As we celebrate two years since the launch of the Global Health Worker Initiative (GHWI), the United States continues to demonstrate our commitment to global health and to the global health workforce, providing more than $10.5 billion in global health program funding with Fiscal Year (FY) 2023 funds. Recognizing that strategic and sustained investments in health workers are critical to overcoming the setbacks from COVID-19 and to achieving sustained progress toward the Sustainable Development Goals (SDGs), the United States contributes more than $1.5 billion annually to support health workers and strengthen the health workforce globally through our bilateral health programs, such as the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. President’s Malaria Initiative (PMI), and global health security programs. For the first time in FY24, USAID is receiving $10 million in new funding to support the GHWI and the President’s 2025 Budget requested $20 million to build on this important work.

All countries, including the United States, must take action now to be prepared for the next pandemic and to achieve the health-related SDG targets, which include ending HIV, tuberculosis (TB), and malaria as a public health threat by 2030, achieving universal health coverage and access to essential health services, and preventing child and maternal deaths.

Health care workers need safe, healthy, supportive working environments to do their jobs – yet across the globe, health workers have to operate in increasingly difficult, even dangerous conditions with limited protections of their rights. Far too many health workers face inadequate pay, safeguards, and equipment, and lack access to mental health and psychosocial support services, and, in many cases, health workers face harassment and violence with targeted attacks on the rise. These challenges have a disproportionate impact on women, who represent 70% of the health workforce, which further hinders women’s economic security.

Through the GHWI, the United States has partnered with countries and communities around the world to support efforts to build a stronger health workforce and make health workers safer and better equipped to provide high-quality care.

PILLAR 1: PROTECTING AND SUPPORTING HEALTH WORKERS
The United States has invested in efforts to protect and support health workers around the world so that they can continue providing services safely while also taking care of their well-being.

The United States supports global efforts to monitor a growing number of attacks on health workers. The U.S. Agency for International Development (USAID) supported the operation of the World Health Organization’s (WHO) Surveillance System for Attacks on Health Care (SSA) to document and disseminate data on attacks on health workers across countries experiencing complex humanitarian emergencies. Since January 1, 2024, this WHO website has documented 395 attacks in 12 countries and territories, resulting in 160 deaths and 267 injuries of health workers.

The United States is supporting efforts to address workplace safety concerns in health settings. In Ukraine, over the past year, USAID has helped safeguard health workers while maintaining access to health care following the Russian invasion through adoption of innovative telemedicine solutions, including the training of 724 health and information technology workers and the facilitation of 2,130 technical support sessions. As a result, health workers have provided over 10,000 telemedicine visits following the training. In addition, the CDC supported training of laboratory staff in infection prevention and control (IPC) practices in Uganda, upgraded and certified biosafety cabinets in Senegal, and supported disease-specific testing for numerous disease outbreaks, including support for molecular serotype testing for dengue during an active outbreak in Bangladesh.

PILLAR 2: EXPANDING THE GLOBAL HEALTH WORKFORCE AND ACCELERATING ECONOMIC DEVELOPMENT
The United States is continuing efforts to create career pathways, improve labor protections, and expand opportunities for paid employment for health workers, including community health workers to address systemic barriers and to close critical skill gaps.

The United States has launched new effort to improve working conditions and encourage fair labor standards. Through USAID’s Gender Equity and Quality (GEEA) Fund, USAID established its first partnership with a global union federation to advance the representation and rights of health and care workers. This multi-country activity strengthens health and care workers’ organizations, and health worker leaders that advocate for improved working conditions, safeguards, and equitable employment in Colombia, Dominican Republic, Ghana, and Philippines. This work advances women’s economic security by addressing key barriers that disproportionately impact women who are more likely to be employed in the health sector, by encouraging fair labor standards and social protections. In addition, USAID, together with UNICEF, WHO and other global and regional partners, launched the Community Health Delivery Partnership (CHDP) to build a common country-led, data-driven agenda to improve alignment, high-level advocacy, and accountability focusing on community health workers’ status, rights, and protections. To date, the partnership has mobilized over 500 participants from Bangladesh, Ethiopia, Kenya, Liberia, Malawi, Uganda, and Philippines.

The United States provides critical support to health workers who provide essential HIV, TB, and malaria services. PEPFAR helps fund salaries for critical health staff in more than 55 countries where the United States supports the expansion and continuation of HIV and TB services—this includes more than 346,000 doctors and medical officers, nurses and midwives, social workers, laboratory staff, pharmacists, public health professionals, and community health workers and other community-based cadres. PEPFAR also supports health workforce management and policies, health workforce training, recruitment, and retention, and human resources information systems. Over the past year, PMI provided training, supervision, and equipment to approximately 100,000 community health workers across Africa and southeast Asia. This support enables community health workers to deliver case management of malaria at the community level, most often through integrated platforms that enable treatment of other common childhood illnesses such as diarrhea and pneumonia.

The Peace Corps, through its Advancing Health Professionals (AHP) Program, has recruited and deployed U.S. health professionals to (1) train health workers in clinical pharmacy and pharmacognosy at the University of Malawi College of Medicine; (2) provide training in medical-surgical nursing to third-year nursing students to advance the primary health care (PHC) system in Uganda; (3) design the Emergency Medical Care (EMC) professional courses curriculum for undergraduates in Eswatini; (4) train nurse practitioners to treat more complex diseases (through task shifting) in Liberia; and (5) train local providers of HIV treatment for indigenous populations in Panama.

Skilled public health workers are essential to rapidly detect and respond to disease outbreaks. CDC’s Field Epidemiology Training Program (FETP) builds global health workforce capacity in countries around the world by better equipping health workers to meet population health needs. When avian influenza A H5N1 resurfaced in 2023, CDC’s FETP-trained health workers in Cambodia swiftly joined an international investigation team from various sectors, including the World Health Organization (WHO) and United Nation’s Food and Agriculture Organization (FAO), to address this highly pathogenic virus of international concern. Their expertise played a pivotal role in the rapid response and implementation of disease control measures during the outbreak, underscoring the critical contribution of health workforce development programs to global health security and improving health threat management on a global scale.

The United States is working to ensure that a strong health workforce is part of building a strong primary health care system. Through Primary Impact, USAID is working to accelerate essential health care provision by supporting country-led plans to strengthen primary health care and investing in the health workforce in seven countries, including Nigeria, Côte d’Ivoire, Ghana, Malawi, Kenya, Indonesia and the Philippines. In early 2024, Primary Impact programs expanded to India, Madagascar, Rwanda, Uganda, and Vietnam. In Kenya, USAID has supported the establishment of 108 Primary Health Care Networks across 25 counties, supporting the rollout of multidisciplinary health teams and a new community health promoter cadre who are equipped with digital devices that link to an electronic community health information system.

CDC supports the Stop Transmission of Polio (STOP) Program, in collaboration with WHO and UNICEF to augment and build capacity of the immunization workforce in the most difficult settings. This program recruits and trains international public health experts and deploys them to countries around the world to strengthen national immunization surveillance programs, support supplemental immunization activities, respond to disease outbreaks, and help support polio eradication. During the past year, CDC trained and deployed 61 experts, while also supporting the activities of an additional 120 experts already trained and deployed in 32 countries.

PILLAR 3: ADVANCING EQUITY AND INCLUSION
Over the past year, the United States has supported efforts to build a more diverse health workforce and health leadership and advance training opportunities for career growth and workforce retention. This has included increasing partnerships and efforts to build capacity for the roles of local community and faith-based organizations as service providers to populations that are under-served and most vulnerable.

The United States has increased its investment in nurses, who serve as the backbone of patient care. In March, PEPFAR launched a Nursing Leadership Initiative in Botswana, Côte d’Ivoire, Eswatini, Malawi, Nigeria, South Africa, and Zambia. Through the initiative, PEPFAR is providing $8 million in 2024 to support nurses at the forefront of the HIV/AIDS response. This initiative aims to: (1) enhance nurses’ skill sets to lead planning and delivery of HIV/AIDS-related services; (2) help nurses to identify, advocate, and leverage innovative digital solutions to enhance quality service delivery; (3) protect nurses by enhancing their infection prevention and control skills, providing supportive work environments, and supporting mental health needs; (4) invest in the development, retention, and equitable distribution of the nursing workforce; and (6) enhance nurses’ communications and leadership skill sets.

The United States builds capacity of community and faith-based partners who play a critical role in the delivery of health services. Through New Partnerships Initiatives (NPI) investments, USAID worked with local community and faith-based partners in Pakistan, Malawi, South Sudan, Kenya and Haiti to train community health workers and volunteers to conduct community outreach to advance social and behavior change among youth, women and men in underserved and hard-to-reach communities. Community health worker and volunteer efforts led to improved community awareness of available services and increased use of locally available family planning and maternal health services.

The United States has partnered with HBCUs to train at-risk adolescents to work in health-related fields. The Department of Health and Human Services (HHS) in partnership with Historically Black Colleges and Universities Global Health Consortium (HBCU GHC), partnered with the Government of Malawi to train and employ adolescent girls and young women (AGYW) as Disease Control Surveillance Assistants. With funding from PEPFAR, this partnership has recruited and trained 220 graduates of the DREAMS Program for AGYW from the three districts with the highest rates of new HIV infections among AGYW – 98 percent of these graduates have been retained and are currently employed providing essential primary health and HIV services with a special focus on AGYW health needs.

The Department of Defense has worked to combat stigma and discrimination in military health services. Since 2018, the Department of Defense HIV/AIDS Prevention Program (DHAPP) has led a comprehensive initiative to combat stigma and discrimination in military health services across over 30 countries. This effort has resulted in the establishment of Codes of Conduct in more than twenty Ministries of Defense (MOD) Health Facilities, driving policy adjustments within MODs to enable service members to serve and deploy on Peacekeeping Missions without bias. With DHAPP’s support, healthcare workers are now providing stigma-free healthcare, fostering inclusivity and support within both military and civilian communities.

The United States is training health workers in equity research. As the largest funder of health research in the world, the National Institutes of Health (NIH) has trained more than 7500 researchers in more than 130 countries since 1989 through the Fogarty International Center (FIC). In the past year, NIH has supported neurology research in Zambia and 8 centers to undertake collaborative cancer research through the Global Training for Research and Equity in Cancer program. Research training topics include cancer genetics, epidemiology, bioinformatics, clinical research, and implementation research.

PILLAR 4: DRIVING AND INVESTING IN TECHNOLOGICAL ADVANCEMENTS AND INNOVATION
Over the past year, the United States has continued to expand digital strategies that equip health workers to provide more efficient, quality-integrated service delivery, including telehealth services that can expand the reach of health services to remote, underserved and marginalized communities.

CDC has developed two health informatics training programs: GEEKS (Growing Expertise in E-Health Knowledge and Skills), a tiered training to apply skills to improve vaccine coverage and strengthen disease surveillance systems; and I-LEAD (Inter-governmental Learning Exchange to Advance Data-Driven Decision-Making), a leadership program that enables participants to develop and implement digital health solutions. Over the past year, GEEKS has trained more than 400 participants and implemented 29 projects, while I-LEAD has trained more than 194 participants from 20 countries.

PMI invests in digital decision-making and data-collection tools for community health workers. These tools can improve the quality of care and job performance by health workers while generating data to identify underserved populations, document program impact on morbidity and mortality, and better forecast commodity needs. Through PMI’s digital community health initiative, digital community health assessments were conducted in 27 PMI partner countries. During the past year, activities identified in these initial assessments were implemented in 8 countries, including support for a community electronic medical record system in Rwanda and a community health worker registry in Zambia.

Virtual learning strategies can now reach the most difficult and remote settings. The United States has supported Project ECHO, a model in which health workers participate in a virtual community of practice with their peers where they share knowledge, experience and feedback. Project ECHO has programs in more than 80 countries with attendees in many more and has reached more than two million health workers with these trainings. While these efforts started prior to the COVID-19 pandemic, Project ECHO provided an essential lifeline when many countries were locked down, and this initiative has continued to expand post-COVID. In many settings, virtual engagements have replaced or augmented costly in-person trainings, and the model has well-demonstrated impact. For example, the Department of Defense HIV/AIDS Prevention Program (DHAPP) supports Project ECHO in 46 countries, including advanced clinical HIV training sessions in 16 countries. U.S. agencies have also funded Project ECHO to train health workers on COVID-19, public health emergency management, tuberculosis (TB), One Health, infection prevention and control, antimicrobial resistance, and laboratory skills.

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