Country Success Stories

Unleashing the power of frontline health workers.

Investments in frontline health workers yield real pay offs both in lives saved and in healthier, more productive populations. With help from international partners from the public and private sector, many countries have unleashed the power of frontline health workers to achieve progress on global health goals and to position themselves for a more prosperous future.

Ethiopia has a new program that has trained more than 38,000 frontline health workers. Results have included a doubling of the rates of young children who have been immunized, treated for pneumonia, and given vitamin A to prevent blindness and build their immune systems. Use of modern contraception has risen four-fold. Reports from the communities indicate that not only are children healthier, they are also doing better in school. Children’s ability to concentrate in class has improved and they miss fewer days of school due to illness.

Nepal has a unique, well-established body of 50,000 female health volunteers who are frontline providers of a wide range of maternal and child health services throughout the country. These health workers have been a bridge between the formal health system and the communities since the 1990s. They have achieved nearly universal coverage of vitamin A supplementation, can diagnose and treat pneumonia cases in the community, and have mobilized communities to increase vaccine coverage. They carry out home visits before and after birth and have been trained in essential newborn care. They counsel women about contraception and link them to needed supplies. In the last two decades, maternal and child death rates have dropped dramatically, thanks in large part to the work of these volunteers. Between 1990 and 2008, Nepal cut its maternal mortality rate nearly in half. Its under-5 mortality rate also declined rapidly, falling 64 percent in that same time period. All this has taken place in a country that is among the world’s poorest – with GDP per capita income of just $438.

In Malawi, many improvements in the survival chances of children can be attributed in part to the health promotion work of more than 10,000 health surveillance assistants who are deployed in rural areas of the country. These trained, salaried outreach workers deliver preventative health care such as oral immunizations, treat common killers like diarrhea, pneumonia and malaria, and care for mothers and babies before and after birth. They are key to promotion and provision of contraception, which is helping to reduce maternal and child death rates, and also reduce the numbers of children born HIV positive. They are also key to promoting voluntary counseling and testing for HIV and to providing treatment for children and parents who are affected. This very poor country has reaped enormous rewards for its smart investments in frontline health care. Malawi is now a proud African success story, having cut its under-5 death rate by more than half since 1990.

These are just a few examples demonstrating that the lives of children and their families can be saved when strategic investments and appropriate policies come together to unleash the power of frontline health workers. But tragically, there are not enough frontline health workers to reach all the families who need care. Worldwide, there are 57 countries with critical health workforce shortages, according to the World Health Organization. Most of these countries are in sub-Saharan Africa and South Asia – regions that also have the greatest share of the “global disease burden” and the highest rates of preventable deaths.