalise career transition pathways between certain complementary but distinct occupational groups. Programmes to facilitate and encourage the transition of army personnel into the healthcare sector in the United Kingdom and the United States are examples of this type.

Successful implementation of flexible pathways that incorporate RPL and modular learning must rely on standardised taxonomies for health occupations, skills and competencies and referencing to well accepted qualifications, to ensure consistency in workforce planning, access to decent work and support worker mobility. The development of new qualifications in emerging areas, such as digital health, geriatric care and community-based services, is equally critical to meeting the evolving health needs of diverse populations and fostering innovation within the workforce. Reference frameworks, such as The ILO Core Skills Framework and the WHO Global competency and outcomes framework for the essential public health function provide valuable guidelines to align training content with international benchmarks, ensuring that health and care workers acquire the essential skills and competencies needed for high-quality care.

Healthcare involves many different specialities and professions working together, with (very) different training requirements, and few opportunities to move across specialties. Career guidance assists adults to make educational, training and occupational choices. Canada’s Health Career Access Program is a notable example of career guidance specifically designed for adults wanting to transition into the healthcare sector for the first time. Career guidance can also be instrumental in attracting applicants from non-traditional groups to the healthcare sector, helping to address critical labour shortages that cannot be filled by (only) recruiting traditional candidates. Norway’s “Men in Health” programme is an interesting example of this approach, as it supports unemployed men in gaining qualifications and employment for health and care roles where they are underrepresented. For workers already in the health sector, career guidance could be used to encourage them to move to new emerging health and care jobs where there are shortages.

Although the use of flexible pathways for entry-level health and care professions is somewhat limited, training requirements for personal care workers in the long-term care sector, including those who work in institutions, remain low, despite the growing complexity of care of older people. LTC workers are often low paid and face poor working conditions and limited career prospect. Expanding training opportunities for LTC workers could facilitate transitions into formal employment, help achieve the right balance of skills, improve the quality of care, and enhance working conditions. Countries such as Australia, Austria, Germany and Iceland have increased training specifically focussed on long-term care needs.

Impact assessment is a key component of policy implementation. Beyond evaluating benefits for individuals, it is important to assess how training and educational pathways to access entry-level health and care occupations affect the overall healthcare system, including having an impact on the quality of care or by alleviating shortages among doctors and nurses through task reallocation. Furthermore, it is important to understand whether the implementation of flexible pathways leads to employment that provides an entitlement to social protection and basic rights at work, as happens with the Barangay Health Workers (BHWs) in the Philippines. However, such evaluations are rare, as the effects of broadening the talent pool in entry-level occupations take time to materialise, are difficult to disentangle from other influencing factors, and available data on the long-term outcomes of these policies are often scarce and incomplete.