Briefs

WHAT YOU SHOULD KNOW

Investments in frontline health workers save millions of women’s and children’s lives, enhance global health security efforts, and bear tremendous economic returns. Frontline health workers provide life-saving services directly to communities, where they are needed more, especially in remote and rural areas. New evidence reveals the economic return on investment in health is 9 to 1.[1]

Improving access to health workers with the right skills, in the right numbers, and in the right places is crucial to global health progress. Threats such as Ebola and Zika can be halted when health workers coordinate community-level prevention, detection, and response efforts. Maternal and newborn mortality can largely be prevented when skilled birth attendants are present. The spread of HIV/AIDS can be slowed when health workers promote awareness, conduct testing, and provide treatment.

But the world faces an acute and growing shortage of health workers. More than 400 million people worldwide lack access to essential services provided by frontline health workers.[2] Consequently, millions of people die or are disabled every year from preventable causes. The health workforce shortage is expected to more than double to 18 million by 2030 without immediate and strategic investments.[3]

The U.S. government’s goals of ending preventable child and maternal deaths, achieving an AIDS-free generation, and ensuring global health security cannot be achieved without significantly more support to strengthen the global frontline health workforce. As the Ebola epidemic in West Africa tragically demonstrated, access to competent and supported health workers must no longer languish as a global health policy afterthought.

9 to 1

New evidence reveals the economic return on investment in health is 9 to 1

400 Million

More than 400 million people worldwide lack access to essential services provided by frontline health workers

18 million

health workforce shortage is expected to more than double to 18 million by 2030

RECOMMENDATIONS FOR CONGRESS

Mandate the administration to release a multi-year, costed, cross-agency strategy or action plan for enhanced U.S. support to assist partner countries in strengthening their frontline health workforce throughout the labor cycle. This strategy should include concrete targets and clear accountability mechanisms for monitoring progress. The strategy should align with the global health Workforce 2030 strategy[4] and the recommendations for multi-sectoral action by the High-Level Commission on Health Employment and Economic Growth to invest in a sustainable health workforce to promote inclusive economic growth.[5]

Prioritize greater accountability for U.S. efforts to expand access to frontline health workers. Congress should lead oversight into activities by the State Department, United States Agency for International Development (USAID), the Centers for Disease Control and Prevention (CDC), the Department of Health and Human Services (HHS), and other relevant agencies and programs to help countries address health workforce gaps, as well as targets within the Global Health Security Agenda to build a resilient health workforce. Congress should also leverage mechanisms like the Foreign Aid Transparency and Accountability Act and appropriations report language to ensure accountability on such efforts.

Affirm the high policy priority of health workforce strengthening to achieve core global health goals, including:

  • The centrality of strengthening the health workforce to achieve the goals and targets of the President’s Emergency Plan for AIDS Relief (PEPFAR);
  • The importance of the USAID Office of Health Systems Strengthening in coordinating USAID’s assistance to partner countries in strengthening their health workforce; and
  • Greater focus and investment under global health security programming to assist partner countries in community-based disease prevention, detection and response, including robust support for CDC’s global health capacity development and polio eradication accounts.

WHY IS THIS INVESTMENT IMPORTANT?

Frontline health workers have been at the forefront of U.S. investments that helped save an estimated 100 million children’s lives from 1990 to 2015[6] and cut AIDS-related deaths by 45% since 2005.[7] Yet, lack of investment and focus on the frontline health workforce remain among the top barriers to achieving greater progress in global health. Consider:

  • The 20 countries with the highest child mortality rates in the world[8] were all classified as health workforce “crisis countries” by the World Health Organization (WHO) in 2006.[9]
  • Guinea, Liberia, and Sierra Leone all had fewer than three doctors, nurses and midwives per 10,000 people before the Ebola epidemic.[10] WHO says at least 44 per 10,000 people are needed to deliver essential services.[11]
  • Among the 73 countries that account for 96% of maternal deaths, only four have the potential midwifery workforce to deliver essential maternal, newborn, and reproductive, health [12]
  • The top barriers identified by PEPFAR focus countries in retaining clients in pre-antiretroviral therapy were lack of adequate staff and staff attrition.[13]
  • There is a shortage of 1 million surgical, anesthesia, and obstetrical specialists in low- and middle-income countries, resulting in 18 million people dying each year of surgically treatable conditions[14].

Beyond the centrality of frontline health workers to advance progress across all health issues, new projections underscore the urgency of workforce investment to drive inclusive economic growth and progress on gender equality in the global labor market. New research by the World Bank finds that investment in health workers drives economic growth improvements more than financial sector investments[15]. Moreover, since women make up 67% of employment in the health and social sectors, compared with 41% across all other sectors, investment in the health workforce is an investment in women’s empowerment.[16]

But with a projected shortfall of 18 million health workers in low- and middle-income countries, much greater focus and investment will be needed to achieve development targets. Strategic and coordinated action focused on ensuring access to health workers could create 40 million jobs worldwide by 2030.[17]

U.S. leadership helped push forward Workforce 2030 – the first ever global strategy guiding health workforce strengthening efforts from 2016-2030. American leadership is needed now more than ever as development progress is threatened by the severe shortage of trained and supported frontline health workers. Investment in health workers is key to the success of all U.S. global health programs, as well as fuel for economic growth worldwide.

Resources

  1. Frontline Health Workers Coalition Resources: http://bit.ly/2dDlqlJ
  2. Working for Health and Growth: Investing in the Health Workforce. Report of the United Nations High-Level Commission on Health Employment and Economic Growth. http://bit.ly/1VR9QQ4
  3. A Global Strategy on Human Resources for Health: Workforce 2030. World Health Organization: http://bit.ly/1PQqoCG

Contributors

Vince Blaser, Frontline Health Workers Coalition secretariat, IntraHealth International, vblaser@intrahealth.org
Michelle Korte, IntraHealth International, mkorte@intrahealth.org


Citations

[1] “Working for Health and Growth: Investing in the Health Workforce.” UN High-Level Commission on Health Employment and Economic Growth, 2016. http://apps.who.int/iris/bitstream/10665/250047/1/9789241511308-eng.pdf?ua=1

[2] “Tracking universal health coverage: First global monitoring report.” World Health Organization/World Bank Group, 2015. http://www.who.int/healthinfo/universal_health_coverage/report/2015/en/

[3] “Working for Health and Growth”

[4] “A Global Strategy on Human Resources for Health: Workforce 2030.” World Health Organization, 2016. http://bit.ly/1PQqoCG

[5] “Working for Health and Growth”

[6] “USAID Global Health Programs: Ending Preventable Maternal and Child Deaths – FY 2017.” USAID, 2016. https://www.usaid.gov/sites/default/files/documents/1864/USAID_EPCMD-and-MCHFY2017-factsheet.pdf.

[7] “Fact sheet 2016.” UNAIDS, 2016. http://www.unaids.org/en/resources/fact-sheet

[8] “Under-five mortality rate (per 1,000 live births).” United National Development Programme, 2013. http://hdr.undp.org/en/content/under-five-mortality-rate-1000-live-births

[9] “The World Health Report 2006 – working together for health.” World Health Organization, 2006. http://www.who.int/whr/2006/en/

[10] “Cost of Scaling up the Health Workforce in Liberia, Sierra Leone, and Guinea Amid the Ebola Epidemic.” Frontline Health Workers Coalition, 2015. https://www.frontlinehealthworkers.org/wafricacosting/

[11] “Global Health Workforce Labor Market Projections for 2030.” World Bank Group, 2016. http://documents.worldbank.org/curated/en/546161470834083341/Global-health-workforce-labor-market-projections-for-2030

[12] “The State of the World’s Midwifery 2014: A Universal Pathway. A Woman’s Right to Health.” United Nations Population Fund, 2014. http://www.unfpa.org/sowmy

[13] “Linkage and Retention in Pre-ART Care: Best Practices and Experiences from Fourteen Countries.” United States Agency for International Development, 2013. https://aidsfree.usaid.gov/sites/default/files/aidstar-one_report_retention_linkages.pdf

[14] Meara, John G, Andrew JM Leather, Lars Hagander et al. “Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development.” The Lancet, 2015. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60160-X/abstract

[15] Horton, Richard. “Offline: A prescription for Prosperity.” The Lancet, 24 Sept. 2016. http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31699-3/fulltext?elsca1=etoc

[16] “Working for Health and Growth”

[17] “Working for Health and Growth”

©2017 Global Health Council