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From Liverpool to Astana: Frontline Health Workers Are a Catalyst for Universal Health Coverage

by Arush Lal

Last week, Health Systems Global, along with a robust group of partners in health systems research and policy, convened the Fifth Global Symposium on Health Systems Research in Liverpool, UK.

The attendees, a passionate and vocal conglomeration of 2,100 health systems researchers, clinicians, policymakers, educators, administrators, and advocates, spent the week focusing on issues ranging from health service gaps in fragile and conflict-affected states to global health security to engaging the private sector in managing noncommunicable diseases.

But what was clear from just about every session I attended was the critical role frontline health workers play in making health care possible in all communities and contexts. Whether it was coping with the migration of health workers from rural to urban areas in search of better-supported jobs to ensuring sustainable and quality health services in vulnerable communities to addressing pervasive power dynamics that perpetuate harmful gender imbalances in health care, health workers were a foundational aspect of much of the research and recommendations being shared throughout the week.

And a unifying theme emerged—well-supported frontline health worker teams made up of multiple cadres that are diverse and qualified to provide a full range of care are a catalytic component of achieving universal health coverage and the triple billion targets set by the WHO.

The Alma-Ata declaration, which boldly committed to “health for all” forty years ago, has unfortunately been sidelined over the past decades as health systems prioritized vertical approaches that focused on treating specific diseases rather than ensuring access to health services through robust primary health care. Today, over 8 million die annually in LMICs due to “inadequate access to quality care,” resulting in over $6 trillion in economic losses yearly.

But it was evident at the Health Systems Research symposium that the tides are shifting. Experts and policymakers are shifting the onus back on community health—and that means having robust frontline health workers who can deliver care at the center of primary health care programs.

In several panels and workshops throughout the week, there were strong appeals to better commit to milestones set forth in the Global Strategy on HRH: Workforce 2030, urgent calls to prioritize investments and funding in the health workforce to support frontline health workers in underserved communities, and countless examples of how training health workers in competency-based education yields massive gains in health outcomes for patients.

So as we look ahead to the 40th Anniversary of the Alma-Ata at the Global Conference on Primary Health Care next week, it’s important that we translate the mountains of evidence and recommendations on supporting frontline health workers to expand access to high-quality primary health services into tangible action through national and global policies and financial commitments.

I sincerely hope that with the incredible momentum being generated around robust primary health systems, the voices of frontline health workers are not only valued in discussions and policy outcomes, but prioritized. Their role as stewards of health services at all levels places them as the primary guardians of health care—and they should be valued as such.

If we have any hope to achieve universal health coverage or resilient primary health care systems, it hinges directly on how we empower frontline health workers so they may do their jobs effectively. From Liverpool to Astana, how we respond to the needs of health workers will either make or break our vision of a world where equitable, quality health services are accessible to all.

Let’s make sure to get it right this time.

Arush Lal, supported in part by IntraHealth International and the Frontline Health Workers Coalition, was selected as an Emerging Voice for Global Health during the recent HSR Symposium and a PHC Young Leader for the upcoming Global Conference on Primary Health Care. He is a former IntraHealth-Global Health Corps fellow and is currently pursuing an MSc in Health Policy, Planning and Financing at the London School of Hygiene and Tropical Medicine/London School of Economics.