The International Labour Organization, with support of the UN Multi-Partner Trust Fund, leads the programme implementation, provides technical assistance, funds activities and coordinates with relevant national stakeholders under the overall umbrella of Pakistan Decent Work Country Programme.
I-7 Is there collaboration with other agencies of the United Nations System or other partners?
Yes
I-7-A Specify agency names
The World Health Organization supports the implementation of HealthWISE, a joint ILO-WHO toolkit promoting decent work in the health sector. The HealthWISE package consists of an Action Manual and a Trainers' Guide to combine action and learning. UNFPA supports the nurses leadership programme.
II-1 Justification of the initiative
The health sector of Pakistan faces poor working conditions, weak occupational safety and health standards, gender disparities, lack of social protection and high risks of violence and harassment. This has affected the performance of the care workforce, leading to physical and mental health burnout, with negative impacts on the quality of health care. The situation has worsened in recent years, especially during the COVID-19 pandemic, resulting in the exhaustion of resources in the sector. The Working for Health Programme (W4H) hence addresses these issues by providing support to the Government of Pakistan to develop, finance and implement multi-sectoral health workforce strategies for Universal Health Coverage (UHC) that will increase the supply through quality training and employment of trained health workers, create decent jobs, maximise the performance of health workers, and deliver essential quality health services. This is done through institutional strengthening and capacity building of health professionals.
II-10 Focus on other branches of economic activity
Human health and social work activities
II-11 Focus on certain categories of enterprises or economic units according to their size
Not applicable
II-12 Focus on specific status in employment
Employees
II-13 Focus on other specific categories of workers and employers, not captured elsewhere
Nurses
II-13-A Specification
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II-14 Focus on specific groups of population / persons prioritized in the initiative
Women
II-14 Focus on specific groups of population / persons prioritized in the initiative
Persons with other care responsibilities
II-15 Has the initiative been developed through effective social dialogue processes and inter-institutional coordination mechanisms?
Yes, through social dialogue
II-15 Has the initiative been developed through effective social dialogue processes and inter-institutional coordination mechanisms?
Yes, inter-institutional coordination mechanisms
II-2 Objectives and description of the initiative
The project aims to enable a conducive environment for health workers that provides a decent working environment and equal opportunities to grow and advance. This objective is achieved through advocacy for policy reforms, direct action programmes aimed at ensuring a safe and healthy work environment, capacity building of the stakeholders to champion the mainstreaming of decent work principles for health workers.The specific aims are to:Promote decent work in the healthcare sector and strengthen the institutional framework.Strengthen occupational safety and health for health workers in Pakistan.Provide guidance on the implementation of international labour standards.Support the development of gender-transformative policy, practices and non-discriminatory working conditions in the health sector.
II-3 Type of initiative
Project / pilot intervention
II-3 Type of initiative
Workplace initiative
II-3 Type of initiative
Training/capacity building
II-3-A Specification
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II-4 Which of the Rs in the 5R Framework for Decent Care Work guides this initiative?
Recognition, reduction and redistribution of unpaid care
II-4 Which of the Rs in the 5R Framework for Decent Care Work guides this initiative?
Reward care workers
II-4 Which of the Rs in the 5R Framework for Decent Care Work guides this initiative?
Representation of care workers
II-5 Which is the main policy area of the 5R Framework for Decent Care Work does the practice focus on?
Labour Protection policies
II-6 Which other policy areas of the 5R Framework for Decent Care Work does the practice focus on?
Care policies
II-6 Which other policy areas of the 5R Framework for Decent Care Work does the practice focus on?
Social Protection policies
II-6 Which other policy areas of the 5R Framework for Decent Care Work does the practice focus on?
Environmental policies
II-7 Which policies or measures to advance decent work in the care economy does the practice focus on?
Design and implement integrated and coherent care policies and systems for decent work and gender equality
II-7 Which policies or measures to advance decent work in the care economy does the practice focus on?
Mainstream care into relevant public policies
II-7 Which policies or measures to advance decent work in the care economy does the practice focus on?
Formalization of informal care jobs and enterprises
II-7 Which policies or measures to advance decent work in the care economy does the practice focus on?
Promoting active labour market policies, education and training, upskilling and re-skilling, skills recognition and skills certification
II-7 Which policies or measures to advance decent work in the care economy does the practice focus on?
Addressing the undervaluation of care work by raising public awareness
II-7 Which policies or measures to advance decent work in the care economy does the practice focus on?
Work-life balance policies and measures, including organization, time and location of work, and other terms and conditions of employment
II-7 Which policies or measures to advance decent work in the care economy does the practice focus on?
Universal social protection systems that provide adequate protection to care workers and recognize unpaid care work
II-7 Which policies or measures to advance decent work in the care economy does the practice focus on?
Preventing and addressing all forms of discrimination against care workers
II-7 Which policies or measures to advance decent work in the care economy does the practice focus on?
Ensuring effective access to labour protection and social security, including through labour inspection, for all care workers
II-7 Which policies or measures to advance decent work in the care economy does the practice focus on?
Policies and strategies on working time, wages, and occupational safety and health, including preventing and addressing violence and harassment
II-7 Which policies or measures to advance decent work in the care economy does the practice focus on?
Promoting the voice and representation of, and consulting with, care worker organizations, organizations of employers of care workers and unpaid family carers
II-8 Which beneficiaries in the care economy does the practice focus on?
Paid care workers (nurses, domestic workers, teachers, childcare workers, personal assistants, etc.)
II-9 Geographical scope
Urban and rural
III-1 In a short paragraph, summarize the main results and impacts obtained
At the policy level, the project contributed to the development of the Minimum Service Delivery Standards (MSDS)—a regulatory framework established by the Islamabad Healthcare Regulatory Authority (IHRA). The MSDS sets baseline requirements for quality and safety in healthcare service delivery, with a focus on key ILO standards, including occupational safety and health (OSH), gender equality, violence prevention, and maternity protection.In parallel, through an integrated approach to mainstreaming OSH into the educational curricula offered by the Health Services Academy, the Master of Science in Public Health (MSPH) course has been updated. Additionally, the Nursing Leadership Programme has been enhanced with a hybrid learning model, exposing aspiring students and nurses to ILO standards and fostering engagement with employers and workers in the sector.HealthWISE, a joint ILO-WHO toolkit promoting decent work in the health sector, has been successfully implemented in seven healthcare facilities in the Islamabad Capital Territory and has now been expanded to two hospitals in Punjab. A Community of Practice has been fostered, including trainers of HealthWISE and recipients of the training at the hospitals, to continue dialogue on improving working conditions and the sustainability of these interventions.The project also supported knowledge generation through the development of several studies: one on women in health leadership, a gap assessment of the ILO Nursing Personnel Convention, 1977 (No. 149), and decent work diagnostics on healthcare and violence and harassment affecting Community Health Workers. These efforts underscore the critical role of women in the sector and aim to inform a coherent strategy for creating inclusive and safe workspaces through the ratification and progressive implementation of relevant ILO Conventions in Pakistan.
III-2 Explanation of the innovative element of the initiative for advancing decent work in the care economy
The initiative stands out for its holistic approach, bringing together multiple levels of action—policy, regulation, training, and workplace improvements—to foster an ecosystem that supports transformation in the care economy.Traditionally, there has been a strong focus on patient care, with limited attention paid to the well-being of health workers. Policy visions often prioritize patient outcomes while remaining silent on the safety and welfare of those delivering care. Most health sector programmes concentrate on clinical service delivery or infrastructure upgrades, without addressing the rights and working conditions of health workers.In contrast, the Working for Health Programme places health workers at the center of its efforts. It focuses on improving their working conditions by aligning national laws with international labour standards, thereby strengthening both the regulatory framework and everyday workplace practices.
IV-1 What were the main challenges or difficulties during the design and implementation? How were they faced/ addressed?
One of the main challenges was the limited awareness and understanding of international labour standards, particularly among health sector institutions unfamiliar with ILO Conventions such as the Nursing Personnel Convention, 1977 (No. 149) and the Violence and Harassment Convention, 2019 (No. 190). This gap was addressed through targeted advocacy efforts, including the Nursing Leadership Boot Camp and public-private dialogues, which helped raise visibility and understanding of these standards.Another challenge was the lack of focus on human resource development and capacity-building for health workers, which is often overlooked in favour of clinical services or infrastructure upgrades. This was mitigated through the implementation of the HealthWISE toolkit, which promotes decent work in the health sector.Additionally, investment in social and environmental safeguards is often perceived as a cost rather than a necessary measure for sustainable and inclusive development, posing a further barrier to effective implementation.
IV-2 Lessons learned and good practices, including room and opportunities for improvement
A key success factor was the establishment of a community of practice, which brought together trainers, health facility staff, and institutional stakeholders to share experiences, promote peer learning, and foster sustained dialogue on improving working conditions in the health sector.An integrated approach—combining advocacy, training, and regulatory alignment with international labour standards, such as the ILO Nursing Personnel Convention, 1977 (No. 149) and the ILO Violence and Harassment Convention, 2019 (No. 190)—proved effective in ensuring that workplace improvements were not isolated interventions, but part of a cohesive and sustainable effort.
IV-3 Key conditions for success
Ownership by constituents was essential, particularly as awareness and recognition of Occupational Safety and Health (OSH) as a Fundamental Principle and Right at Work continued to grow. This shift helped embed OSH considerations into institutional priorities and practices.Post-training handholding through the development of action plans focused on achieving immediate, small wins. These incremental successes helped build momentum and laid the foundation for long-term transformation in workplace conditions.
IV-4 Key conditions for sustainability
Linking the project with ongoing initiatives, such as aligning the Nursing Leadership Boot Camp with the Emigration Ecosystem at the federal level. This connection emphasizes training health workers for potential overseas employment, enhancing relevance and long-term impact.Integrating HealthWISE into the Minimum Service Delivery Standards (MSDS) ensures that decent work principles become embedded in regulatory frameworks, supporting sustained improvements in workplace conditions.
IV-5 Potential for transferability, expansion and replicability in other countries and contexts
The model presents strong potential for replication in countries facing similar economic constraints. The mainstreaming of ILO standards and sectoral guidelines into national policies and regulatory instruments offers a scalable and adaptable approach for other contexts.This strategy can also be explored for regional harmonization, particularly in areas with significant inflows of Pakistani health workers. Such alignment could facilitate mutual recognition of assessments and certifications, contributing to enhanced mobility, quality assurance, and decent work conditions across borders in the health workforce.
V-1 Sources of information and documents used on the characteristics of the initiative, including links to websites, news items, toolkits, policy documents or reports
ILO-OECD-WHO Working for Health Programme (W4H)Islamabad Healthcare Authority and ILO launch revised standards to improve worker safety and patient care MoU signed to strengthen decent working conditions for health workers in Punjab Working for Health Programme – Experiences from piloting HealthWISE in PakistanHealthWISE - Work Improvement in Health Services - Action Manual Caring for those who care – Guide for the development and implementation of occupational health and safety programmes for health workers
V-2 Contact information of ILO focal point
Rabia Razzaque, Senior Programme Officer, ILO Country Office for Pakistan ([email protected])
VI-1 Title and Description
ILO-OECD-WHO Working for Health Programme (W4H)The Working for Health programme W4H is a joint initiative between the International Labour Organization (ILO), the Organisation for Economic Co-operation and Development (OECD) and the World Health Organization (WHO) through which the three agencies collaborate on and support the implementation of the recommendations of the 2016 United Nation Secretary-General’s High-level Commission on Health Employment and Economic Growth to stimulate investment in the health and care workforce.