Frontline Health Workers Are Key to Meeting Family Planning Needs Worldwide

By: Oying Rimon, Bill & Melinda Gates Foundation

Credit: The Bill & Melinda Gates Foundation

Around the world, frontline health workers are often the first link to lifesaving care and supplies, and in some cases they are the only link for families and communities in rural and impoverished areas. This is also where most of the world’s unmet need for family planning resides. More than 200 million women in developing countries want to delay or avoid pregnancy but lack access to modern methods of contraception.

Family planning and frontline health workers: worth the investment

In just a few short weeks, the foundation, together with the UK government and other partners, will host the London Summit on Family Planning. It will be a groundbreaking global convening of developed and developing country government and civil society leaders, who will pledge to address the contraceptive needs of an additional 120 million women in the world’s poorest countries by 2020. The summit will also focus on tackling cultural barriers to contraception and encourage countries to adopt a rights-based approach, which enables women to decide whether, when, and how many children to have. At the foundation, we often talk about how frontline health workers and family planning are extremely cost-effective strategies to save lives, and improve health and development broadly. For instance, every three seconds a child’s life is saved thanks to the care provided by a frontline worker (PDF), who can be provided basic training for as little as $300 (U.S.). Likewise, investing in family planning services has a proven cost-benefit return for both developing and developed country governments, and addressing current unmet contraceptive need could prevent one in three maternal deaths and one in four infant deaths.

A personal connection

For me, frontline health workers are not just a smart investment, but also a community I feel personally committed to. Back in the 1970s, one of my first jobs was as manager of a national family planning program in my native country of the Philippines, which included more than 4,500 outreach workers and 50,000 community-based volunteers providing information and services to couples in their neighborhoods. I met with many of these highly committed community-based workers and saw first-hand how crucial a role they played for the country’s population, nearly half of which resides in urban slums.

In the Philippines, this first-string of health providers, mostly midwives and barangay (village) health workers, fills the gaps of an overwhelmed healthcare system and provides critical health. As of 2012, contraception use in the country, which is 80 percent Catholic, is just 34 percent. Yet current political leadership is committed to bringing family planning services closer to the people. Recently, I was on a personal visit there and was pleasantly surprised to see many of the same individuals I used to know, still working for their communities–although many now qualify for senior citizen discounts!

Progress is possible

In other parts of the world, frontline workers are already doing more to provide family planning services to the poor and marginalized. For example, in Uganda, recent policy changes allow community health workers to provide injectable contraceptives to women, and have resulted in significant improvements in contraceptive access countrywide (PDF).

Frontline workers have the ability to reach those most in-need. We know that progress is possible. Yet in order to see results, frontline workers need to be adequately trained, supported, and integrated into the broader health system, and they need consistent access to cost-effective family planning supplies. Imagine the impact if we worked to prioritize policies like task shifting and training that enable frontline workers to deliver family planning services to meet the needs of millions?

The London Summit on Family Planning will aim to galvanize new financial and political commitments to ensure this progress, and convene leaders to affirm that every woman in the world deserves the opportunity to determine her own future. With the right resources and policy support, I believe there are few limits to what frontline workers can do. Empowering them with family planning knowledge and supplies, which they can deliver to women worldwide, will have an immediate and far-reaching impact. Doing so will benefit not just women themselves, but families, communities, and entire nations.

Frontline Health Workers Are Key to Meeting Family Planning Needs Worldwide’ is also featured on the Bill and Melinda Gates Foundation blog “Impatient Optimists.” You can view the post here.

Written by: Oying Rimon, Bill & Melinda Gates Foundation. The Bill & Melinda Gates Foundation is a member of the Frontline Health Workers Coalition, a dynamic and influential coalition of 25+ NGOs working together to urge greater and more strategic U.S. investment in frontline health workers in the developing world as the most cost-effective way to save lives and foster a healthier, safer and more prosperous world.

The Power of Technology for Training

By James BonTempo and Julia Bluestone, Jhpiego

It starts with a simple question: can information and communication technology be harnessed to improve and address gaps in frontline health worker training? The overwhelming answer, yes!

Dalberg Global Development Advisors, on behalf of the iheed Institute, the Barr Foundation, the mHealth Alliance and the MDG Health Alliance, recently released a landscape report on current approaches to community health worker (CHW) training, exploring what role technology, particularly mobile phones, could play in increasing the number and quality of community health workers. Many Front Line Health Worker Coalition member organizations were involved in the development of the report.

With developing countries facing an acute shortage of health professionals, CHWs—a type of frontline health worker—are oftentimes the only point of contact for patients in need. CHWs provide low-cost, lifesaving interventions in areas like maternal and child health, vaccinations and basic health education. To address the drastic shortage of frontline health workers globally, it’s clear we must scale up the number of CHWs while also improving the effectiveness of existing ones.

So, how can technology help us train more CHWs more effectively? According to the study:

– Evidence indicates that a “blended” approach that combines live  training   with interactive multimedia content can be as or more effective than standard, face-to-face training.

– Up to 80 percent of training content could be standardized and shared, reducing duplication of effort and saving time and money. Open licensing schemes, such as Creative Commons, could facilitate sharing of effective digital content.

– With mobile phone access as high as 80 percent among CHWs in some countries, mobile technology could be used to support training and informal learning. Every CHW with a mobile phone can use it to solve problems and seek advice from peers, mentors and supervisors—with something no more complex than a phone call or text message.

Using technology in the training of community health workers can support more efficient expansion in the numbers of frontline health workers, more effective training approaches and informal, peer-to-peer learning.

So, what’s next? Many members of the Frontline Health Worker Coalition are looking closely at how to develop innovative approaches to education and training supported by technology. What we’ve found, which corroborates many of the findings from the study, is that the development of education and training technologies must be driven by the needs and demands of frontline health workers and the populations they serve. Also, experimentation and innovation should be utilized in targeting well-characterized problems, rather than simply using technology because it’s available. It’s also important to have an appetite for risk, as the inevitable failures associated with innovation are essential to the learning process. And finally, implementing technology-supported training for frontline health workers is only one piece of the puzzle: we must advocate for and invest in all of the components of the health workforce system that contribute to their success.

As the study reminds us, a generation ago, few would have dreamed that mobile technology would create five billion points of contact around the world or that nine out of 10 Internet users in sub-Saharan Africa would access the Internet through mobile devices. Now that this dream has become a reality, it’s our turn to imagine how technology can transform global health for the next generation.

Want to learn more about the study and its findings? Use the technology at your fingertips and visit

Written by: James BonTempo and Julia Bluestone, Jhpiego. Jhpiego is a member of the Frontline Health Workers Coalition, a dynamic and influential coalition of 25+ NGOs working together to urge greater and more strategic U.S. investment in frontline health workers in the developing world as the most cost-effective way to save lives and foster a healthier, safer and more prosperous world.

Supporting Community Health Workers is Critical – But Who, What and How?

By Tana Wuliji, University Research Co., LLC

Community health workers—known by myriad titles, from health extension workers to village volunteers—form a critical part of the frontline health workforce in many low- and middle-income countries. So what kind of community and health system support improves community health worker (CHW) performance?

This very question was debated by around 100 individuals representing government agencies, academic institutions, and development organizations at the U.S Government Evidence Summit convened by USAID on May 31 – June 1.

Despite the hundreds of articles, reports and other documents published on CHWs and digested by the Evidence Review Teams to date, solid evidence to answer this question was scant.  While the evidence was limited, the discussion was anything but, with participants exchanging a flurry of experiences, beliefs and ideas.

That there should be support was clear, but exactly what combination of support was less clear.  Common themes that emerged in the evidence presented  pointed to the importance of communities being engaged to select CHWs, CHWs being physically and socially accessible and trusted, information being used for decision making, ensuring the availability of requisite materials and supplies, ensuring that CHWs have the competencies to perform, and the value of continuous efforts to improve.  Another idea flagged for further exploration was that country ownership of CHW programs should be extended to the idea of “joint ownership” by communities and the formal health system.

The evidence we have so far couldn’t discern what impact specific support activities had on performance and whether the way they were structured or organized had anything to do with it.  Neither could it answer the question of what combination of support activities are required to optimize CHW performance.

So what? 

There was a strong feeling that this gap in current understanding mattered, particularly with many countries scaling up CHW programs.  There was also some dismay that despite over 30 years of experience of large-scale CHW programs, such questions had not been effectively answered in the literature.  We clearly need more rigorous case studies that explain the “how” or the process by which outcomes were achieved.

What next?

Clear take-home messages from this Summit were that CHWs are an essential part of the frontline health workforce, that they need to be supported to perform, that more research is needed to better understand how they should be supported, and that investment is needed to better support CHWs, communities and health systems to perform.

That these take-home messages are translated to action is a call for us all.

Written by: Tana Wuliji. Tana is the Senior Quality Improvement Advisor for Health Workforce Development, University Research Co., LLC. University Research Co., LLC is a member of the Frontline Health Workers Coalition, a dynamic and influential coalition of 25+ NGOs working together to urge greater and more strategic U.S. investment in frontline health workers in the developing world as the most cost-effective way to save lives and foster a healthier, safer and more prosperous world.

Paradigm Shift Needed – 250,000 More Frontline Health Workers in Developing Countries

By Sharon Rainey, African Medical and Research Foundation (AMREF)

“When we went to Africa, it changed us completely – there is no way the Senator could ever vote for cuts to foreign aid now.”   This comment from an enthusiastic young congressional staffer at the Frontline Health Worker Coalition’s briefing in Washington pretty much summed up the theme of the entire session.  Every single person in that room left convinced of the undeniable importance of the frontline health worker in providing cost-effective, indispensable, community health services in developing countries.

From stories of the mobilization of 8,000 frontline workers in Haiti to assail a cholera epidemic (they were already located ‘in communities’), to Afghanistan’s tireless midwives, 70% of whom are illiterate and have found ways to communicate ante-natal and HIV prevention information to their communities through illustrations and unique knowledge training, frontline health workers have an enormous impact on improving global health.

Because they’re there, in their communities, speaking the local language and earning the trust of their neighbors every step of the way.

It was amazing to hear about Ethiopia’s successful Health Extension Worker (HEW) program from Dr Hailu Tesfaye, currently a medical practitioner with Save the Children, with extensive experience in Ethiopia’s Ministry of Health.  Imagine giving Grade 10 girls in rural villages a long term career opportunity that allows them to earn a living, provide much needed health services and become well respected members of their communities.

How did Ethiopia manage to train more than 40,000 HEWs and employ these young women in 15,000+ small villages throughout the country?  According to Dr Tesfaye, it took a very long time and was the result of a combination of factors:  relentless internal pressure on the government from women’s and physician’s groups, never ending perseverance, a need to respond to issues of gender equality and to stimulate employment in rural areas.  The program is now being replicated by neighboring countries in Kenya, Uganda and Malawi.  Although still challenged, Ethiopia anticipates that this program could actually help them attain certain Millennium Development Goals in 2015 – potentially a first among African countries.

I was also impressed by the straightforward, clear thinking of Dr Joia Mukherjee, Associate Professor, Harvard Medical School and Chief Medical Officer, Partners in Health.  Her main points included the need for a ‘strategic rethinking about getting close to those in need – that proximity – or being embedded in the community – is the key’.  Dr Mukherjee also declared that frontline health workers are not a solution unto themselves – that they must be seen as an extension to strengthen overall health systems – a view echoed in a most comprehensive article in The Lancet  about how a systemic approach to global health is required – one that includes more health workers, access, strategic leadership, an ability to leverage existing resources and a concerted global political movement for coordination among donors.

Mathew Taylor, a communications strategist from Intel, spoke eloquently about the value of public private partnerships – how they serve to advance the business opportunities of private enterprise by growing the economic potential of citizens in developing countries, as well as driving the agendas of civil society and facilitating their objectives.  In Intel’s case, their work centers around bringing multi-media e-learning content to health workers to exponentially build capacity in remote areas using mobile technology.  Ideally this will eventually lead to electronic health records which will also feed NGO advocacy efforts.  Technology enables incentives and such partnerships can also provide the means to attract, retain, educate and compensate community health workers.

A passionate plea came from Sheena Currie, a midwife educator, for more support of Afghan midwives who with so few resources manage to reduce post partum hemorrhaging and infection, the main causes of maternal deaths globally.  Having worked extensively with midwives there where even going door to door was a security hazard, Sheena found these frontline health workers to be “the most dedicated group of women I have ever worked with”.

Mandy Moore, a tireless ambassador for global health organization PSI not only lent her glow and eloquence to the gathering, but also spoke personally of her many visits to developing countries and her hope that in future visits to Africa, there will be frontline health workers in every community.

And finally, something for us all to think about.   Compared to the AIDS movement of the 80s, we as civil societies have not yet galvanized public opinion behind our cause.  We have not yet moved mothers in the developed countries to stand up for their sisters in the south.  One of our key challenges is to get the word out – that there is hope, optimism and enormous potential in supporting developing countries in their efforts to improve health, one community at a time.


Written by: Sharon Rainey, communications strategist at the African Medical and Research Foundation’s (AMREF) New York office. AMREF is a member of the Frontline Health Workers Coalition, a dynamic and influential coalition of 25+ NGOs working together to urge greater and more strategic U.S. investment in frontline health workers in the developing world as the most cost-effective way to save lives and foster a healthier, safer and more prosperous world.

Visit AMREF’s website here for more information.

Are You An “Action” Hero?

By Tara Fisher, Save the Children

What is a call to action?  These days, that phrase seems to be used just as much by people on the street as it used to be by politicos, activists and advertisers.  Every day, people are encouraged to write, share, call, or donate.  So has it lost its meaning?

USAID doesn’t think so and neither do we.  Sure, it may feel like a buzzword to some folks but in the right context, with the right message, delivered by the right group of people, it can be totally empowering.

When USAID announced that they, alongside the governments of India and Ethiopia, were going to host an event focused on a Child Survival Call to Action, it gave some of us goose bumps.  Governments were not only rallying around the subject of child survival, they were gathering to discuss the various political and technical issues that contribute to the problem of under-5 mortality and the variety of solutions.

For years, Save the Children, along with other members of the Frontline Health Workers Coalition, has been collecting evidence on the effectiveness of frontline health workers in contributing to increased health and survival of children under age 5 around the world.  As the tracking of the Millennium Development Goals has shown, countries which are able to implement strategic plans around the development and support of human resources for health are able to drastically reduce child mortality in some of the hardest to reach places.  In Bangladesh, for example, increased training and support for frontline health workers has proved crucial in helping that country reduce their child mortality rate by at least half and remain on track for achieving MDG 4.

More importantly, evidence suggests that the world will ONLY be able to end preventable child deaths if governments commit to eliminating the biggest threats to children – newborn complications, pneumonia, diarrhea, malaria, and malnutrition. It is obvious to people inside of the global development arena that frontline health workers are the key to delivering the education and interventions needed to eliminate these threats – and what’s encouraging about the Child Survival Call to Action is that it’s becoming obvious to governments too.

So there are a couple calls to action at play here.  One – governments need to make child survival a priority and allocate the investments needed to make ending preventable child deaths a reality, including substantial investments in training and support for frontline health workers.   Two – the public needs to urge governments to commit to, and hold them accountable for, training and supporting frontline health workers to expand access to health care for children and families around the world.

So here’s my call to action to you.  Take a moment to visit Save the Children’s Child Survival petition and show your support for the millions of existing health workers who are saving children’s lives and help put more of them on the frontlines.

Written by: Tara Fisher, Director of Campaign Strategy for Save the Children’s Newborn and Child Survival campaign. Save the Children is a member of the Frontline Health Workers Coalition, a dynamic and influential coalition of 25+ NGOs working together to urge greater and more strategic U.S. investment in frontline health workers in the developing world as the most cost-effective way to save lives and foster a healthier, safer and more prosperous world.