One year ago, the White House launched the Global Health Worker Initiative (GHWI), recognizing that a health workforce that is supported, equipped and protected to provide essential public health functions is integral to reclaiming lost ground from the COVID-19 pandemic and preparing for future health threats. This initiative aims to meet an urgent need: the World Health Organization expects a global shortfall of 10 million health workers by 2030, mostly in low- and middle-income countries. Through the GHWI we are better aligning investments in health workers across the U.S. Government, building stronger partnerships on health workforce with bilateral partners, multilateral institutions, including the World Health Organization, and other philanthropic partners, and reorienting our global health programs toward cohesive efforts that build stronger and more resilient health systems.
The United States is providing approximately $10 billion in global health program funding with Fiscal Year (FY) 2022 funds. U.S. Government programs such as the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the U.S. President's Malaria Initiative (PMI), and U.S. bilateral global health security partnerships in support of the Global Health Security Agenda, contribute more than $1.6 billion annually to support the health workforce across the globe. Building on those ongoing investments, the President's FY 2024 Budget requests increased investments across health programs to strengthen health systems and the global health workforce, including $20 million in new resources to directly support the Global Health Worker Initiative.
The GHWI has four pillars focused on: 1) protecting and supporting health workers; 2) expanding the global health workforce and accelerating economic development; 3) advancing equity and inclusion; and 4) driving and investing in technological advancements and innovation. One year into our implementation of the GHWI, we have delivered concrete outcomes, including:
PROTECTING and SUPPORTING HEALTH WORKERS
The United States has worked to protect health workers by prioritizing their access to vaccines and personal protective equipment, and working to safeguard them from violence, including in conflict and humanitarian settings. For example:
- The United States is supporting efforts to learn how to prevent and mitigate consequences from attacks on health workers. As part of continuing efforts to support global tracking of attacks on health workers, the U.S. Agency for International Development (USAID) supports research on the impact of attacks on health and best practices for preventing attacks, improving reporting across countries, and identifying ways to mitigate consequences on the mental and psychosocial health of health workers and provision of health service delivery. In 2022, the United States joined more than 100 countries to co-sponsor a resolution at the World Health Assembly calling on Member States to take key actions related to planning, financing, education, employment and protections for the health and care workforce, with support from the World Health Organization.
- The United States is building health worker capacity to advance global health security. This year, the United States has expanded support to assist 50 countries to achieve specific health security goals and to catalyze support for another 50 countries. This effort will continue to increase health workforce capacity, including through support for laboratory staff, epidemiologists, veterinarians, information technology and social communication specialists. In FY 2022, USAID, in partnership with the Africa One Health University Network and the Southeast Asia One Health University Network, supported workforce development in 120 universities across 17 countries in Africa and Southeast Asia, training over 7,000 health workers in FY 2022 to prevent, detect, and respond to global health security threats.
EXPANDING THE GLOBAL HEALTH WORKFORCE AND ACCELERATE ECONOMIC DEVELOPMENT
The United States has worked to expand the global health workforce and accelerate economic development by creating career pathways, expanding paid employment, and better equipping health workers to meet population health needs. For example:
- The United States is investing in primary health care workers as the backbone of health system recovery. At the U.S.-Africa Leaders Summit in December, USAID announced the launch of Primary Impact, an effort to advance primary health care (PHC) working in partnership with governments in seven focus countries in Africa and Asia: Côte d'Ivoire, Ghana, Kenya, Nigeria, Malawi, Indonesia, and the Philippines. Through Primary Impact, the United States aims to build country capacity to effectively manage and finance health worker production and employment, which is critical for the under-resourced ranks of primary health care workers. Priorities for advancing primary health care and supporting health workers were also integrated into the new USAID Policy Framework launched in March 2023.
- Last year, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) supported health workers around the world, including over 169,000 community health workers; over 11,000 doctors, medical officers and medical assistants; nearly 20,000 nurses and midwives; 40,000 social work and case management staff; over 6,000 laboratory staff and nearly 3,000 pharmacy staff; critically skilled health workers, including over 160 epidemiologists and nearly 700 mental health providers; and over 7,000 highly skilled and experienced technical assistance providers and trainers.
- Community health workers are a critical cadre in delivery of services supported across global health programs, and the United States supports efforts to professionalize these cadres across the globe. In June 2021, the U.S. PMI changed their policy to allow for the payment of community health worker (CHW) salaries and stipends with PMI funds, while advancing efforts to catalyze other donors and work with partner governments on a sustainable approach for governments to assume primary responsibility for health worker salaries over time. In addition to supporting efforts in Liberia and Guinea to ensure that CHWs are paid using domestic resources, PMI has conducted assessments to lay out a path for transferring community health worker salaries to governments, including in Sierra Leone. USAID is the primary funder and founding member of the country-led, global Community Health Roadmap partnership that supports more than 15 countries to professionalize and integrate CHWs into health systems. Through this partnership, USAID supported the 3rd International CHW Symposium in March 2023, led by the Government of Liberia. The symposium culminated in a Monrovia Call to Action by 46 countries that calls for investments in country-led community health strategies, professionalizing CHW roles, and integrating CHWs into health sector plans, among other areas. Due in part to this strong partnership, the Government of Liberia announced in March 2023 that they will be allocating $1.6 million to support the payment of CHW supervisors the President of Guinea signed a new law in April 2023 committing the government to paying CHW salaries.
- The United States is supporting multilateral institutions to build a sustainable health workforce. The United States is supporting the WHO Regional Office for Africa (AFRO) in advancing regional dialogue on the investment and protection of the health workforce and in the development of the Human Resources for Health (HRH) Investment Charter, which aims to align and stimulate investments to halve inequities in access to health workers; especially in those African countries identified as having the greatest shortages.
ADVANCING EQUITY AND INCLUSION
The United States is working to advance equity and inclusion by addressing barriers, including gender, racial/ethnic, geographic, age, and others, to build a more diverse cohort of health workers and health leaders who truly reflect their communities. For example:
- The United States is promoting fair and timely pay for all health workers. GHWI priorities are aligned with the White House National Strategy on Gender Equity and Equality and the Biden-Harris Administration's enduring commitment to workers' rights, in support of building the global care economy and care infrastructure, and strengthening women's economic security in the health workforce, including by addressing pay inequity, harassment, and other barriers to career advancement.
- The United States is creating a more equitable and inclusive health workforce to support reduction in maternal and child mortality. USAID launched the 2023-2030 Preventing Child and Maternal Deaths Framework, which includes the health workforce as one of six strategic approaches to further reduce maternal and child mortality across priority countries and expand access to high quality equitable care. Across Ghana, India, Madagascar, and the Caribbean region, USAID is working with country stakeholders to improve nursing and midwifery policy issues aimed at improving reproductive, maternal, newborn, and child health outcomes.
- PEPFAR released its Five-Year Strategy: Fulfilling America's Promise to End the HIV/AIDS Pandemic by 2030. To advance Africa's commitment to increase and retain health care workers, in December 2022, PEPFAR committed to investing approximately $1.1 billion annually to support the more than 325,000 health workers in the region who enable the delivery of HIV/AIDS programs. The support for this health workforce will not only protect and scale HIV gains, but can also be leveraged to fight outbreaks and other disease threats. Important work is also happening in Asia, with an emphasis on building health worker capacity at the community and national level to address the HIV epidemic. For example, in Thailand, PEPFAR-supported community health workers were trained to investigate gender-based violence and intimate partner violence and now use protocols to guide their work with key population clients. In Cambodia, PEPFAR collaborated with the government to train health care providers on non-discrimination.
DRIVING AND INVESTING IN TECHNOLOGICAL ADVANCEMENTS AND INNOVATION
The Biden-Harris Administration is working to drive and invest in technological advancements and innovation to equip health workers with the ability to provide more efficient, quality-integrated service delivery, including through the use of digital platforms. For example:
- The United States is building the capacity of laboratory workers and epidemiologists to detect global health threats. Through the Global Laboratory Leadership Program, the Centers for Disease Control and Prevention (CDC) mentors current and emerging laboratory leaders to build, strengthen, and sustain national laboratory systems with a One Health focus. The Field Epidemiology Training Program (FETP) strengthens countries' capacity to prevent, detect, and respond to public health threats. FETP graduates were mobilized during recent outbreaks of Rift Valley Fever and Crimean-Congo hemorrhagic fever in Mauritania, Sudan Ebolavirus in Uganda, and the 2021 Ebola outbreak in Guinea, as well as the COVID-19 response in multiple countries.
- The United States is improving the availability of health worker data to improve quality of care. USAID supported the revision of the Service Provision Assessment (SPA) survey, part of USAID's Demographic and Health Surveys Program which has implemented over 400 surveys in over 90 countries across the globe. This revision was conducted to support the need for better health worker protection including: the availability of infection prevention items, health workers' professional qualifications and background, recent in-service training, supportive supervision, fair and timely payment, equal treatment and opportunities irrespective of gender, direct and proxy work satisfaction, including their experience of abuse at work. The resulting data will be used to inform more effective policies to protect and support health workers and build stronger health systems.
- The ASEAN Science and Technology Fellowship, now in its fifth cycle, is a partnership between the ASEAN Foundation, ASEAN Committee on Science, Technology and Innovation, ASEAN Secretariat and the U.S. Government that provides opportunities for scientists in Southeast Asia to apply their knowledge and skills in promoting evidence-based policy making in the region. Now in its fifth cycle. This year the themes are Digital Economy, Innovative Startups and Science, Technology and Innovation for the United Nation's Sustainable Development Goals (SDGs).
