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Frontline Health Workers

U.S. investments in frontline health workers save lives.

WHAT YOU SHOULD KNOW

U.S. investments in frontline health workers save lives, enhance global health security, and result in significant economic and social returns globally and domestically. Frontline health workers provide essential health services to communities with the least access to quality care, especially in remote and rural areas. 

Frontline health workers are at the forefront of preventing, detecting, and responding to infectious disease outbreaks, often at significant risk to their own health. During the COVID-19 pandemic, frontline health workers, many of whom lacked adequate personal protective equipment (PPE), faced heightened risk of infection. By early September 2020, one in seven reported cases of COVID-19 were health workers—likely a significant underestimation due to lack of data.[1] 

Frontline health workers are also targets during periods of conflict. In 2019, there were more than 1,200 incidents of violence against health workers and facilities, affecting global health initiatives and global security.[2]

The World Health Organization (WHO) projects a global shortage of 18 million health workers by 2030, mostly in low- and middle-income countries.[3] The tremendous progress made in global health over the last decades will stall without increased investment in frontline health workers. A 2018 Lancet commission found more than 8 million people die annually in low- and middle-income countries because of “inadequate access to quality care,” resulting in $6 trillion in economic losses.[4]

Investments in health yield 9-to-1 returns,[3] with potential to create 40 million new health workforce jobs worldwide by 2030 and spark economic empowerment for women, who make up 70% of the global health workforce.[3]

RECOMMENDATIONS FOR CONGRESS

Make robust investments in more well-trained, supported, and protected frontline health workers and systems to support them. Ensure all USG agencies that receive global health funding have the flexibility to implement workforce investments.

Address gender-specific barriers to decent working conditions for health workers, including eliminating pay inequities and supporting a woman’s distinct needs. Support increasing real-time, gender-disaggregated health workforce data, including infection rates. 

Develop a cross-agency, multi-year USG strategy for agencies to implement integrated and cross-sectoral programming across global health accounts to strengthen frontline health workforce teams and the systems supporting them. The strategy should include concrete targets and clear accountability mechanisms, including for protecting health care in conflict, that align with WHO and national strategies.

Place higher policy priority on health workforce strengthening, including:

  • Mandating robust health workforce strengthening efforts under the President’s Emergency Plan for AIDS Relief (PEPFAR) goals;
  • Supporting the U.S. Agency for International Development (USAID) Office of Health Systems in coordinating U.S. assistance to partner countries to strengthen their health workforce as part of its Health Systems Strengthening Vision;  
  • Investing more under the Global Health Security Agenda and other mechanisms to assist partner countries in ensuring access to frontline health workers that have capacities as laid out by the International Health Regulations;
  • Supporting the Centers for Disease Control and Prevention’s global health capacity development.

Strengthen USG leadership, including through the State Department and Department of Defense, to protect health workers in conflict and seek accountability for violence against health workers to ensure their safety and ability to respond effectively during humanitarian and public health crises.

Photo Credits: Patrick Meinhardt-ALIMA

WHY THIS INVESTMENT IS 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[5] and cut AIDS-related deaths by 60% since 2004.[6] Evidence demonstrates that health financing directed to the health workforce does not represent a cost but an investment that improves the growth rate of national economies. Moreover, since women comprise 70% of the health and social workforce globally, compared with 40% across all sectors, investment in the health workforce is an investment in women’s empowerment. 

Yet, lack of investment in the frontline health workforce remains a significant barrier to achieving greater progress in global health and preventing and controlling infectious disease outbreaks. 

  • Guinea, Liberia, and Sierra Leone all had fewer than three doctors, nurses, and midwives per 10,000 people before the 2014 Ebola epidemic.[9] WHO says at least 44 per 10,000 people are needed to deliver essential services.[10] 
  • 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 interventions.[11]
  • Nurses, who make up the majority of the global health workforce, are inequitably distributed. There is a global estimated shortage of 5.9 million nurses and 5.3 million (89%) of that shortage is in low- and lower middle-income countries.[12]

Exacerbated by COVID-19, these gaps in access to supported and protected frontline health workers who provide quality, essential health services threaten progress in meeting U.S. global health goals. U.S. leadership in global initiatives, including Workforce 2030—a global strategy guiding health workforce strengthening efforts from 2016-2030, and support for country-level health workforce strengthening strategies are critical to continue progress in ensuring that everyone, everywhere has access to quality health care. 

EFFECTS OF COVID-19

Frontline health workers have been at the forefront of the response to COVID-19, providing critical care to patients often at significant risk to their own health. COVID-19 has not only infected millions of people, it has disrupted access to essential health services—including for maternal and child health, HIV, and family planning—threatening decades of progress in global health. Equipped, supported, and protected frontline health workers are critical for responding to global health threats like COVID-19 and for ensuring the continuation of essential health services. Investments in frontline health workers are necessary to ensure that progress on U.S. global health goals continues and that the world never again faces a public health crisis of this magnitude.

RESOURCES

  1. Frontline Health Workers Coalition Resources http://bit.ly/2dDlqlJ
  2. Frontline Health Workers Coalition Policy Recommendations for Safe & Sustainable Health Workforce Teams to Fight COVID-19 https://www.frontlinehealthworkers.org/sites/fhw/files/fhwc_covid-19_recommendations.pdf 
  3. Working for Health and Growth: Investing in the Health Workforce http://bit.ly/2TdkKoS
  4. Global Strategy on Human Resources for Health: Workforce 2030 http://bit.ly/1PQqoCG

CONTRIBUTORS

Carol Bales, Frontline Health Workers Coalition Secretariat, IntraHealth International, cbales@intrahealth.org 

Rachel Deussom, Frontline Health Workers Coalition Steering Committee, Chemonics, rdeussom@chemonics.org 

Mandy Folse, Frontline Health Workers Coalition Secretariat, IntraHealth International, mfolse@intrahealth.org 

Crystal Lander, Frontline Health Workers Coalition Steering Committee, Pathfinder International, clander@pathfinder.org

CITATIONS

[1] “Keep health workers safe to keep patients safe: WHO.” World Health Organization. September 17, 2020. https://rb.gy/ws46u9 

[2] “Health Workers at Risk: Violence against Health Care.” Safeguarding Health in Conflict Coalition. June 2020. https://www.safeguardinghealth.org/sites/shcc/files/SHCC2020final.pdf 

[3] “Working for health and growth: investing in the health workforce,” WHO. http://bit.ly/2TdkKoS.

[4] Kruk, Margaret and Anna Gage, et al. “High-quality health systems in the Sustainable Development Goals era: time for a revolution,” The Lancet Global Health Commission, September 2018; 6(11):PE1196-E1252. http://bit.ly/2z8RyXK.

[5] “USAID Global Health Programs: Ending Preventable Maternal and Child Deaths – FY 2017,” USAID. http://bit.ly/2PV8872.

[6] “Global HIV & AIDS statistics – 2020 fact sheet,” UNAIDS. http://bit.ly/2yAsEA5.

[7] “Under-five mortality rate (per 1,000 live births),” United Nations Development Programme. http://bit.ly/2z9OLh4.

[8] “The World Health Report 2006 – working together for health,” WHO. http://bit.ly/2PWSaZT.

[9] “Cost of Scaling up the Health Workforce in Liberia, Sierra Leone, and Guinea Amid the Ebola Epidemic: FHWC Costing Analysis (March 2015),” Frontline Health Workers Coalition. http://bit.ly/2DDObM7.

[10] “Global health workforce labor market projections for 2030,” World Bank Group. http://bit.ly/2DlQGlk.

[11] “The State of the World’s Midwifery 2014: A Universal Pathway. A Woman’s Right to Health,” UNFPA. https://bit.ly/2C052a0.

[12] “State of the world’s nursing report – 2020.” WHO.  https://www.who.int/publications/i/item/9789240003279

 

HEADER PHOTO CREDIT  Patrick Meinhardt- ALIMA