Frontline Health Workers: Health and Economic Returns on Investments

Authored by IntraHealth International, Inc.

A healthy world depends on frontline health workers. Often the first and only link to health care for millions of people, health workers in communities and health facilities deliver life-saving services directly where they are needed most. They are trusted sources of information in communities around the world, helping to promote healthy practices and providing services ranging from maternal and child health care to infectious and noncommunicable disease surveillance and control.

However, more than 400 million people worldwide lack access to essential health services provided by frontline health workersi. As a result, millions die or are disabled every year from preventable causes.

The lack of investment and focus on the frontline health workforce remains among the top barriers to achieving greater progress in global health. Consider:

  1. The 20 countries with the highest child mortality rates in the worldii all were classified as health workforce “crisis countries” by the WHO in 2006iii.

  2. Guinea, Liberia, and Sierra Leone all had fewer than 3 doctors, nurses, and midwives per 10,000 people before the Ebola epidemiciv. The WHO recommends at least 44 per 10,000 people are needed to deliver essential servicesv.

  3. The top barriers identified by PEPFAR focus countries in retaining clients in pre-antiretroviral therapy were lack of adequate staff and staff attritionvi.

Deficits in the health workforce include:

  • Poor distribution of health workers, especially in rural and remote areas

  • Mismatches between health needs and the composition and competencies of the health workforce

  • Insufficient production and skills tied to inadequate education and training capacity

  • Low retention and productivity

  • Weak human resources management systems and absence or lack of use of data for decision making

Current trends point to a deficit of 18 million health workers needed by 2030 to save lives and meet our global health goals, with much of that deficit confined to low- and middle-income countries.

Role of the US Government

The US government’s goals of ending preventable child and maternal deaths, achieving an AIDS-free generation, and ensuring global health security cannot be achieved without significantly more support to strengthen the global frontline health workforce. As the Ebola epidemic in West Africa tragically demonstrated, access to competent and supported health workers can no longer languish as a global health policy afterthought.

But with the right investments, the US can help usher tremendous health and economic returns. The returns on investment in health are 9 to 1, as economic growth is accelerated when a population is healthier. One extra year of life expectancy has been shown to raise GDP per capita by about 4%.vii New research by the World Bank finds that investment in health workers drives economic growth improvements more so than investments in the financial sector. Moreover, investment in the health workforce is an investment in women’s empowerment, since women make up about 67% of employment in the health and social sectors, compared with 41% across all other sectors.

US leadership helped push forward Workforce 2030, the first-ever global health workforce strategy, guiding health workforce strengthening efforts from 2016-2030. Frontline health workers have been at the forefront of US investments that have helped save an estimated 100 million children’s lives from 1990 to 2015viii and cut AIDS-related deaths by 45% since 2005ix. But American leadership is needed now more than ever as development progress is threatened by the severe shortage of trained and supported frontline health workers.

US health workforce investments must be guided by a multiyear, costed, cross-agency strategy with an implementation plan that sends an unequivocal message to our country partners: that America is committed to the global health workforce and that we expect others to respond in kind. This sign of commitment would go a long way in helping to ensure a serious and coordinated effort by all governments to implement the recommendations set forth in the Workforce 2030 strategy and the report of the UN High-Level Commission on Health Employment and Economic Growth. By maximizing the socioeconomic returns on investment in the health workforce, collectively we will contribute to the attainment of decent work, inclusive economic growth, and human security.

All US global health investments should include an assessment and adequate financing to address sustainability of the workforce and system of the recipient country, and the US should encourage action on UN Security Council resolution 2286 on protection of health care in conflict. In addition, US investments should aim to unlock greater domestic resources to develop state-of-the-art, context-specific training for their health workforces. Sufficiently scaling-up health service delivery is not attainable without the right number and the right mix of health workers in the right place. This can only be accomplished through strong human resources for health (HRH) leadership and efficient systems for health workforce planning, development, recruitment, deployment, and support.

The Road Ahead

Improving access to health workers is crucial to advancing progress in global health for all people everywhere. Threats such as Ebola and Zika can be halted when health workers coordinate community-level prevention, detection, and response efforts. Maternal and newborn mortality can largely be prevented when skilled birth attendants are present. The spread of HIV/AIDS can be slowed when health workers promote awareness, conduct voluntary counseling and testing, and provide treatment and care.

The US has a moral, economic, diplomatic, and security imperative to leave behind a legacy of strong health systems with frontline health workers at the center. Invest in health workers, especially those on the front lines of primary health care. Together we’ll save lives and build a healthier, more productive world.


Laura Hoemeke, MPH, DrPH, Director, Communications & Advocacy IntraHealth International,

Vince Blaser, MA, Director, Frontline Health Workers Coalition Advocacy Advisor, IntraHealth International,

i “Tracking universal health coverage: First global monitoring report.” World Health Organization/World Bank Group, 2015.

ii “Under-five mortality rate (per 1,000 live births).” United National Development Program, 2013.

iii “The World Health Report 2006 - working together for health.” World Health Organization, 2006.

iv “Cost of Scaling up the Health Workforce in Liberia, Sierra Leone, and Guinea Amid the Ebola Epidemic.” Frontline Health Workers Coalition, 2015. v “Global Health Workforce Labor Market Projections for 2030.” World Bank Group, 2016. projections-for-2030

vi “Linkage and Retention in Pre-ART Care: Best Practices and Experiences from Fourteen Countries.” United States Agency for International Development, 2013.


vii “Working for health and growth.” Report of the High-Level Commission on Health Employment and Economic Growth. September 2016.

viii “USAID Global Health Programs: Ending Preventable Maternal and Child Deaths – FY 2017.” USAID, 2016.

ix “Fact sheet 2016.” UNAIDS, 2016.


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