Tell me more about the Frontline Health Workers Coalition.
The Frontline Health Workers Coalition represents a wealth of experience and expertise in improving health around the world. One of the most important lessons from across different sectors is the critical role that frontline health workers play, whether saving newborn lives, preventing and treating diseases such as AIDS or malaria, or teaching families proper nutrition and hygiene. This Coalition is dedicated to ensuring that these lessons and expertise are leveraged to shape the global health policies and programs of the world’s largest global health donor, the U.S. government. As the U.S. government’s Global Health Initiative (GHI) moves into the implementation phase, a coordinated advocacy approach is crucial to 1) articulating a strong, unified voice in support of the development of a frontline health worker strategy and to 2) effectively monitor the full impact and implementation of that strategy.
The Frontline Health Workers Coalition is an action-oriented NGO coalition for coordinated U.S. advocacy. It strives to serve as both an advocate and technical support for the development of and implementation of a U.S. frontline health workforce strategy in the developing world through a range of planned advocacy activities, including: monitoring progress with the GHI in terms of a frontline health worker strategy development, policy and program implementation; maintaining a website and holding events and briefings to share information and facilitate communication; producing relevant and responsive reports; providing its collective expertise on draft GHI implementation plans; and gathering success stories to support the indispensable work of frontline health workers.
How is the Frontline Health Workers Coalition related to other efforts such as the MDG Health Alliance and Health Works?
All these efforts are mutually supportive and share the goal of increasing access to qualified frontline health workers in the developing world. However, they have somewhat different membership and mandates. The Frontline Health Workers Coalition is comprised of NGOs and is the only coalition focused on advancing U.S. policy on frontline health workers. The MDG Health Alliance is a broader group of NGOs, businesses, multilateral agencies and governments that is addressing a global set of health issues, of which health workforce is only one. Health Works, a newly-forming public-private partnership, is an effort by the U.S. government and major corporations to help meet the one million health worker challenge. NGOS will be invited to collaborate with Health Works. The members of these groups, as well as other related efforts, communicate, coordinate and exchange ideas and expertise on a regular basis.
Is part of the Coalition’s work to coordinate programming, technical expertise or advocacy in the developing world?
At present, the Coalition’s focus is on U.S. advocacy for greater and more strategic investment in frontline health workers in the developing world. While on-the-ground advocacy or programming is not an official activity or focus of the Coalition at this time, members are sharing expertise and best practices, and members may be called upon to help coordinate in-country advocacy and implementation efforts.
Who are the Coalition members and who can join?
The Coalition invites membership applications from NGOs with a history of and an interest in U.S. global health advocacy. As of January 2013, current members include Abt Associates, Accordia Global Health Foundation, AMREF, AWHONN (Association of Women’s Health, Obstetric and Neonatal Nurses), Family Care International, Foundation for Hospices in Sub-Saharan Africa, Bill & Melinda Gates Foundation, GAPPS (Global Alliance to Prevent Prematurity and Stillbirth), IAPAC (International Association of Providers in AIDS Care), International Medical Corps, IntraHealth International, Jhpiego, JHU-CCP (Johns Hopkins University Center for Communication Programs), MSH (Management Sciences for Health), Partners In Health, Pathfinder International, Population Communication, PSI, Public Health Institute, RESULTS, ReSurge International, Save the Children, University Research Co., White Ribbon Alliance for Safe Motherhood, Women Deliver, Women’s Refugee Commission, and World Vision. For a complete list of members, visit our website
How can organizations apply for membership?
Does it cost anything to join?
Currently there is no membership fee. Each organization is required to participate in a working group. Coalition members may be asked to provide resources to support the activities of the Coalition such as publications or special events.
Who do we contact for more information?
The Secretariat of the Coalition is based at Intrahealth International’s office in Washington DC. Please contact FHWCoalition@intrahealth.org
for general inquiries. You can also contact the Coalition’s Director Mandy Folse at firstname.lastname@example.org
or the Deputy Director Vince Blaser at email@example.com
. For media inquiries, please e-mail or call Vince at +1 202-407-9444.
Can you tell me more about the Coalition corporate partners and Health Works, the new public private partnership?
The private sector is already working in partnership with national governments and local organizations to educate and train health workers at various levels of the health care system. A number of these corporations are now coming together to support the objectives of the Frontline Health Workers Coalition and the U.S. government’s Global Health Initiative (GHI) in the global effort to meet the one million health worker challenge and the health-related Millennium Development Goals. These corporate partners include Becton Dickinson, GlaxoSmithKline, Intel, Johnson & Johnson, Medtronic, Merck, Novo Nordisk, and Pfizer. Health Works is a new public-private partnership between the private sector and the U.S. government that has been formed to work alongside NGOs in the developing world with the objective of helping increase the numbers of health workers recruited into the profession at all levels, helping increase retention rates of existing health workers, and helping improve standards of care by encouraging health worker re-skilling. In addition, firms will help promote the role and cause of frontline health workers to policy makers and other audiences around the world.
You say there is a shortage of at least 1 million frontline health workers in the developing world, and that the U.S. should set a goal to train and support 250,000 frontline health workers. Where did these figures come from?
The 1 million figure comes from the work of the High Level Taskforce on Innovative International Financing for Health Systems, and was included in the Background Paper for the Global Strategy for Women and Children’s Health: Access for All to Skilled, Motivated and Supported Health Workers, 2010. The report identified shortages of more than 950,000 community health workers and 200,000 nurse midwives, among other groups that include frontline health workers. One million is generally accepted as a conservative estimate of frontline health workers needed in the developing world. It is also generally accepted that the U.S. contribution should be 25% of the need, thus the 250,000 figure. Note that the U.S government has already committed to training and supporting 140,000 frontline health workers as part of PEPFAR (the President’s Emergency Plan for AIDS Relief), but does not have a specific strategy for reaching that target.
Don’t the developing countries have a role in this?
Absolutely — in fact, they have the biggest role and invest far more than the U.S. government in addressing their health needs. Developing countries participation, partnership and ownership of these programs are key to ensuring concrete and lasting change. But the U.S. government and its partners can provide critical expertise and capacity building to help governments achieve their goals. Investing in the skills and capacity of frontline health workers – the backbone of effective health systems — empowers communities, strengthens health systems, and builds sustainability within countries.
Which countries should be targeted for investments in frontline health workers?
The Coalition is encouraging the U.S. government to help train and deploy frontline health workers in countries that have severe health workforce shortages and in which the U.S. is already making a substantial investment to improve health through its Global Health Initiative (GHI). From Bangladesh to Burundi, 18 of the 29 countries are categorized by WHO has having a severe health workforce shortage and are GHI priority countries (see website or Coalition Issue Brief for map of countries). The absolute expansion of the frontline health workforce should be accompanied by investments in health school capacity, health worker remuneration and retention, health worker productivity, and a strategic review of policy, skills and supply gaps that constrain their effectiveness.
What would be the elements of a U.S. health workforce strategy?
The Coalition is recommending a six part strategy: (1) Identify priority countries where the need is greatest; (2) set clear, measurable objectives for training, placing, retaining and supporting frontline health workers; (3) use technically-sound, evidence-based approaches; (4) assess progress regularly and adapt programs in light of lessons learned; (5) allocate and use strategically adequate financial resources; and (6) strengthen the leadership and management of U.S. assistance for addressing the health workforce crisis.
What works? What will it take to ensure success for frontline health worker programs?
We have a lot of evidence about what will make the biggest difference. The absolute expansion of the frontline health workforce should be accompanied by investments in health school capacity, health worker remuneration and retention, health worker productivity, and strategic review of policy, skills and supply gaps that constrain their effectiveness. The key steps are to:
- Encourage national leaders and other key stakeholders to give high priority to addressing health workforce shortages and inequities.
- Optimize “human resources for health” (HRH) policies, plans and management systems so that laws, regulations, budgets, plans and management are all helping to remedy the shortage of frontline health workers.
- Strengthen educational and training institutions so they can produce enough well-trained health workers. Similarly, in-service training should continually upgrade the competencies of health providers to effectively meet health needs in light of evolving epidemiology, growing knowledge, and changing technologies.
- Attract and retain health workers. Health workers should be motivated to stay in the under-served areas where they are most needed. Where possible, health workers should be recruited and trained locally. The GHI should also promote evidence-based packages of financial and non-financial incentives to attracting and retaining workers where they are most needed.
- Foster gender equity in the health workforce. The majority of health workers are women, but gender discrimination often inhibits full use of their talents. The GHI should promote gender equity in such areas as entry into health professional schools, opportunities for advancement, workplace climate, and other issues of human resources management.
- Establish a health care financing strategy that includes covering recurrent costs of frontline health workers and staff upgrading.
How much will this cost and is this doable given the current economic environment?
The Coalition is first asking the U.S. government to commit to a strategy for 250,000 new frontline health workers as part of an overall health workforce strengthening plan, then – by 2015 – to ensure adequate and effective financing for frontline health workers in the context of robust U.S. global health funding. This should include: strategic use of existing bilateral and multilateral funding to achieve the greatest impact; increased bilateral support; and leveraging multilateral health commitments to invest more in frontline health workers. This goal can be met in partnership with the private sector and NGOs who have a vested interest in a healthy workforce and healthy communities. The eventual cost will depend on how the workforce is configured country-by-country. The cost of training a community health worker can be as low as $300. Training higher level professionals would cost more. The optimal mix of health workers will vary by country so the cost will also vary. A good strategy will encourage the most effective and efficient use of available resources in a way that meets a country’s global health needs and priorities. Of the total U.S. federal budget, international affairs programs represents about 1 percent of the total budget. A well-designed program to train and equip 250,000 frontline health workers would cost a small fraction of this 1 percent.
What is the impact of the brain drain? Isn’t that the biggest problem?
Migration is not the main cause of the health workforce crisis, particularly among frontline health workers who are often rooted in their communities. That said, the migration of highly skilled health providers from poor countries to rich countries is a concern. For example, foreign-trained physicians in rich (OECD) countries have increased by 240% since 1980. Countries should work to end the active recruitment of health workers from countries in great need, and implement the WHO Code of Practice on health worker migration. We commend the U.S. government’s support for the Code. At the same time, many countries are not educating enough of the right kinds of health workers nor are they making best use of existing health workers. For that reason, the U.S. role should be to strengthen local capacity to educate, deploy and support health workers.
What will keep health workers in the rural and other underserved areas where they are most needed?
Health workers need to be motivated to stay in the under-served areas where they are most needed. Where possible, health workers should be recruited and trained locally. The GHI/U.S. global health programs should promote evidence-based approaches to attracting and retaining workers where they are most needed. This typically requires crafting a package of financial and non-financial incentives that meet the needs expressed by health workers, which, in addition to wages, may include housing, security, transport, school allowances for children, opportunities for continuing education, career advancement, workplace resources and environment and regulatory reform.