Elements of a Successful Partnership

By: Susan O’Halloran MPH, Frontline Health Workers Coalition

Forming a successful partnership takes commitment, work and significant thought.  Partnerships can help provide more visibility to an issue using the various partner networks, bring the creative thinking of more people to the table on an issue, and share managerial, technical, communication, implementation  and financial tasks, to name a few examples.  Partnerships can also be frustrating and a time burden if certain critical pieces are missing.  Some of these critical elements are:

  • Commitment to a shared goal
  • Leadership so that all partners know what is expected of them and how they can contribute to the shared goal and feel their contributions are valued
  • Communication so partners have a way to be heard and can also hear from other partners
  • Progress toward the shared goal

A new public-private-partnership has formed in Uganda that has tremendous potential to strengthen human resources for health (HRH) in the country.  On June 28, 2012, representatives from the US government, Government of Uganda, global corporations, local Uganda companies, Ugandan private health associations and NGOs from the Frontline Health Workers Coalition gathered for the “Partnering to Strengthen Human Resources for Health in Uganda” meeting.  The purpose was to engage the private and public sectors, identify priority HRH issues and agree on collaborative actions aligned with the Government of Uganda’s Human Resources for Health (HRH) plan.

This might have been just another meeting with some good thought given to the HRH situation in Uganda.  What sets this meeting apart is the leadership exhibited at the last session of the day when participants volunteered to form a steering committee and identified a chair to carry the work forward.  The group is called Health Works Uganda and the partners all share a commitment to strengthen health capacity in Uganda at all levels.  They have two priorities over the next year.  The first is to set forth the Health Works Uganda partnership framework and begin to establish systems to keep the partnership functioning.  The second is a focus on one of the six priority HRH issues identified – Retention and Motivation of Health Workers, especially frontline health workers.  A workplan will be developed within the next two months with specific action steps outlined for the various partners.  This exercise will also allow partners to seek out areas for collaboration in order to cut down on duplication of effort.

This is a new partnership, but it already has members with shared commitment to the HRH issue in Uganda and leadership.  No doubt as the leadership takes the members through the workplan exercise, communication channels and progress benchmarks will be determined.  We wish Health Works Uganda much success in their efforts to strengthen human resources for health in Uganda with a public-private-partnership model.

Written by: Susan O’Halloran, MPH.  Susan is the Director of the Frontline Health Workers Coalition. The Frontline Health Workers Coalition is a dynamic and influential coalition of 25+ NGOs working together to urge greater and more strategic U.S. investment in frontline health workers in the developing world as the most cost-effective way to save lives and foster a healthier, safer and more prosperous world.

Policy Champion Rep. Lowey Takes Up Frontline Health Workers Cause

By: Nora O’Connell, Save the Children

The world has achieved unprecedented successes in global health in recent decades. In just over 20 years, child deaths have dropped by nearly 40 percent. The number of women dying due to complications during pregnancy and childbirth has decreased by 34 percent in a decade, and the global rate of new HIV infections has fallen 25%. These gains would not have been possible without investments in frontline health workers.

Frontline health workers are finally getting the recognition they deserve in the U.S. Congress. On Wednesday, July 18, Representative Nita Lowey (D-NY) introduced H. Res. 734, a resolution recognizing the importance of frontline health workers to accelerating progress on global health, saving the lives of women and children, and enabling millions to lead healthier, more productive lives.

The resolution acknowledges the role that frontline health workers have played in getting health services to those in need, especially in rural and other under-served communities. They are productive members of their communities because a midwife helped them give birth, a nurse gave them their shots, or a community health worker taught them about breastfeeding, hand washing, or birth spacing.

The resolution also recognizes that now is the time to do more for increasing access to frontline health workers. In June, the U.S. along with 56 other governments, pledged to end child deaths from preventable causes such as diarrhea, malaria, and pneumonia. This month, over 20,000 people are gathering in Washington, DC to discuss how to get to zero deaths and zero new infections from HIV. Reaching these ambitious goals will not be possible without more frontline health workers and making sure the existing health workers are empowered and have the training, equipment and support they need.

The resolution commends the efforts of the U.S. government to train and support health workers including midwives, community health workers, doctors, nurses, lab technicians and others who are in short supply around the world, creating employment and healthier families.  However, it also notes that more can be done.

As U.S. global health programs have become more integrated and coordinated on the ground, it has become increasingly necessary to better coordinate efforts to train and support health workers across programs to ensure that together, they are helping build sustainable, effective health systems. It has also become necessary to increase efforts on focusing on training, equipping, and deploying more frontline health workers to ensure successes in global health are maintained and that progress continues.

The resolution calls on all U.S. government agencies, including U.S. Agency for International Development, Centers for Disease Control and Prevention and the Department of State to develop a coordinated and comprehensive health workforce strategy that focuses on increasing equitable access to health workers in developing countries, especially frontline health workers. This will help increase the impact of U.S. government investments not only by improving internal coordination, but perhaps more importantly, by helping ensure that they are aligned with partner country plans and coordinated with other donors, the private sector, and civil society organizations who all engage in this field.

We commend Representative Nita Lowey for helping raise the profile of frontline health workers in Congress. Please help frontline health workers gather the attention they deserve by helping support H. Res. 734. They are the unsung heroes delivering the results we all celebrate.

Family Planning: It Takes a Health Worker—and Saves Money and Lives

By Laura Hoemeke, IntraHealth

During last year’s International Conference on Family Planning, IntraHealth promoted health worker empowerment with the slogan “Family Planning: It Takes a Health Worker.” We had the phrase printed on posters and buttons, proudly displayed at our booth and on our lapels. We posited that all of the contraceptive technologies in the world will not make a difference if there are not skilled health workers to deliver them. Visitors to our booth, seeing our theme, sometimes laughed and said, “Well, technically it doesn’t take a health worker to put on a condom or promote abstinence.”

During the conference, I responded—and continue to assert—that it does take a health worker, or more accurately millions of health workers, to meet the need that hundreds of millions of couples worldwide have for family planning. It takes a health worker not only to administer most modern methods of contraception, but also to provide counseling and services in a holistic way, and to offer reproductive and other health services throughout the life cycle of both women and men.

A new report issued by the Guttmacher Institute and UNFPA this week, Adding It Up: Costs and Benefits of Contraceptive Services—Estimates for 2012, supports that notion. Guttmacher and UNFPA released the report in preparation for next month’s Family Planning Summit, to be held on July 11 in London with the support of the Government of the United Kingdom and the Bill & Melinda Gates Foundation. The summit aims to mobilize new partners and more resources to address family planning needs, especially in the developing world. Labor—or salaries of health workers—currently accounts for an estimated $0.7 billion of the $4 billion spent on family planning in developing countries in 2012, but we need to invest more, globally, to ensure that health workers are there to expand access and offer services.   At IntraHealth, we truly hope that the summit also will focus on the need for health workers—not only in numbers, but also in training, deployment, and ongoing support.

Modern Contraceptive Methods and Health Workers

There has undoubtedly been increased international attention to family planning over the past several years, as illustrated during the International Conference on Family Planning in Kampala, Uganda, in 2009, and the second international conference in Dakar, Senegal, in 2011. (I had the opportunity to attend and blog about both the Kampala and the Dakar conferences.) Despite this attention, however, the report documents that the annual increase in modern contraceptive users between 2008 and 2012 was significantly lower than between 2003 and 2008—10 million versus 20 million per year.

The Guttmacher and UNFPA report outlines the grim ramifications of the unmet need for family planning. In 2012, an estimated 291,000 women in developing countries will die from pregnancy-related causes; more than one-third of these women will not have wanted to become pregnant.  And approximately one-third of newborn deaths and one-fourth of later infant deaths are associated with unintended pregnancies.

The report highlights, too, the incredible benefits and potential of family planning. If all women, and all couples, worldwide could use the contraceptive methods that they want and need, unintended pregnancies would decline by two-thirds, from 80 million to 26 million. There would be 26 million fewer abortions. There would be 21 million fewer unplanned births, and seven million fewer miscarriages. Pregnancy-related deaths would drop by 79,000. And amazingly, there would be 1.1 million fewer infant deaths.

According to the report, 645 million women of reproductive age (15–49 years) in the developing world are now using modern contraceptive methods, up from 603 million in 2008. However, population growth accounts for about half of the increase. The overall proportion of married women using a modern method—92% of all modern method users—plateaued between 2008 and 2012, at just over 50%. However, there were significant regional variations, with substantial increases in Eastern Africa (from 20% to 27%) and Southeast Asia (from 50% to 56%), and stagnation—or even declines—in countries in Western Africa and Central Africa, where fewer than 10% of married women use modern contraceptives.

To meet the global unmet need for family planning, the report calls for the “training of health workers and others involved in provision of these services,” as well as improved access to high quality services.  This includes not only training health workers to administer contraceptives, but also to offer counseling and follow-up support and to recognize clients’ rights. Offering client-friendly services means that health workers have to be skilled to respect confidentiality and provide family planning services—to adolescents and unmarried individuals, too—with a nonjudgmental attitude. Tracking health workers is important, too. The report also calls for systematic data collection of indicators, including numbers of health workers and the training they receive.

Saving Lives Saves Money—and It Does Take a Health Worker

Meeting the unmet need would not only save lives—it would save money, too.  Given the current global economic environment, cost-effective solutions are essential. The current level of contraceptive care in the developing world costs about $4 billion annually, but saves $5.6 billion in maternal and newborn health service costs. Fully meeting all need for modern contraceptive methods would cost $8.1 billion per year, but would save a total of $11.3 billion. For every dollar spent, $1.40 would be saved. Is there another cause or investment opportunity out there that provides more bang for the buck?

At IntraHealth, we know that it takes a health worker, not only to offer family planning counseling and services, but also to support individuals, families, and communities. While it is true that family planning can happen without health workers, one thing is sure: family planning is not happening nearly enough without them.

Written by: Laura Hoemeke, IntraHealth International. IntraHealth is a member of the Frontline Health Workers Coalition, a dynamic and influential coalition of 25+ NGOs working together to urge greater and more strategic U.S. investment in frontline health workers in the developing world as the most cost-effective way to save lives and foster a healthier, safer and more prosperous world.

The US Government and the Health Workforce Crisis: A Dialogue on Strategy and Approach

By: Laura Hoemeke, IntraHealth

Credit: IntraHealth International

The Frontline Health Workers Coalition held a technical meeting with representatives of the US Government on June 26, The US Government and the Health Workforce Crisis: A Dialogue on Strategy and Approach. The meeting brought together approximately 55 participants, including representatives of Coalition members and colleagues from the US Agency for International Development, the Centers for Disease Control and Prevention, the Office of Global AIDS Coordination, and the Health Resources and Services Administration (HRSA). The overall goal of the Coalition is to encourage the US government to adopt and implement a comprehensive strategy that will increase the number of frontline health workers and empower health providers who are serving communities in need. The purpose of the June 26 event was to begin the process of defining the content of a USG frontline health workers strategy.

“Health workers are at the heart of health care delivery,” said keynote speaker Ambassador Mark Dybul.  “In a way, they are also the glue that holds together a continuum of prevention, care, and treatment.  We need the right health workers in the right place to offer not only curative care, but also preventive services.” Ambassador Dybul served as the United States Global AIDS Coordinator leading the implementation of the President’s Emergency Plan for AIDS Relief (PEPFAR) during the presidency of George W. Bush. He is currently a distinguished scholar and serves as co-director at Georgetown’s O’Neill Institute for National and Global Health Law. “We absolutely need more health workers,” Ambassador Dybul continued.  “And we need to ensure that those serving are treated with the dignity they deserve.”

Dr. Caroline Ryan, Director of Technical Leadership at the US Government’s Office of the US Global AIDS Coordinator, talked about the need to support health workers “in the context of supporting all of the critical components of human resources for health.” Dr. Ryan described the progress being made towards achieving the PEPFAR goal of training and retaining 140,000 new health workers. She discussed the important partnership between the Department of Health and Human Services, Health Resources and Services Administration (HRSA), and PEPFAR and African medical and nursing schools to transform African medical and nursing education to dramatically increase the number of health workers. Through the Medical and Nursing Education Partnership Initiative (MEPI and NEPI, respectively), grants are awarded directly to African institutions, working in partnership with US medical schools and universities. Ryan spoke of the important role of doctors and nurses in supporting frontline health workers, and also of some of the challenges of addressing faculty retention.

Following the opening speeches, participants broke up into six working groups to address key issues of a US government strategy to support frontline health workers. The groups addressed: 1) priority countries, 2) objectives for strategy, 3) costing a strategy, 4) the technical framework for the strategy, 5) leadership and management of the strategy, and 6) measuring the impact of the strategy. Following the working group sessions, discussions emphasized the importance of the strategy focusing on frontline health workers, and the need to work closely with the US government to propose elements of a strategy that are feasible and measurable. Next steps will include the development of a series of policy briefs that will provide recommendations to the US government with regard to a USG health workforce strategy.  The policy briefs will lay the groundwork for a continuing dialogue between the Coalition and key USG agencies.

Written by: Laura Hoemeke, IntraHealth International. IntraHealth is a member of the Frontline Health Workers Coalition, a dynamic and influential coalition of 25+ NGOs working together to urge greater and more strategic U.S. investment in frontline health workers in the developing world as the most cost-effective way to save lives and foster a healthier, safer and more prosperous world.