- The Independent Authority for Fiscal Responsibility (AIReF) highlights that Extremadura faces significant challenges in the management of health human resources, driven by care pressure, ageing, and unequal territorial distribution
- AIReF notes rigidities in the regulatory framework, territorial imbalances in the organisation of human resources, and care burden and waiting times above the national average in both primary and hospital care
- It proposes reviewing the regulatory framework, linking workforce planning to demographic trends, offering incentives to professionals in hard-to-cover areas, and implementing measures to optimise supply—such as telemedicine and dynamic scheduling—while improving demand management through referral protocols, active appointment confirmation programmes, and no-show management
- AIReF proposes creating incentives in job offers to reduce temporary contracts and moving towards a pay system more closely linked to results, with objective indicators and continuous evaluation
The Independent Authority for Fiscal Responsibility (AIReF) today published a study on the human resources of the Extremadura Health Service (SES), identifying the main challenges faced by the region and putting forward proposals to ensure efficient use of resources and to promote an equitable and sustainable healthcare system.
The evaluation confirms that Extremadura faces significant challenges in the management of human resources in its healthcare system, exacerbated by care pressure, ageing, and unequal territorial distribution. The study focuses on five areas: the regulatory framework, the planning and management of human resources, the balance between supply and demand of care, job temporariness, and the remuneration and incentive model for professionals.
AIReF notes that the current regulatory framework combines state and regional guidelines, generating rigidities and limiting the capacity of centres to adapt to their specific needs. It also identifies high regulatory fragmentation in recruitment and staff selection processes. In this regard, AIReF proposes reviewing the framework to increase flexibility in personnel management while maintaining the guarantees of the public system.
In terms of human resources planning and management, the study shows that since 2016 the SES workforce has grown by 12%, with more residents and young professionals joining. However, territorial imbalances remain between rural and urban areas. To address these disparities, AIReF proposes linking planning to demographic projections, reinforcing incentives for hard-to-cover areas, and establishing generational replacement plans.
The evaluation also reveals that primary care in Extremadura shows signs of strain, the number of consultations per doctor higher than the national average and an average wait time of 3.6 days per consultation. In hospital care, waiting times for outpatient consultations are also above the national average, while surgical waiting times reach 181 days, compared with the national average of 128 days. Between 2016 and 2023, 64% of hospital services experienced worsening average waiting times. AIReF proposes dual strategies combining supply optimisation (telemedicine, high-resolution programmes, dynamic scheduling) with demand management measures (referral protocols, active appointment confirmation and no-show management, and health education). It also suggests expanding strategic alliances between hospitals to reduce disparities across healthcare areas.
About temporary employment, the evaluation finds that the rate reaches 50% in primary care nursing and 47% in hospital care. Although public employment offers (OEP) have partially reduced this situation, their effect diminishes over time due to high staff mobility. AIReF therefore proposes redesigning OEPs by including incentive programmes linked to retention in hard-to-cover areas, predictive needs analysis, prioritisation of high-turnover positions, and monitoring coordination between OEPs and staff transfers.
Regarding remuneration and incentives, AIReF highlights significant limitations, with fixed salaries predominating and insufficient development of variable or non-financial incentives. AIReF proposes moving towards a pay system more based on results and professional performance, with a greater role for incentives linked to objective indicators and continuous evaluation tools.
In conclusion, the evaluation stresses the need to strengthen planning, improve the management of professional supply, and advance towards more flexible and incentive-based models. However, these goals face challenges related to territorial heterogeneity, persistent care pressure, and the need to balance flexibility with stability in management. According to AIReF, the sustainability and success of these initiatives will also depend on effective monitoring and continuous adjustment.
