The world needs more health-care workers — millions more

(The Week, Posted on June 19, 2012)

By Bill Frist, M.D.

The most impressive part of any hospital or health clinic is the caring, skilled employees who prevent and treat illness. But the workforce we have is not enough.


As I visit health programs in far off corners of the world and right here at home, the most impressive part of any hospital or clinic is the health workers themselves — the hands behind the health care that is provided to mothers and newborns, to children and the elderly, to teens and adults to prevent and treat illness.

Health workers heal. It’s as simple as that. And in this country, and around the world, there are not enough of them. Doctors are included in that shortage, but it doesn’t stop there. Recent estimates suggest the world is short some 4 million to 5 million community health workers, midwives, pharmacists, lab technicians, nurses, and doctors. Fifty-seven countries have severe health workforce shortages — meaning there are less than 23 clinicians per 10,000 people.

And health workers, particularly in developing countries, are scarcest in the poorest communities and neighborhoods — both rural and urban — where poverty, poor sanitation, and disease conspire to take the lives of children and adults through preventable killers like pneumonia, diarrhea, pregnancy complications, and tuberculosis.

Fifty-seven countries have severe health workforce shortages.

Later this week I am heading back to Haiti with the Clinton Bush Haiti Fund to review past investments in sustainable human health capital. Haiti is in dire need of indigenous health workers who are from and remain committed to their local communities. Long-term health and economic results can only be achieved by partnering with Haitians to build health training and service programs that they own and that they populate.

In targeted areas around the world, training armies of much-needed health workers has become a smart, key goal of U.S. foreign assistance. We are helping train new midwives, community health workers, lab technicians, and nurses through partnering programs supported by the U.S. Agency for International Development, the National Institutes of Health, and the Centers for Disease Control and Prevention. These new health workers are serving in communities hardest hit by infectious diseases and the complications from pregnancy and childbirth.

And it works! Countries that have made a concerted effort to increase the numbers and skills of their health workforces have shown tremendous progress: Malawi has trained more than 10,000 health surveillance assistants in the past 20 years, and in the same period child mortality dropped almost 60 percent. In India, turning normal community members into lay health workers to support healthier newborn care practices reduced newborn deaths by over 50 percent.

Training community-level health workers does not have to be expensive — people who can provide the most basic levels of treatment for sick children and promote healthy practices can be trained for as little as $300. More-skilled community health workers and midwives cost roughly 10 times that amount to train. These workers provide the lifesaving interventions needed to address most of the leading causes of death of newborns and children — all with no need for huge medical school bills. It’s basic health care, but it is lifesaving.

Highlighting the humble service of health workers around the world is the subject of a campaign launched by Save the Children, with whom I have traveled to countries like Bangladesh and Mozambique to witness these health workers going about their daily tasks. The care is effective and affordable. In fact, I think we in the U.S. have a lot to learn from these community health workers delivering local care. Take a look at some of the powerful stories at, where you glimpse the simple and affordable care provided by people who go the extra mile on behalf of others.

No matter what diseases and conditions are threatening, and what new technologies for treatment might come along, we can say for sure that progress will depend on an expanded army of health workers, properly trained and placed, with the right skills and supplies, intent on delivering the best quality health care possible.

As we look at America’s international assistance around the world, surely one of the best examples of success can be seen in the faces of these committed community servants.


This article was originally featured in The Week

How the U.S. Can Find and Train More Great Teachers

(The Week, April 10, 2012)

By Bill Frist, M.D.

Consider Laura. When she entered the third grade, she couldn’t understand the stories all her friends enjoyed. She was even too embarrassed to read aloud. Why? She could only read at a first grade level.

Laura’s hardly alone — but that’s small comfort. A recent study from the Annie E. Casey Foundation found that one in six children who are not reading proficiently by the third grade does not graduate from high school on time. In other words, Laura’s abilities in third grade may very well determine her future.

By the time Laura finished third grade, however, she loved to read and was prepared for the fourth grade. How did she catch up? She had a highly effective teacher.

There are no silver bullets in the education reform movement, but one area we cannot afford to overlook is expanding the pool of talented teachers. Popular reform efforts tend to focus on supporting current teachers and improving the standards they teach. But to maximize Laura’s chances, and those of our country, we need to start even earlier.

Our lack of teacher accountability is akin to a drug company producing medicines without measuring if the pills actually cure disease.

Research shows that the No. 1 school-based factor in improving student achievement is a great teacher. Of course, other factors are important as well: High standards, strong school and district leadership, and parent and community involvement, to name a few. But great teaching is the lever that most dramatically changes the trajectory of a child’s future.

To foster great teaching, first we need to know what makes a great teacher. And the good news is, we’re making headway in better understanding teacher effectiveness. Many states are implementing new systems to evaluate teachers, designed to give them feedback on how they are doing and a clear picture of what they can improve on. These evaluation methods replace antiquated approaches in which teachers received feedback only once every few years — feedback that had little connection to what students were learning or to the day-to-day operations of a classroom.

But evaluations alone are of little use without providing the support for a teacher to improve. Thus, many of these new evaluation systems are being connected with professional learning to help teachers continuously improve, as is done in many other industries. Weaknesses identified through these new evaluations are addressed with ongoing, collaborative support, as teachers work in teams to improve their instruction.

Many school districts have also begun to reward teachers for effective teaching, paying them more if they are able to substantially improve student performance. Laura’s teacher, for instance, might see a bonus at the end of the year for the kind of dramatic achievement she brought forth in her students. This replaces the traditional and still-common system in which all teachers with similar education and years of service are paid the same, regardless of how effective they are at actually teaching. The concept of performance-based pay is not new, only new to teaching.

Identifying and rewarding great teaching is critical, but the reform movement is failing to tackle a third important area — focusing on the start of the teacher pipeline and growing the pool of better-prepared teachers before they enter the classroom. U.S. Secretary of Education Arne Duncan said last year that “unfortunately, we all know that the quality of teacher preparation programs is very uneven in the U.S. In fact, a staggering 62 percent of all new teachers — almost two-thirds — report they felt unprepared for the realities of their classroom.” Let’s better prepare our teachers before they enter the classroom by raising the quality of programs that train teachers to teach.

Here are three ways.

We must first enhance accountability in teacher preparation programs by tracking the success and effectiveness of candidates once they begin teaching. Most programs have no idea how their products, the teachers, actually fare in educating students over the ensuing years. This would be like a drug company producing medicines without measuring if the pills actually cure disease.

Second, we must align the curricula of teacher prep programs with the most current, innovative, and proven policies, so that teachers are prepared to teach effectively from the moment they first step into the classroom. There will always be on-the-job training, but our teachers should not have to start over from square one weeks after they themselves graduate.

Preparation should include the use of new teacher evaluation systems which highlight what effective teaching looks like, training on the use of data to improve classroom instruction, and robust preparation to teach the new Common Core State Standards, the state-led higher academic standards being implemented today in 45 states and the District of Columbia.

Third, it’s time to fully open the door to alternative teacher training programs, like Teach for America, that are able to recruit, train, and inspire effective teachers in a short period of time. More collaboration between alternative programs and traditional programs would allow for the sharing and replication of best practices across all teacher training programs.

Yes, all this takes time, and won’t be easy. But the time is ripe for systemic change to identify, prepare, support, and reward great teachers. Research suggests the results will be dramatic for kids. All must participate in this work — teachers and principals, backed up with a lot of backbone from policymakers. But remember: Catching up students like Laura and better preparing millions of other students for college and a career is worth the work.

Dr. William H. Frist is a nationally acclaimed heart transplant surgeon, former U.S. Senate Majority Leader, the chairman of Hope Through Healing Hands and Tennessee SCORE, professor of surgery, and author of six books.


This article was originally featured in The Week