Frequently-Asked Questions

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. The Coalition believes 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 coalition of nongovernmental organizations or companies – both public and private – 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 developing countries through a range of planned advocacy activities..

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?

A complete list of members is available on our website. Interested U.S.-based nongovernmental organizations or companies – both public and private – with a history of and an interest in global health and health workforce advocacy can inquire about membership by e-mailing Deputy Director Vince Blaser at vblaser@intrahealth.org.

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 mfolse@intrahealth.org or the Deputy Director Vince Blaser at vblaser@intrahealth.org. For media inquiries, please e-mail or call Vince at +1 202-407-9444.

You say there is a shortage of at least 1 million frontline health workers in the developing worlD. Where did thIS figure 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. At least 1 million is generally accepted as a conservative estimate of frontline health workers needed in developing countries.

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 U.S. also should 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 U.S. 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 financing strategy that includes covering recurrent costs of frontline health workers and staff upgrading.

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 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.