The AHA’s Hospitals Against Violence initiative, Jones Day and HEAL Trafficking (Health, Education, Advocacy, Linkage) recently hosted a special convening, Forced Labor in Health Care Supply Chains: What Hospital Leaders Need to Know, to provide practical information and resources to health care providers. The meeting featured experts from the Office of Management and Budget, the departments of Health and Human Services, Labor and State, and the Association for Health Care Resource & Materials Management (AHRMM), a first-hand account from a labor trafficking survivor and a case study showing how hospital systems and supply chain leaders can collaborate to address forced labor through procurement processes.

According to the International Labour Organization (ILO)1, indicators of forced labor include abuse of vulnerability, deception, restriction of movement, isolation, physical and sexual violence, intimidation and threats, retention of identity documents, withholding of wages, debt bondage, abusive working and living conditions, and excessive overtime. Hospitals and health systems may inadvertently intersect with forced labor through product procurement and labor contracting practices. The Office on Trafficking in Persons in the Administration for Children & Families at HHS published an informational memorandum, Federal Statutory and Regulatory Framework of Forced Labor in Healthcare and Public Health Supply Chains, for health care administrators and procurement professionals that explains how forced labor occurs in health care supply chains, overviews relevant laws and regulations, and additional resources.

Product procurement and labor contracting practices

The COVID-19 pandemic exposed the increased risks of forced labor by manufacturers. For example, Top Glove, the largest nitrile glove manufacturer located in Malaysia2, was added to the Department of Labor’s List of Goods Produced by Child Labor or Forced Labor coinciding with a nationwide shortage of personal protective equipment (PPE). While hospitals (excluding federally operated facilities) are not mandated to cease procurement activities from identified and confirmed suppliers, they will actively work with distributors, tier one trading partners, group purchasing organizations (GPOs) and clinicians to identify and source clinically acceptable products from alternative suppliers. Raw materials tainted by forced labor, whether in part or in whole, also present a concern of forced labor in other health care manufacturing supply chains.

The workforce shortage may increase the risk for hospitals and health systems in using forced labor. Jones Day recently published the white paper, Global Spotlight on Labor Trafficking in Health Care and Corporate Supply Chains, stating that recent litigation across the globe demonstrates the need for companies to consider conducting due diligence to identify forced labor in their supply chains. In recent years, there has been at least five federal class-action forced labor lawsuits against staffing agencies, and courts continue to find merit in this type of lawsuit.

Executive sponsorship, interdisciplinary committee and resource efforts

CommonSpirit Health shared about a component of their program to combat human trafficking, specifically their efforts to address forced labor, led by Elise Nagowski, a surgical sourcing contract manager, and supported by Laura Krausa, system director of advocacy programs. The team attributes the success of their efforts thus far to having executive support and buy-in and developing an interdisciplinary team. Their team meets regularly to create and monitor short- and long-term goals, provide updates and discuss partnerships. The first, and most important step, is to create awareness and develop internal education. They link to others for support in this area and identify allies willing to share tools, including vendors, suppliers, distributors and/or GPOs.

Generate awareness

January is Human Trafficking Prevention Month, an opportunity to raise awareness on how we can all prevent and respond to human trafficking. This year's theme is "Partner to Prevent," and HHS Office on Trafficking in Persons is promoting resources that highlight the importance of partnerships and collaboration in strengthening anti-trafficking efforts. Need a place to start? The AHA’s Hospitals Against Violence initiative webpage offers resources on developing a human trafficking victims’ identification and response program. Hospital and health system leaders can look to the National Human Trafficking Training and Technical Assistance Center and their Core Competencies for Human Trafficking Response in Health Care and Behavioral Health Systems. The goal of the core competencies is to clarify the skill sets needed for health care professionals to identify, respond to, and serve individuals who have experienced sex and/or labor trafficking and individuals who are at risk of trafficking with trauma-informed, culturally responsive and patient-centered principles. Listed below are additional resources.

Department of Health and Human Services, Office on Trafficking in Persons

Department of Labor, Office of Child Labor, Forced Labor and Human Trafficking

Department of State, Office to Monitor and Combat Trafficking in Persons

Customs and Border Protection

Jones Day Resources


Deborah Sprindzunas serves as the executive director of the Association for Health Care Resource & Materials Management, a professional membership group of the American Hospital Association, and Laura Castellanos is associate director at AHA overseeing the association’s Hospitals Against Violence initiative.


1. ILO Indicators of Forced Labor (International Labour Organization 2012), p. 3,

2. 1 Bengali, S., These gloves help fight COVID-19. But they’re made in sweatshop conditions (L.A. Times Sept. 22, 2020),

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