Health ministers and senior representatives from the WHO European Region’s small countries have committed to urgent action to strengthen and sustain the health and care workforce, adopting the Riga Outcome Statement at the 12th High-level Meeting of the WHO Small Countries Initiative (SCI) in Riga, Latvia, on 4–5 June 2026.
Every aspect of health security, from routine services to emergency response, depends on having enough skilled, motivated and supported professionals. However, health systems across the European Region face growing workforce pressures with health workers increasingly overstretched and unable to meet people’s changing and rising health needs.
The Riga Outcome Statement sets out commitments to improve retention, protect health workers, and prepare health systems and the health and care workforce for the future.
Long-term planning
WHO estimates a shortage of nearly 1 million health workers in the European Region by 2030, driven by ageing populations, rising demand for care, workforce ageing and difficulties in attracting and retaining doctors, nurses and other health professionals.
Under the theme “From scarcity to sustainability: can small nations lead workforce innovations?”, ministers agreed to strengthen long-term workforce planning, improve retention, promote digital literacy, support the mental health and well-being of health workers, and create safer and more supportive working environments.
“Our health workforce is the backbone of every health system,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe. “No country can deliver quality care, respond to emergencies or build resilience without health workers who are valued, protected and supported.”
“No recruitment campaign alone will solve the crisis of retaining health workers,” Dr Kluge added. “The countries that recognize this earliest will have the strongest health systems in the years to come. Small countries have the flexibility to lead this transformation by improving working conditions, attracting new professionals, and listening to what health workers really need to remain in the profession. This is not a small contribution to European health. This is leadership.”
Small countries, big solutions
Established in 2013, the SCI has grown into one of the Region’s strongest platforms for practical collaboration, bringing together countries that share similar challenges, but also a strong ability to innovate.
“Twelve years ago, we took a bold step when we launched the Small Countries Initiative in the WHO European Region. Today, it has become one of the most successful political and technical platforms in our Region,” said Dr Kluge. “The countries gathered here may be small, but they continue to show great leadership, solidarity and a strong willingness to learn from one another.”
Speaking during the opening session, European Union Commissioner for Health and Animal Welfare Olivér Várhelyi said, “A secure and resilient health system starts with its people: doctors, nurses, pharmacists and many other specialists who care for patients, day in and day out.”
“This is why we need bold coordinated action, action to strengthen our health workforce, to give them the tools they need to care for patients, and actions to make our health systems more resilient.”
Participants emphasized that small countries have repeatedly demonstrated the value of practical multilateralism: sharing solutions, adapting quickly and translating commitments into action.
Through the Riga Outcome Statement, countries are committing to:
- improve health workforce governance and long-term planning
- strengthen the use of data to anticipate future workforce needs
- adapt education and training to changing health needs
- improve working conditions and career development
- protect the mental health and well-being of health professionals
- address health worker mobility through cooperation and sustainable approaches.
These commitments build on previous action by SCI countries, including work to develop national health workforce strategies aligned with the Framework for Action on the Health and Care Workforce in the WHO European Region 2023–2030.
Listening to and supporting health workers
A major focus of discussions in Riga was the need to retain existing health workers by improving the environments in which they work.
New evidence from WHO/Europe’s Mental Health of Nurses and Doctors (MeND) survey –the largest survey to date on the mental health of health workers in Europe – shows that levels of depression and anxiety among doctors and nurses are 5 times higher than among the general population.
Countries discussed practical solutions to address these pressures, including reducing excessive workloads, improving shift patterns, strengthening team-based care and ensuring health workers have safe ways to provide feedback and seek support.
Violence against health workers was also highlighted as an urgent concern. On average, a third of doctors and nurses reported being exposed to bullying or violent threats at their workplace.
Participants emphasized that clear reporting mechanisms, stronger workplace policies and supportive leadership are essential to ensuring health workers feel safe, respected and able to continue caring for others.
Keeping care close to communities
The meeting also explored how countries can ensure that health workers are available where they are needed most, including in rural and underserved communities.
Latvia presented its Health Workforce Development Strategy 2025–2029, which focuses on workforce planning and financing, education, employment conditions and strengthening access to professionals across regions.
The country highlighted measures including better residency planning, financial support for professionals working outside major cities and strengthening the role of nurses.
Recent legislation introducing advanced nursing practice in Latvia was highlighted as an important step towards strengthening primary health care and improving access to services in communities.
“Training more doctors and nurses is essential, but it is only one part of the solution,” said Hossam Abu Meri, Minister of Health of Latvia. “We must also create the conditions that allow health workers to build sustainable careers, remain motivated and continue serving patients throughout their professional lives.”
Preparing the workforce of tomorrow
Ministers also recognized that demographic change is reshaping health systems. People across the Region are living longer, but ageing populations require stronger primary health care, prevention and integrated services.
At the same time, health systems must prepare for increasing threats, including pandemics, climate change, geopolitical instability, cyber risks and supply chain disruptions.
The Riga Outcome Statement recognizes that a strong health workforce is the foundation of health security, and that countries must act now to ensure health systems remain sustainable for future generations.
The SCI includes Andorra, Cyprus, Estonia, Iceland, Latvia, Luxembourg, Malta, Monaco, Montenegro, North Macedonia, San Marino and Slovenia.