Investments in frontline health workers save millions of women’s and children’s lives, enhance global health security, and result in tremendous economic and social returns, both globally and domestically. Frontline health workers provide lifesaving services to communities with the least access to quality care, especially in remote and rural areas.

However, global health progress will stall without immediate action to facilitate greater and more strategic investment in frontline health workforces. 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.[1]

By and large, communities with the highest maternal and child death rates, as well as the greatest burden of disease — from Ebola, Zika, HIV, tuberculosis, and malaria, plus noncommunicable diseases — are also the same communities with the least access to quality health workforces. Without bold leadership and investment, the World Health Organization (WHO) projects a shortage of at least 18 million health workers by 2030.[2]

Investments in health have been shown to yield 9-to-1 returns,[2] offering the massive potential to create 40 million new health worker jobs worldwide by 2030 and spark greater economic empowerment for women.[2] Multisectoral investment in frontline health workers can halt outbreaks like Ebola and Zika, control disease epidemics, prevent millions of maternal and child deaths, and support resilient and self-reliant health systems.


Ensure all agencies receiving global health appropriations have the flexibility to implement investments in frontline health workforces with high long-term or catalytic potential.

An action plan for ensuring sustainable, fit-for-purpose frontline health workforces should be a key pillar of any cross-agency global health strategy, with concrete program targets and clear accountability mechanisms that strengthen health systems, catalyze multisectoral investment, and work toward resilience and self-reliance. This action plan should align with WHO’s Workforce 2030 global health strategy and the Working for Health Action Plan. It should also include concrete accountability mechanisms for the protection of health care workers and services in conflict zones.

Domestic U.S. programs have also benefited from proven and innovative models that were supported by U.S. foreign assistance to address health workforce access and quality issues. The United States should facilitate more collaborative learning and lead efforts to mobilize additional private and public resources outside of the federal government, with the goal of strengthening frontline health workforces domestically and globally.

The United States should place a high policy priority on strengthening health workforces in the following ways:

  • Mandate robust efforts to strengthen health workforces and reach the President’s Emergency Plan for AIDS Relief (PEPFAR) goals;
  • Support the U.S. Agency for International Development (USAID) Office of Health Systems in coordinating U.S. assistance to partner countries for strengthening their health workforces;
  • Invest more under the Global Health Security Agenda and other mechanisms that assist partner countries in ensuring access to frontline health workers with the capacities laid out by the International Health Regulations; and
  • Support the Centers for Disease Control and Prevention (CDC) global health capacity-development and polio-eradication accounts.
Marliatou, a health worker working in Guinea with the USAID Stop Palu project, administers a rapid diagnostic test to a patient to test for malaria. Credit: RTI International/Patrick Adams


Frontline health workers were at the forefront of U.S. efforts that helped save an estimated 100 million children’s lives from 1990 to 2015[3] and cut AIDS-related deaths by 51% since 2004.[4] Yet, a current lack of investment and focus on frontline health workers remains among the top barriers to achieving greater progress in global health. Consider:

  • The 20 countries with the highest child mortality rates in the world[5] were all classified as health workforce “crisis countries” by WHO in 2006.[6]
  • Before the Ebola epidemic, Guinea, Liberia, and Sierra Leone all had fewer than three doctors, nurses, and midwives for every 10,000 people.[7] WHO estimates that at least 44 of these health workers are needed per 10,000 people to deliver essential services.[8] This is more important than ever now that Ebola has reemerged in the Democratic Republic of the Congo (DRC).
  • Among the 73 countries that account for 96% of maternal deaths, only four have the potential midwifery workforce needed to deliver essential maternal, newborn, and reproductive health interventions.[9]
  • Increases in PEPFAR support for health workforces are also associated with a higher total number of patients receiving treatment for HIV.

Beyond the central role of frontline health workers in advancing progress across all health sectors, projections also underscore the urgency of investing in this workforce to drive inclusive economic growth and progress on gender equality in the global labor market. Evidence demonstrates that financing directed toward 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 global health and social services workforce, compared with 40% across all other sectors, investment in health workforces is an investment in women’s empowerment.[2] For these investments to have the most impact for women, issues of uncompensated or undercompensated labor, occupational sex segregation, sexual harassment and assault, and discrimination in harassment and training must also be addressed.

U.S. leadership has been instrumental in the creation and implementation of the Workforce 2030 strategy — the first-ever global guidelines for strengthening health workforces through 2030. This leadership is needed now more than ever, as development progress is increasingly threatened by gaps in access to the quality and essential health services provided by frontline health workers. Investment in health workforces is critical to the success of all U.S. global health programs, as well as fuel for economic growth worldwide.


  1. Frontline Health Workers Coalition Resources
  2. Working for Health and Growth: Investing in the Health Workforce
  3. Global Strategy on Human Resources for Health: Workforce 2030


Vince Blaser, Frontline Health Workers Coalition secretariat, IntraHealth International,
Sarah Kashef, IntraHealth International,
Samantha Rick, Frontline Health Workers Coalition secretariat, IntraHealth International,


[1] 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.

[2] “Working for health and growth: investing in the health workforce,” WHO.

[3] “USAID Global Health Programs: Ending Preventable Maternal and Child Deaths – FY 2017,” USAID.

[4] “Global HIV & AIDS statistics – 2018 fact sheet,” UNAIDS.

[5] “Under-five mortality rate (per 1,000 live births),” United Nations Development Programme.

[6]  “The World Health Report 2006 – working together for health,” WHO.

[7] “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.

[8] “Global health workforce labor market projections for 2030,” World Bank Group.

[9] “The State of the World’s Midwifery 2014: A Universal Pathway. A Woman’s Right to Health,” UNFPA.

©2019 Global Health Council