This pandemic has spotlighted the critical role and bravery of health and care workers. That's why I've asked my Administration to develop a global health workforce plan, to accelerate our contributions to the Sustainable Development Agenda and investments in health and care workers.
President Joseph R. Biden, April 7, 2022
Strategic and sustained investments in the global health workforce are key to catalyzing the U.S. Government's efforts to achieve the 2030 Sustainable Development Agenda. The COVID-19 pandemic has further exacerbated the estimated global shortage of 18 million health workers by 2030. With growing health demands from new and emerging pathogens, aging populations, climate shocks, and increasing conflict and migration, the ever-increasing demand for health workers needs greater coordinated attention and action. A comprehensive, trained, protected, well-equipped, and supported workforce is foundational to expanding equitable access to public health services and health care across the globe. Investments in health workers not only improve health outcomes, they create jobs and career pathways and economic development by strengthening human capital as part of the care economy. Funding advancements for the health workforce will accelerate ending the COVID-19 pandemic, stimulate economic recovery, and support critical components of President Biden's values-driven global infrastructure initiative announced at the 2021 G7 Summit by strengthening global health systems, expanding national and regional capacity, including manufacturing of essential medical products. These investments will also build on commitments made by global partners at the 2nd Global COVID-19 Summit co-hosted by the United States to accelerate combatting COVID-19 and advancing future preparedness.
Currently, 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 approximately $1.56 billion annually to support the health workforce across the globe. Further, the President's Fiscal Year (FY) 2023 Budget prioritizes advancing investments across health programs to strengthen health systems and the global health workforce and support. Notably, the President's Budget includes an additional $1 billion for this new Global Health Worker Initiative to support and protect the global health workforce as part of the Administration's increased prioritization and investments in health workforce. This funding, if provided by Congress, would be directed through the U.S. Department of State and the United States Agency for International Development (USAID) and coordinated with others in the U.S. government.
The Global Health Worker Initiative expands and defines "health workers" broadly to include a multidisciplinary workforce including clinicians, community health and care workers, and public health professionals. It provides a framework to guide and organize the U.S. Government's investments and strengthen coordination with key partners including G7 and G20 countries, multilateral and regional organizations, and the private sector. While global in focus, this effort complements President Biden's efforts to support the domestic health workforce.
From the beginning of the Biden-Harris Administration, the United States has demonstrated renewed leadership in global health through action and smart, targeted investments. The United States will continue to advance global health priorities and build upon existing efforts aligned to the following four pillars of focus under the Global Health Worker Initiative:
PROTECTING HEALTH WORKERS
Through global health programs, the U.S Government will advance work to ensure health workers across facilities and communities have prioritized access to vaccinations [and treatment], personal protective equipment (PPE), and services to support their physical and mental health and well-being and better protection and safeguards from violence and attacks on health facilities, including in conflict and humanitarian settings.
- Accelerate coordinated efforts to protect health workers fighting COVID-19. The COVID-19 Global Action Plan (GAP), announced by Secretary Blinken on February 14, 2022, has six lines of effort to help end the acute phase of the pandemic, including a dedicated effort specifically to support health workers. The GAP aims to galvanize partner countries and international organizations to decrease risks posed by COVID-19 by increasing vaccine and treatment availability, encouraging vaccine uptake, addressing workplace safety, and health worker training.
- Provide tools and resources for health workers responding to COVID-19 while ensuring delivery of primary health services. Ongoing U.S. Government programming is adapting to account for the pandemic. For example, PMI trains health workers to efficiently and effectively diagnose and treat malaria in the context of COVID-19, including educating patients to avoid risk of transmission and where to access COVID-19 and malaria treatment services. PEPFAR-funded health workers have ensured delivery of essential HIV prevention and treatment services while responding to the pandemic, by leveraging over 100,000 health workers to support COVID-19 needs across more than 40 countries. PEPFAR is also focused on reducing the risk of health worker burnout and longer-term mental health effects by providing support, including time off for self-care, recuperation, and family's needs; and advancing access to mental health services. Additionally, the U.S. Centers for Disease Control and Prevention (CDC), at the Department of Health and Human Services (HHS), is working to improve local and regional healthcare personnel safety and infection prevention and control in more than 15 countries across four continents. These efforts involve healthcare worker surveillance to quickly detect infections; facility-based comprehensive safety assessments and quality improvement initiatives; infectious disease detection and response; training, supervision, and regional communities of practice; and technical engagement with Ministries of Health to ensure implementation consistent with global norms.
- Supporting health workers in conflict settings. In Ukraine, USAID is supporting the Ministry of Health and National Health Service of Ukraine to develop an incentive system to attract, retain, and equitably distribute health care workers in war-impacted regions, using both financial and non-financial incentives so that local authorities will be better able to hire health care workers to fill critical shortages. To address the significant mental health strains of COVID-19 and the subsequent Russian invasion, USAID is also supporting the scale-up of mental health counseling services for conflict-affected populations, including health workers.
EXPAND THE GLOBAL HEALTH WORKFORCE AND ACCELERATE ECONOMIC DEVELOPMENT
The U.S Government will continue efforts to create career pathways and expand paid employment opportunities for a more diverse and gender equitable workforce in the public and private health sectors, better equipping healthcare and community health workers, to meet local population health needs including provision of patient-centered services at the primary health care level. These efforts will further build local and regional institutional capacity to manage and support a global health workforce that is adequately prepared and aligned to respond to routine and emergency surge capacity needs.
- Promote fair and timely pay for all health workers. Through our global health programs, including PEPFAR and PMI, we will continue to promote fair and timely compensation for health workers. PEPFAR will continue to align its financial support for over 330,000 health workers, a $1 billion annual investment, helping achieve HIV epidemic control in over 40 countries. Similarly, PMI recently updated their policies to allow the use of PMI funds to provide salaries or stipends to community health workers in settings where payment to them is in line with government policy.
- Develop a multidisciplinary Global Health Security workforce. Achieving global health security requires a multi-sectoral approach that incorporates an understanding of the linkages among human, animal, and environmental health- a "One Health" approach. As part of the U.S. Government's Global Health Security programs, USAID is investing up to $85 million over five years to create a "next generation" health workforce. In 2021, USAID worked with more than 110 universities in 17 countries across Africa and Southeast Asia to train more than 18,000 current and future health workers for more effective disease surveillance and control. CDC has partnered with five leading international organizations to develop the Global Laboratory Leadership Programme (GLLP). The GLLP is a comprehensive One Health-based training program for human and animal health laboratories. The GLLP is currently implemented in over 20 countries in the Americas, Africa, Asia, and the Middle East. In addition, the CDC Field Epidemiology Training Program (FETP) is recognized worldwide as an effective means to strengthen countries' capacity to prevent, detect, and respond to public health threats through enhanced surveillance, epidemiology, and outbreak response functions. CDC works with partner countries to establish FETPs and to train epidemiologists across all levels of a country's health system. To date, FETP has been implemented in more than 80 countries around the globe with more than 20,000 graduates with many FETP graduates becoming leaders and managers in Ministries of Health or national public health institutes. These activities accelerate progress of the United States Global Health Security Strategy, and will continue to help our partners build country-level capacities in line with their World Health Organization Joint External Evaluations, National Action Plans for Health Security, and other tools the strengthen compliance with the International Health Regulations (IHR 2005).
- Collaborate with local partners and country governments to build a sustainable health workforce. As part of localization efforts, USAID is advancing work with local partners to strengthen human resources planning, management, and oversight to overcome health worker shortfalls. Increasing direct partnerships with host country government entities is essential to improving sustainability of health systems. For example, USAID, through a $10 million Government-to-Government (G2G) investment, is working with the Government of Malawi to fill critical health workforce financing gaps and strengthen health systems. Part of the Malawi G2G programming agreement includes a phased transition of these health workforces to Malawi Government financing, with immediate provision of critical health services while building systems to sustain those health workers beyond USAID funding.
- Optimize the health workers to support global COVID-19 vaccination efforts. The Initiative for Global Vaccine Access (Global VAX), a whole-of-government effort to turn vaccines in vials into vaccinations in arms around the world, builds on existing U.S. Government efforts with total cumulative commitments of more than $1.7 billion, helping over 100 countries prepare to receive and administer COVID-19 vaccines with surge funding and support to 11 countries (Angola, Côte d'Ivoire, Eswatini, Ghana, Lesotho, Nigeria, Senegal, South Africa, Tanzania, Uganda and Zambia). Through Global VAX, the U.S. Government is providing financial and technical assistance to engage and train additional health workers for vaccination efforts, including vaccine delivery, community engagement, record keeping, local micro-planning, and cold chain maintenance.
ADVANCE EQUITY AND INCLUSION
President Biden's commitment to advancing equity and inclusion goes beyond our borders. The U.S Government will carry forward his commitment globally to address numerous barriers, including gender, ethnic/racial, geographic, age, and others, particularly among the community health workforce, to build a more diverse cohort of health worker graduates and leaders that reflects inclusivity, is better-equipped to serve local populations and provide patient-centered care including at the primary health care level.
- Addressing the gender gap. Recognizing that women represent 70 percent of the global health workforce, the U.S. Government is increasing waged employment opportunities and leadership opportunities for women in the health workforce in alignment with the U.S. Government's first-ever National Strategy on Gender Equity and Equality with commitment to advance the full participation of all people- including women and girls- in the United States and around the world, focus on building the global care economy and care infrastructure, and improve economic security and accelerate economic growth. This includes USAID's development of recruitment strategies for employment of at-risk, vulnerable youth and women; partnership with the private sector; and supporting the professionalization of community health workers. PEPFAR has invested more than $1.3 billion supporting nearly 2.5 million adolescent girls and young women through the Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) program in the last five years. The partnership supports adolescent girls and young women with socioeconomic opportunities, including employment in the health sector, as part of efforts aimed at reducing rates of HIV among adolescent girls and young women in the highest HIV burden countries.
- Health workers reflect the populations they serve. It is critical that countries recruit and retain a diverse health workforce to help meet the needs of those populations. PEPFAR has partnered with Historically Black Colleges and Universities through Health Resources and Services Administration (HRSA), at HHS, to provide opportunities for adolescent girls and young women, who are at high risk for early sexual debut and HIV, to receive training as community health workers and be employed to provide essential health services to their home communities in areas where there are critical shortages of health care workers. This work has started in Malawi.
- Diversifying the global health research workforce. The National Institutes of Health (NIH), part of HHS, is the largest funder of health research in the world, and is building an inclusive, diverse, and global scientific workforce conducting research in Federal government laboratories. In addition, the NIH Fogarty International Center (FIC) has an exclusive international mission and responsibility for foreign research coordination that includes a focus on building research capacity in low- and middle-income countries (LMICs) by providing training and research support through a variety of programs to address emerging global health needs. Much of FIC's resources are dedicated to building research capacity in LMICs. Since 1989, more than 7,500 individuals from over 130 countries have trained through FIC programs.
- Reaching rural and remote populations. Across the globe, Peace Corps staff and Volunteers continue to work alongside existing health service providers and community health workers in difficult to reach rural and "last mile" communities and provide training of health workers to support vaccination, community engagement, disease prevention measures, surveillance activities, referral facilitation, and social and behavioral change to promote delivery of improved quality health services delivery.
DRIVE AND INVEST IN TECHNOLOGICAL ADVANCEMENTS AND INNOVATION
The U.S Government will further harness innovation and expand digital technologies that equip health workers with the ability to provide more efficient, quality-integrated service delivery, including telehealth services that can extend the reach of health services from facilities and into communities, including the most marginalized populations. The use of digital platforms will be expanded to improve the availability and routine use of quality health workforce data to inform decisions about workforce planning and operations, including performance management and consistent remuneration, and also expand the use of digital tools.
- Digital health as a tool to advance primary health care. USAID's Vision for Action in Digital Health and Vision for Health System Strengthening 2030 together lay out a plan for how USAID can increase the responsible use of digital technologies to accelerate programming in the health sector in strategic coordination with partner countries. USAID is investing in integrated digital platforms to advance patient-centered care and support front-line health workers. Current investments include working to advance broad-based functionality and guide improvement of standardized digital health tools and systems used to support health workers in providing a set of essential patient-centered primary health care services.
- Digital systems provide real time data to health workers. PMI supports digital tools in partner countries to equip health workers with real-time data. PMI improves evidence-based decision making by strengthening data collection, management, analysis, and utilization at all levels of the health care delivery system. PMI has invested $8.5 million in Rwanda, Senegal, and Burkina Faso to strengthen integrated and equitable care by equipping community health workers with tools needed to be better-connected to other health workers, bring care to unreached populations, and improve access to near real-time data.
- Technology to support data for decision making. PEPFAR invests nearly $22 million annually to support the development and use of human resource information systems and digital health platforms. These investments provide data for better understanding of the available health workforce and health worker utilization and an additional modality to ensure continuity of safe provision of services. These investments proved invaluable during the COVID-19 pandemic with the employment of modified service delivery models including telehealth service.
