A care worker in Bogotá may leave an established organization for more predictable hours. A nursing assistant in a smaller Colombian municipality may accept employment in a departmental capital because professional opportunities are limited locally. A family in a remote community may struggle to find anyone available to provide dependable assistance, regardless of whether it can afford to pay. These are different labor-market experiences, but they raise the same operational question: how can Colombia maintain a sufficiently stable care workforce to deliver consistent support?
Recruitment and retention are becoming increasingly important as Colombia's population ages, the number of people living with chronic conditions grows, and expectations for disability inclusion and community-based support develop. The wider Colombia Aging, Long-Term Care & Community Support Knowledge Hub examines the policies and service arrangements within which these workforce pressures arise.
Colombia has an established healthcare workforce, technical training institutions and a substantial body of people providing paid and unpaid care. Yet these resources are distributed unevenly. Employment opportunities, contractual arrangements, supervision and service financing differ considerably between regulated healthcare institutions, territorial social programs, private homecare arrangements and family-supported care.
The central challenge is therefore not simply increasing the number of people willing to work in care. It is creating employment arrangements that make skilled workers available where they are needed, encourage them to remain, and protect the continuity and dignity of the people they support.
Why Workforce Retention Is a Service-System Issue
Recruitment is often measured through vacancies, applications and appointments. Retention is commonly examined through turnover rates and employment duration. Both measures matter, but neither fully describes what workforce instability means for people receiving care.
For an older person who needs assistance with bathing and mobility, frequent changes of caregiver may mean repeatedly explaining personal preferences and rebuilding trust. For someone with an intellectual disability, unfamiliar workers may struggle to understand established communication methods. For a person recovering from hospitalization, an interruption in available support may affect the practical feasibility of returning home.
Workforce continuity also influences organizational performance. Every departure creates recruitment, induction and supervision costs. Experienced workers may need to cover additional duties, increasing fatigue and the likelihood of further turnover. Managers can become occupied with replacing staff rather than improving services.
These consequences make retention part of workforce capacity planning, not merely a human resources indicator. A service can have an apparently sufficient number of employees while still experiencing serious continuity problems if those workers are frequently unavailable, leave soon after appointment or cannot cover particular locations.
Colombia's care workforce also operates across distinct service systems. An EPS or IPS working within the General System of Social Security in Health (Sistema General de Seguridad Social en Salud, SGSSS) faces different financial and operational conditions from a municipal community program or a household directly employing a caregiver. These differences influence the available responses to recruitment and retention problems.
A credible national discussion must therefore distinguish labor supply from funded service capacity. Training additional workers does not automatically create sustainable positions, and increasing service budgets does not guarantee that appropriately skilled workers will be available in every territory.
Colombia's Fragmented Care Labor Market
The term care workforce covers several occupational groups whose responsibilities, qualifications and employment arrangements differ. Colombia's regulated health professions and auxiliary health personnel work within established professional and service frameworks. Other paid caregivers provide personal assistance, companionship, domestic support or community participation services through organizations and private arrangements. Unpaid family members undertake extensive additional care responsibilities.
The Ministerio de Salud y Protección Social has responsibilities for health policy and health workforce regulation. The Ministerio del Trabajo oversees national labor policy, while the Servicio Nacional de Aprendizaje (SENA) contributes to technical training and competency development. Departments, districts and municipalities influence the operation of territorial social and community programs within their respective powers and resources.
These institutions do not collectively operate one unified national employment system for all long-term-care workers. In particular, Colombia's SGSSS healthcare coverage should not be confused with a universal entitlement to nonclinical personal assistance or publicly funded homecare.
Within healthcare, employment opportunities depend on institutional service demand, provider financing, contractual arrangements and professional requirements. In community support, demand may be less visible because families purchase assistance privately, rely on informal networks or receive support through locally available programs.
This distinction creates a workforce planning problem. Formal employment data can provide valuable information about recognized occupations, but it may not fully capture irregular paid care, mixed domestic and caregiving responsibilities or unpaid assistance. A labor market that appears adequately supplied in aggregate may still have substantial gaps in dependable local care.
For recruitment policy, the implication is that Colombia needs differentiated workforce intelligence. Nursing, rehabilitation, nonclinical personal assistance and community support cannot be treated as interchangeable labor categories. Nor should the presence of unpaid family caregivers be interpreted as evidence that formal service demand has been met.
Pay, Contractual Stability and the Real Value of Care Employment
Pay influences recruitment and retention, but its effect cannot be separated from employment security, working hours, travel requirements and access to social protection. Two positions offering similar headline remuneration may provide very different levels of financial stability.
A worker employed on predictable hours with appropriate benefits and supervision may be better able to plan household finances than someone dependent on irregular assignments. Conversely, a worker whose nominal hourly rate appears attractive may face unpaid travel, cancelled visits or substantial periods without income.
Colombia's labor legislation establishes protections for employees, including applicable requirements concerning remuneration, working time, social security and occupational risks. The precise obligations depend on the employment relationship and current law. Employers cannot assume that describing a person as a contractor removes employment obligations where the substantive relationship has the characteristics of employment.
Domestic employment is particularly relevant because some privately arranged caregiving takes place within household employment. Colombia's ratification of ILO Convention No. 189 through Law 1595 of 2012 forms part of the legal context for domestic workers' rights. However, legal recognition does not establish that every private care arrangement is formalized or consistently compliant.
Retention strategies must also account for the financial position of service purchasers. An IPS may face pressures associated with health-service contracts and payments. A territorial program may operate within an annual or project-specific budget. A household may have limited capacity to absorb higher costs even when it recognizes the value of skilled care.
The strongest approach connects fair employment with provider financial sustainability. It examines the complete cost of reliable delivery rather than treating wages as an isolated expense.
Improved conditions may reduce replacement costs and strengthen continuity, but savings should be demonstrated rather than assumed. In some settings, better employment standards will require additional sustainable funding even after operational efficiencies are considered.
Regional Inequalities Shape Who Can Be Recruited and Retained
Colombia's geographic diversity creates markedly different care labor markets. Major urban areas offer concentrations of hospitals, universities, technical training institutions and potential employers. Rural municipalities may have fewer qualified applicants, limited public transport and restricted access to specialist supervision.
These differences are not simply a matter of population size. A worker in a dispersed rural area may spend considerable time traveling between households. Seasonal weather, road conditions and security circumstances can affect access in some territories. In remote communities, a service may depend on a very small number of available workers, making each departure especially consequential.
Urban areas face different pressures. Workers may have more alternative employment opportunities, but commuting costs, fragmented schedules and competition between providers can undermine retention. A worker who can obtain more predictable employment outside care may leave even when committed to supporting vulnerable people.
Training institutions also influence mobility. People may move to larger cities to obtain qualifications and remain there because career opportunities are greater. This can create a continuing mismatch between where workers are trained and where community support is needed.
Territorial authorities examining rural and underserved communities therefore need to consider workforce availability alongside service geography, transport and local employment conditions.
A recruitment initiative that works in Medellín cannot automatically be transferred to a municipality in Chocó, La Guajira or the Amazon region. The underlying principles of fair employment and competent support remain relevant, but delivery arrangements must reflect local infrastructure, cultural expectations and economic realities.
Scenario One: Retaining Experienced Home Support Workers in Bogotá
Illustrative scenario: A Bogotá organization provides privately purchased home support to older adults who need assistance with personal care and daily routines. It has recruited several capable workers, but departures have increased during the preceding six months.
Management initially assumes that higher wages are the principal solution. Exit discussions reveal a more complicated picture. Workers report long gaps between visits, unpaid or poorly compensated travel time, frequent changes to schedules and limited notice when families cancel arrangements. Some also feel unsupported when relatives request tasks beyond the agreed service.
The organization reviews its operating model before making recruitment promises it may be unable to sustain. It groups visits geographically where practical, establishes clearer cancellation arrangements, reviews contractual obligations and introduces regular supervision. Managers also clarify which activities fall within nonclinical care and when advice from appropriately qualified health personnel is necessary.
These changes carry costs. More predictable scheduling may require the organization to negotiate different purchasing arrangements with families, maintain some reserve capacity or accept lower short-term utilization. Management therefore models the financial consequences rather than assuming improved retention will pay for itself immediately.
The organization measures turnover, worker-reported schedule stability, missed visits, continuity of assigned caregivers and feedback from older people. It also monitors whether revised arrangements increase prices beyond what existing households can afford.
If retention improves but some families reduce purchased hours, management must reconsider affordability and service design. The scenario demonstrates that workforce stability is created through employment, operations and purchasing decisions together. Recruitment advertising alone would not address the underlying causes.
Recruitment Should Reflect the Work People Will Actually Perform
Care recruitment becomes less effective when job descriptions are vague, responsibilities expand after appointment or applicants are selected primarily because they appear willing to undertake demanding work. Colombia's varied care settings make occupational clarity particularly important.
Employers should distinguish clinical responsibilities from nonclinical assistance and explain the practical conditions of the position. A nursing assistant working within an authorized healthcare service has different professional responsibilities from a caregiver providing companionship, mobility assistance and support with community activities. Both roles may be demanding, but they require different qualifications, supervision and escalation arrangements.
Recruitment also needs to assess the interpersonal qualities that support continuity. Communication, reliability, respect for autonomy and sensitivity to cultural differences are essential in home and community settings. These qualities should be evaluated alongside technical competence rather than treated as substitutes for it.
Organizations recruiting people with previous unpaid caregiving experience should recognize the value of that experience while assessing whether applicants can adapt to professional boundaries. Supporting one's own relative differs from working with several people who have different preferences, risks and communication needs.
Realistic recruitment information can reduce early departures. Applicants should understand expected travel, working patterns, supervision, documentation, physical demands and the circumstances in which they may work alone. The same transparency helps people receiving support understand what a service can reasonably provide.
The principles of effective recruitment and onboarding are particularly useful where care organizations compete for workers with other service sectors. An attractive recruitment message should be supported by employment conditions that remain credible after the worker begins.
Supervision, Wellbeing and Occupational Risk Influence Retention
Care work involves emotional demands as well as physical responsibilities. Workers may support people experiencing pain, cognitive changes, disability-related barriers, bereavement or family conflict. Some undertake physically demanding tasks in homes that were not designed for care delivery.
These conditions can contribute to fatigue, injury, uncertainty and emotional strain. Workers may also encounter unrealistic expectations from relatives, difficult travel conditions or pressure to accept responsibilities outside their competence.
Colombia's occupational safety and health framework, including the Sistema de Gestión de Seguridad y Salud en el Trabajo (SG-SST), provides an important foundation for employers with applicable obligations. Decree 1072 of 2015 and Resolution 0312 of 2019 form part of the relevant regulatory context. Their application should be assessed according to the organization's circumstances and the current requirements rather than treated as a universal care-specific inspection regime.
For care organizations, occupational risk assessment should reflect the actual work environment. A worker assisting someone with mobility in a private home may encounter restricted space, unsuitable equipment or repeated lifting demands. A community worker traveling alone may face transport and personal security concerns. A residential worker may experience different risks associated with shifts, staffing and exposure to infectious illness.
Supervision provides an opportunity to identify these problems, but only if workers can raise concerns without fearing automatic blame or loss of employment. Managers need to distinguish individual performance issues from problems caused by inadequate staffing, poor scheduling or unclear service expectations.
Worker wellbeing is closely connected with retention, burnout and moral injury. A caregiver may understand what good support requires yet feel unable to deliver it because visits are too short or necessary assistance is unavailable. Repeated exposure to that gap can undermine professional commitment.
Organizations should therefore examine supervision quality, occupational incidents, workload, absences and worker feedback together. A low recorded incident rate is not necessarily reassuring if employees lack confidence that reporting will lead to constructive action.
Scenario Two: Maintaining Care Coverage in Rural Boyacá
Illustrative scenario: A municipality in rural Boyacá supports a locally funded initiative helping older residents maintain daily routines and access community services. The program relies on a small group of workers who travel between villages. Two experienced employees leave within a short period, one for employment in Tunja and another because the travel requirements are incompatible with family responsibilities.
The immediate problem is service continuity. Some older residents live alone, while others depend on relatives who work outside the municipality. Replacing workers quickly is difficult because applicants with relevant experience are scarce.
The municipal administration and the organization delivering the program review the existing agreement, available funding and the practical requirements of the service. They identify which visits are most time-sensitive, consult the people affected and establish temporary arrangements that remain within the capabilities of available personnel.
Rather than relying exclusively on recruitment from larger towns, the program explores local training partnerships and more predictable geographic scheduling. It also considers whether workers can be offered sufficient contracted hours to make the positions economically viable. The financial analysis includes transport and supervision costs, which had previously received limited attention.
The municipality cannot assume that healthcare insurance funding will cover the nonclinical assistance involved. Any expansion must be supported by an appropriate territorial program, agreement or other lawful financing arrangement.
Residents help assess whether revised visits meet their priorities. Program managers monitor cancelled support, travel-related disruption and staff retention. If shortages continue, the evidence informs future budget and service-design discussions rather than being treated solely as an individual recruitment failure.
The case illustrates how workforce retention in dispersed communities depends on local employment opportunities, geography and service financing. A standardized urban staffing model would not resolve these conditions.
Continuity of Care Requires More Than Keeping Workers Employed
Retention is valuable partly because stable relationships support better care. However, an organization can achieve low turnover without ensuring that people consistently receive support from workers who know them.
Continuity also depends on scheduling, handovers, absence cover, appropriate skill matching and the availability of clear information about individual preferences. A worker may remain employed for several years while being assigned to many different people with little opportunity to develop meaningful relationships.
For people living with dementia, familiarity may reduce distress and support communication. For someone with a disability, consistent assistance can help maintain autonomy and established routines. For an older person recovering after hospitalization, continuity may support recognition of functional changes and timely contact with healthcare professionals.
Organizations therefore need to distinguish workforce retention from continuity experienced by the person receiving support. The two measures are related but not interchangeable.
Where people receive both healthcare and nonclinical assistance, the distinction becomes especially important. An EPS and its contracted IPS network may be responsible for healthcare services under applicable arrangements, while a territorial program or privately engaged caregiver provides other support. The organizations involved may not share one scheduling or information system.
Continuity requires clear boundaries and practical communication. A nonclinical caregiver should know how to report concerning changes without being expected to diagnose or manage clinical conditions. Healthcare personnel should understand the practical support available at home rather than assuming that a family or community worker can undertake every task.
The broader principles of coordination between healthcare and social support help explain why workforce planning must consider transitions and relationships across organizations.
For people receiving care, the relevant outcome is not simply whether a service has filled its vacancies. It is whether dependable, competent assistance remains available when circumstances change.
Scenario Three: A Hospital-to-Home Transition in Medellín
Illustrative scenario: A 76-year-old man in Medellín is preparing to return home following hospitalization. His healthcare team identifies rehabilitation needs and provides information about the clinical follow-up required. His daughter expects to help with meals and household activities but works full-time and cannot provide continuous assistance.
The family approaches a private home support organization. The organization has sufficient employees overall, but only one worker with suitable availability and experience can cover the requested schedule. That worker is considering leaving because of unpredictable assignments.
The organization must avoid promising support that it cannot reliably deliver. It discusses the proposed tasks with the family, distinguishes nonclinical assistance from healthcare activities and confirms what can be provided within the agreed service. Clinical questions remain with the appropriate health professionals and responsible healthcare arrangements.
Management reviews whether the assignment can be organized around a consistent primary caregiver and a suitably prepared backup. It also examines the worker's schedule and employment concerns. A stable arrangement may require adjustments to travel routes and the price charged to the family.
The man's preferences remain central. He wants to maintain control over his daily routine and does not want unnecessary visitors entering his home. The organization therefore limits avoidable worker changes and ensures that any substitute receives an appropriate handover.
Over the following weeks, the family reports improved confidence because the caregiver understands the man's routines. The organization tracks continuity, missed visits and worker feedback. If the arrangement becomes financially unsustainable, it addresses that problem openly rather than allowing service reliability to deteriorate.
The scenario demonstrates that successful transitions depend on the availability of workers whose employment conditions make consistent support possible. A clinical discharge plan cannot, by itself, create nonclinical care capacity in the community.
Building a Workforce Evidence Base Across Different Care Settings
Colombia has important sources of labor, demographic and health information, but workforce planning requires careful interpretation. The Departamento Administrativo Nacional de Estadística (DANE) provides labor-market and demographic evidence, while the Ministry of Health and Social Protection maintains information relevant to the health workforce and health-service system.
The Registro Único Nacional del Talento Humano en Salud (ReTHUS) is relevant to authorized health personnel, but it should not be treated as a comprehensive register of every paid or unpaid caregiver in Colombia. Likewise, general employment statistics may not fully identify workers whose responsibilities combine domestic assistance and personal care.
Organizations can strengthen their own evidence through consistent definitions and proportionate records. Useful measures include:
- Workforce availability: funded positions, vacancies, contracted hours and actual coverage by location.
- Employment stability: turnover, employment duration, reasons for leaving and changes in contractual arrangements.
- Continuity: changes of assigned caregiver, missed visits and disruption caused by absence or travel.
- Workforce experience: supervision access, workload concerns, occupational incidents and reported wellbeing.
- Service outcomes: feedback from people receiving support, complaints, safety concerns and evidence of maintained independence.
These measures should be interpreted together. A service might reduce turnover by limiting recruitment while still leaving demand unmet. Another might improve coverage by relying heavily on overtime, creating future wellbeing and retention risks.
For organizations seeking a structured approach, the Quality Dashboard Builder can help organize workforce and service indicators into a coherent management view. It is a general planning resource rather than a Colombian regulatory reporting system.
The strongest evidence connects workforce conditions to the experience of people receiving care. That connection enables leaders to distinguish problems requiring additional recruitment from those requiring changes in scheduling, employment practices, supervision or funding.
Scenario Four: Workforce Stability and Community Inclusion in Chocó
Illustrative scenario: A community organization in Chocó operates a small support initiative for adults with disabilities and older residents in communities where transport and access to specialist services can be difficult. The organization has developed trusted relationships with local families, but it struggles to retain workers because assignments are irregular and travel can be expensive.
Several employees have knowledge of local cultural practices and established relationships with community members. Recruiting replacements from outside the area might provide access to additional formal qualifications, but it could also introduce language, transport and continuity difficulties.
The organization works with community representatives to identify the support activities that require dependable local capacity. It then reviews its available funding, employment arrangements and opportunities for practical training. Rather than attempting to reproduce an urban service model, it explores a smaller, geographically organized workforce supported by periodic specialist advice.
Community participation is important, but it does not remove the need for employment protections or competent practice. Workers should not be expected to accept unsafe conditions simply because they have strong relationships with the people receiving assistance.
The organization also considers what happens during transport disruption or severe weather. Its continuity arrangements identify which activities can be rearranged, which require urgent attention and when relevant healthcare or emergency services should be contacted.
Evaluation focuses on dependable access, worker retention, community satisfaction and whether the organization can sustain the model within its actual resources. The initiative does not presume that a national health insurance entitlement finances all community support activities.
This scenario highlights a broader Colombian priority: workforce development must preserve local knowledge while improving employment conditions, practical competence and access to specialist support. Regional equity cannot be achieved simply by distributing identical recruitment targets across very different territories.
Digital Workforce Planning Can Improve Decisions Without Replacing Local Knowledge
Digital scheduling, workforce analytics and communication systems may help Colombian care organizations understand patterns that are difficult to identify through manual administration. These include repeated travel delays, concentrations of vacancies, short-notice cancellations and the relationship between scheduling practices and employee departures.
However, technology is useful only when it reflects the realities of the service. A scheduling system designed for dense urban neighborhoods may underestimate travel time in dispersed rural communities. A predictive model based on historical staffing patterns may reproduce existing inequalities if communities with limited previous service provision are treated as having little demand.
Organizations should also consider workers' privacy and autonomy. Digital monitoring can support safety and accountability, but excessive surveillance may damage trust or create additional stress. Colombia's personal data protection framework, including Law 1581 of 2012, is relevant when employers process identifiable workforce information. Health information and other sensitive personal data require particular care.
Artificial intelligence could support future workforce forecasting by identifying patterns associated with turnover, absence or service disruption. These applications should be treated as emerging possibilities rather than established national practice. Automated outputs require human review, appropriate data governance and an understanding of the limitations of the underlying information.
The Predictive Workforce Risk Module offers a general framework for examining workforce instability and service continuity. Organizations considering its use should assess local data quality, privacy requirements and the suitability of any assumptions for Colombia's particular service context.
Digital investment should ultimately reduce avoidable administrative work and improve decisions. It should not become a substitute for fair employment, appropriate supervision or direct engagement with workers and people receiving care.
Governance Must Connect Workforce Decisions With Service Outcomes
Workforce accountability operates at several levels in Colombia. National institutions establish relevant labor, professional and health-service requirements. Territorial authorities oversee programs and resources within their responsibilities. Healthcare providers, community organizations and other employers manage the practical conditions under which workers deliver services.
These responsibilities overlap in some circumstances but should not be treated as interchangeable. The Superintendencia Nacional de Salud has oversight functions within the health system; it is not a universal regulator of every privately purchased nonclinical care arrangement. Similarly, the existence of municipal social programs does not mean that every local authority operates an identical workforce assurance system.
For employers, governance begins with knowing whether the workforce model is capable of delivering the service promised. Recruitment plans, staffing budgets, employment arrangements and supervision should be consistent with actual service obligations.
Leaders also need visibility of emerging instability. Repeated vacancies in one area, increasing overtime, deteriorating worker feedback or frequent changes of assigned caregiver may indicate problems before they become serious service failures.
Organizations examining their leadership arrangements can use the Governance Maturity Assessment to structure questions about responsibility, assurance and organizational decision-making. The resource does not certify compliance with Colombian labor or healthcare regulation.
Effective governance requires evidence to influence action. If a provider identifies persistent turnover associated with travel demands, it should examine scheduling and financial arrangements. If workers report inadequate supervision, management should investigate the capacity and competence of supervisors. If service users experience repeated disruption, continuity should become a priority in workforce planning.
The broader principles of quality assurance and accountability are relevant because staffing stability is not simply an internal employment matter. It affects whether services deliver their intended outcomes.
What a Sustainable Colombian Recruitment and Retention Strategy Could Look Like
Colombia's future care workforce strategy will need to address different labor markets without creating an unnecessarily rigid national employment model. The objective should be to establish stronger connections between workforce development, service demand, employment quality and territorial capacity.
At national level, the relevant institutions can support clearer occupational information, appropriate labor protections and training pathways. Health workforce planning can draw on existing professional and service information, while wider care policy development can examine the less visible employment arrangements associated with nonclinical assistance.
At departmental and municipal levels, workforce planning can become more closely connected with population needs and the practical availability of services. Territorial authorities can identify locations where recruitment is particularly difficult, assess the sustainability of funded programs and consider partnerships that strengthen local training and employment opportunities.
Employers have a more immediate responsibility to examine why workers join, remain or leave. Recruitment campaigns may be necessary, but they should sit alongside credible job descriptions, appropriate remuneration, predictable arrangements, supervision and meaningful opportunities for development.
Workers and people receiving support should influence these decisions. Their experience can reveal problems that employment statistics alone cannot explain, including unsafe travel expectations, inconsistent visits, cultural barriers and the emotional consequences of repeated changes in caregiver.
International experience offers a useful principle: stable care work depends on aligning employment conditions with the real cost and responsibilities of delivering support. The institutional mechanisms used elsewhere cannot simply be transferred to Colombia, where healthcare financing, territorial programs, private purchasing and family caregiving interact in distinctive ways.
A progressive strategy would test changes in specific settings, evaluate workforce and service outcomes, and expand approaches that demonstrate sustainable benefits. It would also recognize that improving recruitment and retention may require additional investment rather than assuming that better management can resolve every structural constraint.
Conclusion
Recruiting and retaining Colombia's care workforce is not simply a question of attracting more applicants. It is a question of whether the country's healthcare institutions, community organizations, territorial programs and private care arrangements can offer employment conditions that support competent, dependable and sustainable care.
Colombia has important foundations for workforce development, including established health professions, technical education institutions, labor protections and growing recognition of the social and economic value of care. Yet workforce opportunities remain unevenly distributed, and the practical conditions of employment differ considerably across service settings and territories.
The strongest response connects recruitment with retention, supervision, occupational wellbeing and realistic financing. It also measures workforce stability through the experience of people receiving support. A filled vacancy has limited value if assistance remains inconsistent, workers are repeatedly replaced or families cannot rely on agreed services.
Regional differences require particular attention. Urban providers may need to improve scheduling and employment quality in competitive labor markets, while rural communities may need locally grounded training, viable employment arrangements and stronger access to specialist support. Neither challenge can be resolved through a single national staffing formula.
As Colombia develops its wider care policies, workforce sustainability should be treated as a core condition of implementation. Better training and stronger recognition will matter most when workers can build stable careers and people can depend on continuity of support.
The long-term opportunity is to create a care workforce that is not only larger, but more secure, appropriately skilled, geographically accessible and accountable to the people whose lives depend upon it.
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