Positive Practice Environment Campaign: a retention initiative from health professionals


The severe shortage of physicians in many countries is not always caused strictly by a low number of physicians being educated, but often to high attrition rates as well.  People in the developing world may acquire a medical education and then choose to leave their country to practice in safer and more stable communities with better working conditions. Similar problems exist in developed countries where staff shortages in rural and urban communities compromise the availability of healthcare. 

WHO's alarming estimates (2006):

  • The gap between the supply of health care professionals and the demand for their services is growing;

  • The global shortage of 4.3 million health professionals includes 2.4 million physicians, nurses & midwives. In other words, over a billion people have no access to healthcare;

  • Sub-Saharan Africa faces the greatest challenges: 11% of the world population, 24% of the global burden of disease, 3% of the world’s health professionals.

Read more on the global shortage of health workers and its impact (WHO)

The impact of shortages in the health workforce

  • Shortages of physicians and other healthcare professionals results in unsafe, inadequate and unattractive working conditions, in particular:

  • Exposure to occupational hazards;

  • Physical / psychological violence;

  • Unreasonable workloads;

  • Insufficient remuneration and discrimination;

  • Limited career development opportunities.

One way forward: the Positive Practice Environment Campaign

Decision-makers have increasingly turned their attention to incentives (financial and non-financial) to attract, retain, motivate and improve performance of health care professionals.

The World Health Professional Alliance, including the WMA, together with the World Federation for Physical Therapy, the International Hospital Federation and the International Confederation of Midwifes developed the Positive Practice Environments Campaign (PPE).

The PPE campaign partners recognize poor working conditions as a major contributing factor to poor recruitment and retention of healthcare professionals. The PPE promotes the development of safe and healthy workplace environments with the aim of improving recruitment and retention of healthcare professionals, and ultimately improving productivity and quality of healthcare systems. The PPE activities include a variety of efforts:

  • Raising the awareness, understanding and support of all relevant stakeholders about the positive impact healthy and supportive work environments have on the recruitment and retention of staff, patient outcomes and the health sector as a whole.
  • Offering a global platform to share information, good practices and lessons learned in relation to healthy and supportive workplaces.
  • Stimulating a sustained trend toward the establishment of positive practice environments across the health sector.
  • Highlighting good practice in order to support the introduction of effective strategies that promote sustainable health systems.
  • Applying the principles of positive practice environments and facilitate their establishment in the health sector.
  • Recognising those who meet the criteria of PPE

The campaign also seeks to educate governments and decisions makers of the potential benefits of positive practice environments to long-term performance of healthcare systems. In order to cultivate this work environment, the PPE campaign seeks the involvement of all stakeholders, at the international, national and local levels, who influence the workplace environment of healthcare professionals.

Get involved in the Campaign: (website not yet online)

The PPE Campaign of the health professions is supported by a grant of the Global Health Workforce Alliance

WMA Current Policy & Action in the field of retention:

Comments from the World Medical Association on WHO Code of Practice on the International Recruitment of Health Personnel, September 2009

The World Medical Association Statement on Ethical Guidelines for the International Recruitment of Physicians, May 2003

See also the WMA pages on migration and scope of practice

Useful links

The World Health Report - Working together for health. Geneva, World Health Organization, 2006

PPE Website

World Health Professions Alliance

The Global Health Workforce Alliance

PPE Banner