Frontline Health Workers – Policy Position

September 2020

An Urgent Issue

Good health does not start in hospitals, but in homes and communities. Well-functioning health systems must be anchored in community-based and primary care—prioritizing the pursuit of health, not just the detection and treatment of disease. Frontline health workers (FLHWs)—in particular nurses, midwives and community health workers (CHWs)—play a critical role in delivering primary care and universal healthcare (UHC) by helping communities manage their health and creating a trusted bridge to the formal health system.

Yet the world is facing a critical health worker shortage and a crisis in quality of care. Today, there is a deficit of nine million nurses and midwives globally, plus a lack of training, resources, supervision, growth opportunities, emotional support and recognition, impacting those serving on the front lines to deliver quality care. There is increased recognition that investing in FLHWs and making their concerns a priority in policy agendas will support health systems and communities. FLHWs form the backbone of primary and community health systems and are a vital resource for matters of global health security, such as rapidly emerging pandemics like COVID-19.

Our Policy Position

We call on all stakeholders to advance policies and programs that support FLHWs and ensure the global health workforce is adequately resourced to care for future generations. This includes ensuring labor market demand and sufficient compensation to motivate qualified individuals to choose these professions. FLHWs should be supported with fair pay, ongoing professional development, support systems that ease the burden of their jobs and allow work-life balance, safety and security, and meaningful diversity in leadership.

We advocate for advances in five areas to directly support FLHWs, including:

  • Training & Education – Ensuring FLHWs have the skills and capabilities they require by supporting evidence-based education and professional development opportunities.
  • Leadership & Management – Ensuring FLHWs have opportunities to grow as leaders and have access to effective supervision and performance management within strong, interprofessional teams.
  • Well-being & Resilience – Ensuring FLHWs can prioritize their own health and access resources to manage the stress and demands of the job. Workloads should be manageable, with assurance of workplace safety—particularly in conflict zones and during pandemics like Ebola and COVID-19.
  • Connection & Integration – Ensuring FLHWs are connected to each other, to communities, and to health systems for efficient, data-driven and responsive care. We encourage governments to establish digital health policies, strategies, investment and infrastructure, with consideration for data security and patient privacy—from integrated systems that extend through community care to digital tools such as telemedicine. Partnerships with civil society should facilitate and strengthen these efforts.
  • Respect & Recognition – Ensuring FLHWs are valued by the communities they serve, their perspectives are heard, and they are accredited and appropriately compensated by government and health systems. We call for the elimination of bias and discrimination on the front lines of healthcare, where women and people of color continue to face barriers to employment, equal pay and advancement.

We applaud government efforts, particularly across emerging markets, to pioneer new community-based approaches to health. We encourage governments across the globe to scale up integrated and sustainably financed models of community-based care in support of UHC.

Learn more about our advocacy efforts across our five areas:

Training & Education
Leadership & Management
Well-being & Resilience
Connection & Integration
Respect & Recognition
Training & Education
Ensuring FLHWs have the skills and capabilities they require by supporting evidence-based education and professional development opportunities.
Coordinate global funding to support sustainable frontline health workforce strengthening in countries identified as pandemic hot spots or countries with low capacity to respond to outbreaks and high vulnerability based on the Infectious Disease Vulnerability Index.

Target investments in workforce education to communities with greatest need, to enable recruitment of FLHWs within those same communities.

Civil society, including academia and standard setting organizations, should partner with governments to formalize training and accreditation for FLHWs, to include evidence-based education, skill development and leadership/management training.

Governments should prioritize digital infrastructure and use of innovative solutions like mobile health technologies to facilitate FLHW education and ongoing development.
Leadership & Management
Ensuring FLHWs have opportunities to grow as leaders and have access to effective supervision and performance management within strong, interprofessional teams.
Health system leaders at all levels should articulate clear pathways for advancement that begin at the entry level, improved retention for employers and more efficient health systems at at the national level.[i][ii]

We call for greater professionalization of primary care teams, in part through accreditation and by defining and broadly communicating career pathways and promoting effective supervision at all levels.

[i] https://www.healthaffairs.org/do/10.1377/hblog20170705.060894/full/
[ii] https://www.advisory.com/research/hr-advancement-center/studies/2016/health-career-pathways
Well-being & Resilience
Ensuring FLHWs can prioritize their own health and access resources to manage the stress and demands of the job. Workloads should be manageable, with assurance of workplace safety—particularly in conflict zones and during pandemics like Ebola and COVID-19.
Health system leaders should prioritize health worker well-being and resilience at the individual, organization and system level and take steps to identify and support health workers at risk of burnout by offering adapted schedules, additional staffing and links to support services.

All health workers have a right to safe working conditions (including personal protective equipment), fair workplace policies and manageable workloads.

The essentials of good hygiene must be available to all FLHWs, including water, sanitation and hygiene (WASH) services, including adequate clean water, supplies and soap, plus personal hygiene products, who are often working long shifts in continuous personal protective equipment (PPE). FLHWs should also be trained on WASH procedures.

Funds for health workers’ own health-related expenses, including mental health services, nutrition and relief for the families of health workers, should be provided.

Policy and response working groups must be gender balanced, as diverse perspectives are necessary to develop innovative solutions that avoid gaps in service delivery, response and recovery.

Health facilities should provide free, safe childcare for working parents and support the distinct needs of women in their workplace—for example, the ability to breastfeed. Emergency childcare services, or economic relief for fees associated with these services, should be provided for health workers.

Measures should be taken to prevent sexual harassment and assault in the workplace, which has a range of serious consequences, including job performance, earnings and advancement, among others.[i][ii]

Throughout epidemics or pandemics, on-site or near-site temporary housing and childcare should be provided for FLHWs who need it.

FLHWs should be prioritized to receive new evidence-based tests and vaccines. Those health workers responding to pandemic situations should be routinely tested, at no personal cost.

[i] https://www.nationalpartnership.org/our-work/resources/economic-justice/fair-pay/sexual-harassment-and-the-gender-wage-gap.pdf
[ii] https://iwpr.org/publications/sexual-harassment-work-cost/
Connection & Integration
Ensuring FLHWs are connected to each other, to communities and to health systems for efficient, data-driven and responsive care. We encourage governments to establish digital health policies, strategies, investment and infrastructure, with consideration for data security and patient privacy—from integrated systems that extend through community care to digital tools such as telemedicine. Partnerships with civil society should facilitate and strengthen these efforts.
We encourage governments to establish digital health policies and strategies to bridge FLHW gaps and augment brick-and-mortar services. Digital infrastructure needs should be assessed and prioritized to equip, strengthen and support the healthcare system and FLHW.

The adoption of tools to improve systems integration, connections between FLHW and their patients, and workflow efficiencies should be prioritized.

Data privacy and security frameworks should be implemented that appropriately balance the rights of individuals to control the collection, use and dissemination of their personal information with the needs of healthcare systems and participants to collect, use and share information for treatment and prevention, research, scientific, innovation and regulatory purposes.

In epidemic or pandemic situations:
  • National and donor agency plans should align with WHO guidance. Member states should agree to both regional and global plans, including the Workforce 2030 Global Strategy for Human Resources for Health[i]
  • Countries should provide transparent, timely data on the number of FLHW infections and deaths, including capturing demographic data such as gender, race and ethnicity.
  • Every jurisdiction should provide transparent data of key medical supplies, including PPE availability, staff at each facility, ICU and regular hospital beds, ventilators, and other needed data to ensure supply needs of frontline health workers are rapidly known by policymakers.
  • Any restrictions from USAID, State Department, HHS, CDC, HRSA or other federal agencies that inhibit needed support to FLHW, including salary support, should be lifted.
  • Mechanisms should be created that would allow all relevant agencies to facilitate collaborative learning between domestic and global FLHWs, strengthening programs to improve effectiveness and outcomes.

[i] https://www.frontlinehealthworkers.org/sites/fhw/files/fhwc_covid-19_recommendations.pdf
Respect & Recognition
Ensuring FLHWs are valued by the communities they serve, their perspectives are heard, and they are accredited and appropriately compensated by government and health systems. We call for the elimination of bias and discrimination on the frontlines of healthcare, where women and people of color continue to face barriers to employment, equal pay and advancement.
Women occupy 70% of health worker roles but only 25% of leadership positions[i]. Governments must take action to address racial and gender disparities in the healthcare workforce. Gender-transformative policies to eliminate discrimination are also important to support FLHWs.

We support policies that address gender- and race-related inequalities and barriers, such as:
  • Appropriation of sufficient government funds for FLHW wages and/or creation of public/private partnerships to provide sufficient financial support for FLHWs, including access to affordable (e.g., subsidized or free) childcare and other needs.
  • Elimination of the gender pay gap;
  • Supporting the distinct needs of women in the workplace (e.g., breastfeeding and flexible schedules to address family demands)

Safety and security measures should be available to all FLHWS. Calls for such measures should be nonpunitive; workers at all levels should have a voice and be encouraged to speak up about discrimination, hazards, and other safety problems.

Policies should be reviewed and updated based on a mindset of continuous improvements. Relevant data that measures FLHW experience and patient health outcomes should be collected and analyzed to inform policy.
  • Legislative frameworks should recognize community health workers by law, and not just as volunteer services.
  • Governments should work with partners and communities to leverage media and communication channels to promote messages about protecting health workers as national and community assets.

[i] https://www.who.int/hrh/resources/health-observer24/en/