Exploring the definitions of the healthcare workers at the frontlines

We asked healthcare workers, "how do you define frontliners"?

By Dr. Prachi Pundir, Research Fellow at The George Institute of Global Health (India) 

As the host team of The Resilience Collaborative (TRC), we have been exploring the definitions of frontline health workers (FLW) to inform our work and support our research efforts for an upcoming systematic review. 

As a part of this initiative, we asked a group of seventeen healthcare workers, program managers and thought leaders for their functional definition of frontline health workers. Some of the defining criteria from the respondents were “contact or spending time (in-person or virtual) or interaction with the community or patients”, “delivering prevention, promotion, curative and rehabilitation services”, “working under government or authority”, “holding the larger responsibility of the health, hygiene, sanitation and supply of the population”, “providing first aid in times of emergency, threat, disaster”,  “registered practitioners and healers”, “leader, contributor ad liaison” and “making changes in policies”. The respondents brought to light an important issue, we have a wide range of definitions for frontline healthcare workers, many of which rely on our positionality and context. With this short blog, we want to take you through a short journey of our inquiry into the definitions of frontline health workers and the available assessment criteria to help with the accurate identification of this group. 

Historically...

Historically, frontline workers’ meaning had its roots in describing those at the forefront of the battle, often facing immediate action. Over time, the term has expanded to encompass employees on the frontline of industries. The use of the “war” metaphor in communications related to COVID-19 and the use of terms like “enemy”, “invader”, “fight” and that “each and every one of us is enlisted” by the former Prime Minister of the United Kingdom (UK), Boris Johnson (and other world leaders) has been documented and noted to have contributed to the rise in the use of the word “frontline” to describe those occupations which were considered vital to the pandemic response; more commonly referred to as “critical workers” prior to the pandemic. 

Frontline health workers comprise of all types of health workers—including nurses, midwives, community health workers, doctors, laboratory staff, pharmacists, and more—who provide care directly to their communities via institutions or outreach activities. Frontline health care workers deliver essential health-related services in hospitals, mental health care units, community-based care, ambulance care & services, directly interacting with patients. This word encompasses all staff involved in patient care including   ward clerks, porters involved in moving patients around the hospital and domestics working in clinical areas. Students and trainees in these disciplines and volunteers working with patients should also be included. Frontline healthcare typically takes place in   high-pressure work environments, where health workers are required to make numerous decisions and perform multiple tasks within short timeframes, often with limited resources. 

The consensus definition of healthcare workers based on the International Standard Classification of Occupations (ISCO-08; 2008 revision) comprises the following:  

1. Health Professionals

General practitioners, specialist medical practitioners, nursing professionals, midwifery professionals, traditional and complementary medicine professionals, paramedical practitioners, dentists, pharmacists, environmental and occupational health and hygiene professionals, physiotherapists, dieticians and nutritionists, audiologists and speech therapists, optometrists and ophthalmic opticians, health professionals not elsewhere classified (e.g. podiatrists, occupational therapists, recreational therapists and other professionals providing diagnostic, preventive, curative and rehabilitative health, services) 

2. Health associate professionals  

Medical imaging and therapeutic equipment technicians, Medical and pathology laboratory technicians, Pharmaceutical technicians and assistants, Medical and dental prosthetic technicians, Nursing associate professionals, Midwifery associate professionals, Traditional and complementary medicine associate professionals, Dental assistants and therapists, Medical records and health information technicians, Community health workers, Dispensing opticians, Physiotherapy technicians and assistants, Medical assistants, Environmental and occupational health inspectors and associates, Ambulance workers, Health associate professionals not elsewhere classified (including, for instance, chiropractors, osteopaths, respiratory and anesthesia technicians, HIV counsellors and others performing technical tasks and providing support for diagnostic, preventive, curative, promotional and rehabilitative health services)  

3. Personal care workers in health services  

Health care assistants, Home-based personal care workers, Personal care workers in health services not elsewhere classified (including, for instance, dental aides, hospital orderlies, medical imaging assistants, pharmacy aides and other providers of routine health and personal care support services)  

4. Health management and support personnel  

Health service managers, Health management personnel not elsewhere classified, Life science professionals, Biomedical engineers, Clinical psychologists, Social work and counselling professionals, Non-health professionals not elsewhere classified, Life science technicians, Medical secretaries, Social work associate professionals, Non-health technicians and associate professionals not elsewhere classified, Clerical support workers, Service and sales workers, Trades workers, Plant and machine operators and assemblers, Elementary occupations (for instance, cleaners, food preparation assistants, refuse workers and others who perform simple and routine tasks which may require the use of hand-held tools and considerable physical effort)  

5. Health service providers not elsewhere classified  

Armed forces occupations, other health service providers not elsewhere classified (participating in the formal or informal health labour market but providing health services including, for instance, medical interns and trainees who are providing clinical services as part of their basic medical education. 

Questionnaires to identify frontline healthcare workers

Assessment criteria for frontline health worker 

Questionnaire 1

1. Are you a health worker?  
   • Refer to International Standard Classification of Occupations (ISCO-08; 2008 revision) to verify if your role / occupation is listed. 
   • If your role / occupation is not listed, it is unlikely that you meet the criteria / definition of a health worker. However, given the rapidly evolving nature of roles & professions within the health space, it is possible that the role meets the criteria. In this instance it would be necessary to assess on a case-by-case basis. 
   • If your role / occupation is listed, proceed to the next question
2. Are you a frontline health worker? 
   • Could your job be performed from home? 
   • If yes, then it does not meet the definition of a frontline health worker 
   • If no, then it is likely that your role meets the criteria of frontline health worker. Additional criteria may apply. 
   • Optional / context specific criteria:  
     Does your role involve interacting directly with members of the public?

Questionnaire 2

1. Are you a health worker? Y/N (Refer to ISCO 2008 version) 
2. If YES, do you have direct contact (in-person/virtual) with patients as part of your job? Y/N 
3. If YES, are there potential risks to your health and/or life associated with your job duties? Y/N. A “YES” answer to all three questions will qualify an individual as a frontline health worker according to the criteria defined in this question

Based on the above inquiry, the definition of frontline health workers is, a professional or a worker who engages in physical (or virtual) contact with patients or recipients of healthcare in an institution or outreach setting, with the explicit understanding of the risk to their health and their life. 

About the Author

Prachi is a Research Fellow at The George Institute of Global Health (India) and Co-Founder of C4ES. Prachi’s research experience includes evidence synthesis in projects funded by the Department for International Development, Inclen trust International, UNICEF- Innocenti, Scheme for Promotion of Academic and Research Collaboration (SPARC) and the World Health Organization. She holds a PGDCM in Community media for health promotion in addition to her master's degree in public health from the Manipal University. 

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