Before COVID-19, the world was facing a shortage of 18 million health workers by 2030, mostly in low- and middle-income countries. By September of this year, one in seven reported cases of COVID-19 were health workers and at least 7,000 health workers had died—likely significant underestimates due to lack of data.

Although the true burden of COVID-19 infections on the health workforce is unknown, the loss of health workers from COVID-19 will have widespread health impacts, says Dr. Tom Frieden, president and CEO of Resolve to Save Lives, and former director of the US Centers for Disease Control and Prevention. And in low- and middle-income countries especially, the pandemic is already diminishing access to essential health services, and threatening to reverse decades of progress in global health.

“Deaths in Africa from health care disruption are likely to far exceed deaths from COVID-19,” Frieden says. 

Here are five steps he and other global experts shared during a virtual event alongside the 75^th United Nations General Assembly for how countries, donors, and others can better protect and support our most precious resource—frontline health workers:

1. Make national policies and investments in safety

“COVID-19 is here to stay for a while—and we need policies and investments to support both health care workers and health care systems,” Frieden says.

Frontline health workers, the heart of health systems, have been at the forefront of the COVID-19 response while still responsible for delivery of essential health services like immunizations, family planning, and HIV treatment. Many have lacked the personal protective equipment (PPE) and other measures they need to keep themselves and their patients safe. 

“Protecting our health care workforce is critically important,” Frieden says. “Health care workers are at increased risk of COVID-19. But they can’t be the canaries in the mineshaft. We cannot sacrifice our health care workers as an early warning system. We can’t afford to lose our health care workforce.”

2. Collect more data on health worker infections

Frieden recommends countries routinely collect information on health worker infections and, along with the WHO, report it publicly.

“What gets measured can get managed,” he says. “And what gets measured publicly is more likely to get managed effectively.”

This is the case not just for COVID-19, he says, but for other occupational risks for frontline health workers, like TB.

“We’re all in this together, whatever affects any person in any country can affect all of us,” Frieden says. “Let’s all work together to get health workers more support so all of us can be safer, healthier, and more productive.”

​3. Invest in health worker professional education 

“With COVID-19, we’ve understood the crucial need for a resilient health system that can promptly put in place appropriate measures to combat outbreaks and continue to manage critical patients,” says Dr. Patrick Ndimubanzi of Rwanda’s Ministry of Health.

Before the pandemic, the Rwandan government had been working intently to strengthen its health system and health workforce, establishing the Human Resource for Health Secretariat to improve health education and infrastructure, and finalizing a ten-year national strategy for health professional development to train more than 6,500 health workers.

“In times like this, we realize the significant shortage of health workers at all levels,” he says. COVID-19 has also revealed new opportunities to leverage digital and online platforms to meet Rwanda’s health workforce education goals, Ndimubanzi says, adding, “Health professional education is not just an investment. It’s a common good that should be prioritized.” 

​4. Keep services available to women and children

Dr. Diana Nambatya Nsubuga of Living Goods in Uganda notes that essential services for women and children have been disrupted during the pandemic, including safe labor and delivery at health facilities, family planning, and routine immunizations for common diseases like childhood pneumonia.

“It’s important we respond to community health system needs,” she says. “A strong community health system means community health workers are properly protected so they can safely continue to provide essential health services and contribute to pandemic response. In Uganda, there’s been great political will and leadership for the continuation of community-based services,” Nsubuga says.

For example, the Ministry of Health provided community health workers with PPE. This is critical to community health, she says, because it’s community health workers who are ensuring the continuity of services—almost 85% of diseases are preventable at the community level.

Acknowledging the influx of donor resources to fund initiatives to support health workers during COVID-19, Nsubuga adds, “These investments need to be directed not only to the current pandemic, but to longer-term solutions to support frontline health workers.”

Tabinda Sarosh of Pathfinder International Pakistan notes some of the challenges family planning providers faced and overcame during the pandemic.

“We found a lack of PPE, rising stigma for COVID-19, strain on the health system, disruption of supply chain, restricted mobility of people—especially women and girls, and reports of gender-based violence and domestic violence.”

The response, she says, was three-fold: ensuring a conducive policy framework that recognized the importance of ensuring continuity of services, including family planning and gender-based violence services; bringing services closer to women and girls through community-based midwives and referral systems and ensuring commodity security; and putting in place a multi-channel communications campaign that built on work already in place to promote post-pregnancy family planning.

Sarosh says that the public sector and public health community, along with youth community networks, and community partnerships already in place were all critical for adapting quickly once the virus began spreading.

“Although we saw a dip in service delivery in May and June, we see an uptick now on par with pre-pandemic data,” says Sarosh. The Government of Pakistan is now exploring digital technologies for service delivery to prepare for the next emergency. 

5. ​Don’t neglect health workers’ mental health

Brazil has been hit hard by the pandemic, both among its general population and among the health workforce, especially nurses, who have suffered a high rate of fatalities. As a result, the country has seen “skyrocketing” levels of anxiety among health workers, according to Michael Kapps, CEO of Vitalk, creator of a mental health chatbot designed as a digital solution to this growing problem.

“Brazil lacks mental health resources, and mental health care professionals,” says Kapps. “We have five times fewer mental health workers than the US, for example.”

Powered by artificial intelligence, the Vitalk app is a virtual health assistant, designed to interact with health workers and screen them for mental health disorders—anxiety, burnout, and depression. It provides psychosocial programs to address specific challenges that health workers are dealing with during COVID-19, such as issues of loss and guilt, and refers health workers needing more complex resources to a human service provider.  

Piloted with 5,000 workers, mostly nurses, initial research shows the digital tool is having an impact, with 85% of users describing the experience as positive or very positive.

Calls to action

“Frontline health workers are our most precious resource in protecting our collective health,” says Polly Dunford, president and CEO of IntraHealth International. “The world needs more health workers that are well-trained, supported, and equipped,” she says. Dunford and other members of the Frontline Health Worker Coalition are calling for:

• Strong pre-service and in-service training for health workers
• Decent working conditions for health workers, including adequate PPE and overcoming gender-specific barriers to decent work
• Addressing stigma of and violence against health workers 
• Ensuring health workers have supportive supervision
• Increasing the collection of real time and gender-disaggregated data on the health workforce—including infection rates—and sharing that data across countries. 

“Governments and donors must catalyze the current spotlight on frontline health workers and learnings from the pandemic to ensure long-term investments in and strong policies for frontline health workers,” Dunford says. “This means fulfilling global commitments to health, including the Political Declaration on Universal Health Coverage (UHC), which calls for the scale-up of competent, skilled, and motivated health workers. And we must listen to and involve frontline health workers in decision-making.”

Watch the event to see the full discussion about how to support frontline health workers during COVID-19 and beyond.   

Carol Bales is advocacy and policy communications manager at IntraHealth International, where she also leads communications for the Frontline Health Workers Coalition. Elizabeth Walsh is director of communications and knowledge management  for HRH2030, based at Chemonics.

The Frontline Health Workers Coalition and member organizations Chemonics, IntraHealth International, Living Goods, Management Sciences for Health, and Pathfinder International organized a virtual event—The Health System after the COVID Pandemic: Policies and Investments Needed to Support Frontline Health Workers—alongside the 75th United Nations General Assembly, with the discussion focusing on how investments in the health workforce today can better position countries to meet their populations’ health needs in a post-pandemic world.

This blog originally appeared on the Frontline Health Workers Coalition website.