Making global health ‘work’: Frontline workers’ labour in research and interventions

ABSTRACT

This Special Issue of Global Public Health draws on the concept of ‘body work’ among those employed to support operationalising, researching, and implementing global health while in direct contact with the bodies of others. This collection brings into sharp focus the specific forms of labour of those occupying positions as frontline workers - those who make global health work. Making Global Health Work includes authors from diverse backgrounds, disciplines, and geographies. Through compelling ethnographies, qualitative interviews, and focus group discussions, they explore ‘body work’ globally, including: Afghanistan, Bangladesh, Ethiopia, India, Indonesia, Kenya, Malawi, Myanmar, Nigeria, Nepal, Pakistan, Sierra Leone, South Sudan, Tanzania, Thailand, The Democratic Republic of the Congo (DRC), The Gambia, Vietnam, and Zimbabwe. These papers demonstrate that proximity to, and work on, the bodies of others engenders specific forms of (physical, emotional, mental, social, ethical, and political) labour, which occur not only in emergencies and pandemics, but also throughout the quotidian practice of global health. Making Global Health Work provides insights into the provision of maternal healthcare, treatment of multidrug resistant tuberculosis, rapid HIV testing programmes, sleeping sickness and polio eradication campaigns, mass drug administration clinical trials, epidemic preparedness and response, and the management and care of dead bodies. These papers argue for greater attention by global health actors on frontline workers in management of the complexities involved in making global health work.

KEYWORDS:

• Body work
• Frontline workers
• Global health
• Labour
• Ethics

Editorial

During the peak phase of the COVID-19 pandemic, most governments followed the recommendations made by the WHO and encouraged or mandated that the entire population, with few exceptions, stay home to protect themselves and others from infection. At the same time, the media widely reported on the extreme difficulties and risks faced by certain groups unable to ‘work from home.’ In particular, this included frontline healthcare workers who necessarily carried out the duties of their work while also initially lacking the essential large-scale supplies of personal protective and life support equipment. As the impact of the pandemic unfolded, the disproportionate rates of mortality, and emotional, mental, and physical morbidity among frontline healthcare workers became apparent, and drew public attention and appreciation (e.g., the ‘Clap for Carers’ initiative) to the distinct nature and type of work conducted by those in healthcare service provision (Bandyopadhyay et al., 2020; Dyer, 2020; Herron et al., 2020; Khunti et al., 2021).

The challenges faced by frontline healthcare workers during the COVID-19 pandemic are not new. Similar to the 2014–2016 Ebola Virus Disease (EVD) outbreak in West Africa, frontline workers during the COVID-19 pandemic were (and are) non-discriminatorily providing healthcare and services amidst fear of a highly contagious and fatal illness often stigmatised by the community (Cheung, 2015). Again, during the COVID-19 pandemic, frontline healthcare workers – particularly those from the Global South – interacted with and attended to patients under severely constrained circumstances and devoid of personal protective equipment, support, or specific guidelines (Dyer, 2020; Nyashanu et al., 2020; Jaffe et al., 2021). Unsurprisingly, frontline workers in both disease outbreaks suffered from disproportionate rates of infection and mortality. Furthermore, amidst concerns of vaccine hesitancy in the general population, frontline workers were among the first human subjects exposed to both the EVD and COVID-19 vaccines. While simultaneously being tasked with promoting and administering vaccines to local populations, frontline works became both the actors and subjects of global health work (Beer, 2021; Nyashanu et al., 2020; Thompson et al., 2021).

This Special Issue explores the relevance of the concept of ‘body work’ among frontline workers. The term ‘frontline worker’ is often used to describe a multitude of labourers, including, but not limited to, community health workers, field/community health nurses, data collectors, field workers/surveyors, humanitarian response workers, and contact tracers, among others. They are usually employed to support operationalising, researching, and implementing global health on its ‘frontlines’ and in ‘the field’ through trials and interventions, and play a critical and integral role in service delivery; they are most often the staff responsible for engaging directly with individuals and communities as part of their everyday work (Durose, 2009). Body work is a defining characteristic of frontline workers and is defined by Twigg et al. (2011) as labour that ‘focuses directly on the bodies of others, including assessing, diagnosing, handling, treating, manipulating, and monitoring bodies that thus become the object of the worker’s labour’ (p. 171). Therefore, the proximity to and work on the bodies of others engenders specific forms of labour which occur not only in times of emergencies and pandemics, but also throughout the mundane and ordinary quotidian practice of healthcare provision within myriad contexts (Sheikh & Wahlberg, 2021). In this Special Issue, we wish to seize on the renewed attention given to frontline healthcare workers during the COVID-19 pandemic and extend the lens to focus on the body work involved in global health provision and research.

This collection of papers is timely and important. Through compelling ethnographic and in-depth, grounded accounts, this Special Issue of Global Public Health asks that the current discussions of justice, care, and respect in global health be extended to include not only those considered to be the beneficiaries of its interventions and research, but also to those on its frontlines - those who make global health work (Ruger, 2009, 2012; Young, 2006). The included papers make explicit the specific and varied challenges invoked through body work conducted in locations where little attention is given to the practical, emotional, ethical, and psychological demands of working on bodies in need. Further, they demonstrate how ‘assessing, diagnosing, handling, treating, manipulating, and monitoring’ the bodies of some of the world’s poorest involves daily moral craft (Parker, 2015; Parker & Kingori, 2016), care, and the management of a range of different risks for the frontline workers. In so doing, the papers elucidate the divisions of labour that occur in global health. For example, distance and geographies privilege those in senior roles most often occupied in the Global North (or in the headquarters of capital cities in the Global South) and removed from body work in numerous ways. Not only are they distanced from witnessing ‘the pain and suffering of others’ (Sontag, 2004), but the ignorance of their positions (strategic or otherwise) also come to make the body work of frontline workers invisible through a lack of acknowledgement of their labour (McGoey, 2012). Poorly designed interventions and research, alongside the misdistribution of resources to those on the frontline, entrenches and exacerbates the different forms of global health labour and further divides it into 1) those who cannot delegate or outsource the demands of being proximate to bodies in need, and 2) those who do not have to bear witness to such bodies (Bloor et al., 2010; George, 1996; Mosavel et al., 2011; Maes, 2016).

The Call for Papers of this Special Issue, advertised widely, occurred while many countries were still in the grips of the COVID-19 pandemic, and, as such, we anticipated many accounts of those involved in the response. However, given these demands on their bodies and the increase in body work that occurs during times of crises, it is not surprising that there is often a considerable lag between events as they happen, and detailed ethnographic or qualitative accounts of the labour required from frontline workers. Notwithstanding the small proportion of frontline workers (based mostly in the Global North) who were able to publish their own accounts as opinion pieces during the pandemic, as well as the ‘slow research’ (Adams et al., 2014; Ajab et al., 2021) needed to gain grounded and insightful accounts among this group, it is possible that our call for papers preceded and/or coincided with the data collection and analysis of studies exploring such issues among COVID-19 frontline workers. Instead, the papers which emerged formed a collection of accounts from authors who saw a growing interest in frontline workers during the COVID-19 pandemic as an opportunity to discuss their longstanding research and the otherwise neglected issue of body work among this cadre of global health workers across a range of fields and specialities.

The papers in this collection, Making global health work, contain authors from diverse backgrounds, disciplines, and geographies who have all explored and reflected on the value of ‘body work’ in countries across the globe, including: Afghanistan, Bangladesh, Ethiopia, India, Indonesia, Kenya, Malawi, Myanmar, Nigeria, Nepal, Pakistan, Sierra Leone, South Sudan, Tanzania, Thailand, The Democratic Republic of the Congo (DRC), The Gambia, Uganda, Vietnam and Zimbabwe. Unintentionally, and despite this wide range of countries, all included papers focus on activities that took place in the Global South – the area where the majority of global health attention and resources are located. The particular disease or health issue of focus also varied across the papers and included accounts from frontline workers operating in the provision of maternal healthcare, treatment of multidrug resistant tuberculosis (MDR-TB), rapid HIV testing programmes, sleeping sickness and polio eradication campaigns, mass drug administration clinical trials, epidemic response and preparedness, and the management and care of dead bodies. These studies bring into sharp focus the specific forms of labour and tasks for those occupying positions as frontline workers who, while being invaluable, are often rendered invisible in global health. However, through this collection we gain nuanced insights in the body work that lies behind these job titles from a range of methodological approaches which include ethnography, qualitative interviews, and focus group discussions alongside observations of frontline healthcare workers.

The papers

The first group of articles in this collection focus on the gendered and racialized nature of the body work in global health. These papers demonstrate the ways in which the powerlessness of frontline workers, compounded with racial and gender characteristics, increases the form and degree of the body work they experience. They also make clear that not only are women and women of colour more likely to experience some of the negative features of body work, but – precisely because they are women and women of colour – their experiences are often rendered invisible in accounts of what is involved in the practice of global health and what it takes to make it work. For example, in Kalbarczyk et al.’s paper, we learn of the potential risk of severe bodily harm experienced by the frontline workers of the Global Polio Eradication Initiative. Most of the frontline workers were women of colour, and they had to work in contexts of deep mistrust of vaccines and of the countries deemed to be sponsoring vaccine programmes. Some of these women have been killed in the process of undertaking their duties as part of this initiative taking place in conflict and post-conflict settings.

Authors such as de Waal (2014) have argued, ‘  …  the language of warfare risks turning infected people and their caretakers into objects of fear and stigma.’ While there is some reasonable objection to terms such ‘frontline’ as promoting the use of military metaphors in health and medicine, the meaning is broader than working at military fronts. It originates from being involved in work at the boundaries of something and includes direct interaction with members of the public; it refers to the most advanced, responsible, or visible position in a field or activity (Kane, 1994). The value of Kalbarczyk et al.’s paper is that it demonstrates that global health does operate alongside, and can often become entangled in, political concerns and military operations. Global health does this in ways that reflect the multiple meanings of the term ‘frontline’ as accurately reflecting the position of those acting to implement its initiatives during military operations, while also being the most responsible and visible in the conduct of global health activities (Ahmad et al., 2018; Ahmad, 2019). Kalbarczyk et al.’s paper has insightfully shown how the militarisation of global health has introduced an additional feature of body work, beyond the conception of Twigg et al. (2011), as increasingly concerned with personal and bodily safety and the management of fear of interventions by others. The paper explores the body work involved in going door-to-door in environments, such as within Pakistan and Nigeria, where women almost exclusively dominate the domain of domestic work. Being women of colour, the frontline workers are placed in considerably complicated situations. On one hand, they are considered non-threatening and are more likely to be given positions as vaccinators. At the same time, precisely because they are considered non-threatening, these women of colour are more likely to be attacked – and in some cases killed – for breaking social norms and for being associated with a global health campaign entangled in a military operation. This paper not only draws attention to the body work of these women, but also to how in the process of making global health work, the risks in their roles are either overlooked or considered a normal part of working in these contexts. This has the effect of normalising dangerous work, and, importantly, ignoring the questions alluded to by Kalbarczyk et al.: ‘What is the price worth paying in order to make global health work?’ and ‘Who should pay this price?’

This theme is carried through in the ethnographic evidence provided by Strong and Varley on the frontlines of global maternal health. Their paper demonstrates how the brunt of daily life-saving care in many low-resourced settings is intimately tied to gender, and is long associated with people of colour, workers in lower resource settings, and low status workers. For this reason, Strong and Varley argue that a shift is needed in ideas of body work so that it considers intersectional risks for such frontline workers in their unique positions within global health. They argue that women of colour, who represent a significant proportion of the global health workforce, must manage the effects of physical working conditions (which are intimately tied to many forms of caring and caretaking) in addition to the embodied effects of stress, anxiety, anger, isolation, and trauma—both primary and secondary—in the workplace. Making global health work on the frontlines of global maternal health requires managing, coping, and mitigating these physical, emotional, and mental forms of work.

The value of the papers by Kalbarczyk et al. and Strong and Varley is that through careful writing and rich accounts written from the perspective of the frontline workers, they are able to demonstrate that body work in global health goes beyond the purely corporal and also includes emotional, ethical, social, and political labour for women and people of colour. Importantly, as Strong and Varley argue, global health too often blames the healthcare systems and providers in the Global South for the poor treatment of frontline workers, rather than the entirely manufactured inequalities that could — if political will, priorities, power, and capital were appropriately realigned — be ended entirely.

This collection of papers elucidates that frontline workers are often ambivalently positioned in relation to power. They are also entangled in personal and structural relationships that have the potential to be both positive in making global health work, and also maintain negative implications for the labour of those on the frontlines. While papers such as Kalbarczyk et al. and Strong and Varley expose the ways in which much of the body work of frontline workers involves managing demeaning and physically dangerous situations, Fehr et al.’s paper provides a different perspective on ideas of power dynamics and how for frontline workers operating outside institutional settings like clinics and hospitals, being embedded in communities also requires its own form of labour and body work.

In their paper, Fehr et al. discuss the nuances of body work in a mass drug administration clinical trial in The Gambia. They show that, in addition to distributing medication and measuring bodies, in order for the trial to be successful, the fieldworkers must also balance complex relationships of reciprocity among themselves, the implementing institution, and the trial communities. Fehr et al. illustrate that for these frontline workers, making global health work means operating within the ‘micro-political relations’ of body work (Twigg et al., 2011). This means that the trial’s frontline workers are heavily dependent on communities and individuals to comply with their requests of participation. This dependency holds the potential to shift the balance of power away from fieldworkers, as enrolling participants in research means that they have to demonstrate that what they are proposing will be beneficial immediately to the specific individuals and communities – in contrast to the focus on future population-level benefits common in global health research. Therein lies a considerable amount of tension for frontline workers, and yet they must convince individuals and communities that in return for their participation, they will gain access to otherwise unavailable basic healthcare and medication. As part of their ‘reciprocity work’ the MDA trial’s frontline workers must extend themselves beyond the research protocol, as being on the frontline means being seen to share in the good fortune, grief, and material goods of the community and research participants; there is an expectation that if one shares with fieldworkers then they will reciprocate.

A large proportion of this ‘reciprocity work’ goes beyond the forms of labour identified as being a regular part of global health politics and yet it is vitally important. This paper provides a nuanced insight into who held power in these relationships and how or in what point of time that power was more prevalent. Reciprocity also gives insight into obligations, responsibilities, and the pressure to act beyond the protocol for fieldworkers. Being seen to be reciprocal is what is needed to make global health work; without it, individuals and communities have the power to halt research projects. In this way, Fehr et al.’s paper adds to accounts presented by Kalbarczyk et al. and Strong and Varley which show that frontline workers can only make global health work if they are seen to operate within local societal and ethical norms. A considerable amount of their body work is in contextualising global health goals in locations where their roles are not uncritically accepted and, at times, actively opposed.

By focusing on the frontline workers involved in epidemic preparedness and response, Lee et al continue the discussion of the nuances of the relational dynamics – the ‘relational work’ – that body work often entails. Before the COVID-19 pandemic, frontline workers in Sierra Leone were required to navigate the harsh demands of responding to the 2014–2016 Ebola Outbreak. Like other papers in this Special Issue, Lee et al show the physical risks and social consequences that can result from conducting body work; in this case, that included a lack of PPE and having to work – often uncompensated – additional roles and extensive overtime simply to make the Ebola response system ‘work.’ However, beyond these demands, Lee et al make an important contribution by clearly demonstrating the overlooked importance of leveraging social relationships to fill these systemic gaps. In their study, frontline workers necessarily utilized their social networks and personal relationships in their daily work. For example, a respondent discussed having to make a personal call in order to facilitate the timely turnaround of a patient’s diagnosis and lab report. These lessons further came into view with the arrival of COVID-19. When looking at such epidemic preparedness efforts, Lee et al argue that it is not only the possession of equipment and supplies or the technical capacity of staff that will ensure success, but it is also the relational infrastructure that results from frontline workers’ body work that is critical. This relational infrastructure, however, comes at a cost suffered by the frontline workers, which, Lee et al argue, further strengthens the need for additional, widespread support for this cadre of labourers in and out of emergency situations.

Continuing the importance of experiential knowledge, the focus of Falisse et al.’s paper is on the generations of Human African Trypanosomiasis (HAT) workers and their success in elimination programmes in the Democratic Republic of the Congo and South Sudan. In their study, frontline workers gained experiential knowledge through navigating the body work inherent in their tasks, including the constraints, contradictions, and dilemmas described in the papers above. Falisse et al. demonstrate that this has produced a cadre of specialised workers who have honed their skills in the field and through their direct contact with communities. This emphasis on the cumulative skills and expertise of these frontline workers is important as it runs counter to perceptions that frontlines workers are expendable. Instead, the authors argue that their embodied knowledge and practical and social expertise is required for the elimination not only of HAT, but also for the ‘last mile’ in a multitude of neglected tropical disease elimination efforts.

The collective body work and the institutional memory of disease control efforts held by frontline HAT workers will be critical to achieving global health goals in the future. However, while their knowledge is deeply ingrained in being part of a wider community, frontline HAT workers rarely feature at the level of global HAT discussions. These frontline workers worry about the risk of dismantling the human resource structures represented by mobile teams, and the training opportunities they have provided over decades for the DRC health workforce, which will continue to be needed to achieve long-lasting HAT elimination. While the paper focuses on HAT, many of the themes are common across global health. Particularly, this paper raises questions of what happens to frontline workers when global health priorities shift and their experience of making global health work is not consulted and their expertise is overlooked.

Running throughout all the papers are questions of ethics and the ways in which unresolved ethical issues contribute to the body work involved in making global health work. Should women, particularly women of colour, be placed in dangerous and life-threatening circumstances in the process of trying to achieve global health goals? How should ideas of fieldworkers’ reciprocity be reconciled with ideas of equipoise in contexts where community members know that research is the only access to healthcare? How should frontline healthcare workers be treated after global health interventions are completed?

In their paper, Arora explicitly discusses the ethical dilemmas faced by frontline workers trying to treat multi-drug resistant tuberculosis (MDR-TB) in settings with weakened healthcare infrastructure. A central feature of the paper is the attention given to describing the types of ethical dilemmas experienced by frontline workers – particularly dilemmas not addressed in international guidelines. For example, they show that many patients die of MDR-TB while being assigned to waiting lists until sufficient and appropriate medications are available. In such scenarios, frontline workers face a serious ethical dilemma between waiting to provide the ideal medication or providing sub-optimal medication because it is the most readily available. While providing the sub-optimal medication may alleviate immediate symptoms, or even potentially cure a small portion of patients, this practice has proven to contribute to further drug resistance, ultimately limiting the availability of efficacious anti-TB medicines, and negatively impacting the future of TB programmes.

This paper highlights the isolation of those on the frontline who are aware of the potential impact of their actions and left to make these decisions without the support of guidelines – and while confronting patients in need. Further, it contributes to ongoing discussions regarding the misalignment between international ethical guidelines and the daily, real-world ethics on the frontline, as well as the need to provide support and resources to address these issues in global health (Kingori, 2013). Along with the argument presented in Falisse et al., this finding highlights the need to engage with those on the frontline as part of policy strengthening efforts to avoid the repetition of avoidable mistakes and to mitigate ethical dilemmas.

Falisse et al. ask what happens when good quality medicines are not there to realise global health goals. Furthering this theme, Beckmann et al.’s paper seeks to explore the ethical issues generated for frontline workers when technologies do not work as intended. The technologies being explored in Beckmann et al.’s paper are rapid field-level tests for HIV, designed to provide quick, easy, and convenient testing at the point of care. These technologies have drastically aided in expanding access to life-saving antiretroviral treatment and HIV prevention for millions of people. However, compared to laboratory-based testing technologies, rapid field-level tests for HIV still remain crude and less accurate. This has produced disconcerting levels of misdiagnosis in the scale-up of HIV rapid testing programmes and led to severe consequences for the affected clients. Beckmann et al.’s paper explains that false-negative clients may unknowingly transmit the virus to others, as well as experience potentially life-threatening delays to treatment initiation; false-positive clients may suffer from stigmatisation and discrimination, and, in the era of test-and-treat programmes, may be put on unnecessary lifelong treatment, which can cause serious side-effects and pose high costs to the health system.

Against this background, the clinicians and primary counsellors who perform rapid HIV testing generally lack the resources to authenticate their test results. Therefore, the frontline workers fear they cannot provide accurate results with certainty, and the cases of misdiagnosis are rendered largely invisible. Moreover, HIV testers must perform careful work to mitigate misclassifications. These practices of body work, argues Beckmann et al., are unsustainable as they rely entirely on the care ethics of the HIV testers in the absence of supportive structures. A considerable amount of their body work and labour was involved in mitigating misclassifications, and as the paper makes clear, the frontline workers worried deeply about issuing wrong results, as they were acutely aware and very proximate to the serious consequences such a misdiagnosis could have for their client. In an effort to find a sense of confidence in the results they issued, testers ritualized careful procedure, forcing themselves to focus, even in high-pressure, resource-limited work environments with long queues. The frontline workers felt they must make additional quality assurance procedures a part of their daily routine, and often cross- and double-checked procedures and test results as a team. In this way, Beckman et al.’s paper echoes an important theme from the accounts of Falisse et al. on the importance of embodied knowledge, teamwork, and peer support in the process of making global health work.

Nevertheless, these HIV testers still find themselves at the forefront of an ethical issue that lies at the heart of much ongoing debate in global health: Who and what should be responsible when misdiagnoses occur or when things do not work? While this ethical debate wages on, frontline workers, such as these HIV testers, are employing their personal and professional resources and know-how to address such dilemmas in real-time as part of their efforts to make global health work. As Strong and Varley argue, a lack of care to the emotional, psychological, and ethical body work required to meet the onerous demands of global health continues to make frontline workers invisible to the institutions and broader global interventions that define their care relationship and obligations.

While frontline staff work to save bodies that are alive, little is known about the experiences and roles of those who care for deceased bodies in global health – in times of crises and not. Suwalowska’s original paper provides insights into the value of the ‘body work’ performed by pathologists, also known as ‘last responders,’ charged with caring for dead bodies in low-resource contexts in the Global South. Their roles involve managing dead bodies through the retrieval, storage, burial processes and, importantly, determining and recording the cause of death. Despite its importance, the field of pathology remains overlooked in comparison to other medical disciplines and practices (e.g., public health, internal medicine, obstetrics) and has not yet attracted necessary funding from governments or global health donors.

The physical body work of pathologists conducting autopsies focuses directly on the bodies of the deceased. However, though the body is dead, it is still closely identified with the person from when it was living. As such, pathologists’ body work may also have significant implications for the living, including the family members of the deceased who may be occupied with representing the best interest of their loved one. Moreover, a lack of care and respect towards dead bodies has been shown to derail global health programmes and interventions and further endanger the lives of others, as was witnessed during the 2014–16 West Africa EVD epidemic (Suwalowska et al., 2021). But even when not working in ethically charged infectious disease outbreaks, the body work of those handling and managing dead bodies involves overcoming strong socio-cultural beliefs and taboos, as well as work-related stigma, in order to carry out their labour. For instance, in contexts where suicide is taboo, families may place considerable pressure on the certifying doctor in an attempt to conceal the cause of death by suicide.

Suwalowska’s paper demonstrates some of the ethical conundrums faced by those required to provide the cause of death information upon which so much of global health metrics depend. The proximity of last responders to family and community members requires body work that involves finding a balance between 1) the right of the deceased (and their family) to not to be stigmatised after their death, and 2) not withholding pertinent health information from the official records used by global health institutions and policy makers. Last responders are aware of the importance of these records and the impact of misrepresenting causes of death on monitoring and evaluating global health outcomes, but often also feel an immediate obligation to the dead and their family. For example, in contexts such as those described by Beckman et al., where there is considerable stigma around a person’s HIV/AIDS status, there might an underreporting of deaths from HIV/AIDS as a result of active choices made by the certifying doctors in response to the social contexts in which they work. Suwalowska’s paper, therefore, provides yet another ethical dilemma faced by frontline workers regarding ‘the right thing to do’ in making global health work. Both Suwalowska and Arora’s studies illustrate that deviations from the ‘best practices’ of global health institutions can occur as a result of those on the frontlines necessarily mitigating complex ethical dilemmas.

Lastly, Nkosi et al. summarise the similarities and commonalities of the physical, mental, and emotional challenges of body work conducted by frontline workers across the globe. The value of this paper is that it aggregates these experiences and challenges over and above the individual level and geographically/culturally specific contexts. This shifts attention to the lack of political will, priorities, power, and capital which frame and structure the nature of the body work conducted by those on the frontline to ways which make visible the particularities of their work. The crossovers and commonalities between these fields were among the most fruitful aspects of the contribution by Nkosi et al. Using the concept of ‘body work’, these authors demonstrated how the production of global health interventions and evidence is shaped through the invisible bodies and touch of those on its frontlines.

As evidenced by the diversity of papers in this Special Issue, frontline workers play a critical, but often undervalued, role in the making and doing of global health work. This Special Issue has highlighted the importance of body work as it is conducted by global health’s frontline workers and the physical, emotional, mental, social, ethical, and political nuances and complications it contains. We argue for more investment by all global health actors and for them to develop a deeper understanding and insight to the different forms of knowledge that operate on the frontline, including but not limited to cultural knowledge, institutionalised formal training, and tacit knowledge skills, all of which must be reconciled while conducting frontline global health work. We strongly believe that frontline workers have a critical role to play in understanding and evaluating the success and impact of global health trials, research, and interventions. As such, greater and more responsive attention by global health actors is needed to support this cadre and enable frontline workers to deal with the complexities involved in their roles in global health. Appreciating the centrality of and investing in frontline workers has the potential to ensure the success and sustainability of global health in the future.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This research was supported by the Wellcome Trust (grant numbers 221717/Z/20/Z, 209830/Z/17/Z, 203132/Z/16/Z).