How To Inspire Courage, Spur Action And Save Lives

By Julia Bluestone, Jhpiego 

NOTE: This post originally appeared in the Huffington Post Global Motherhood Blog

April and early May are bookended by World Health Worker Week (April 7-11) and International Day of the Midwife (May 5) — two opportunities to recognize the invaluable contributions of health workers in saving and bettering the lives of our communities. The women and men who have been on my mind are the innumerable hard-working, selfless, often heroic frontline health workers I’ve worked alongside while training nurses and midwives in the last 15 years.

I think of Beatrice — a midwife posted in rural Tanzania, far from her family — working alone in a small health facility, always on call, always the one. I think of the nurse-midwives I’ve met in Nepal who work 18-plus hour shifts without basic necessities like electricity. I hear stories of the women they’ve lost: women who arrived at the facility too late, who had obstructed labor, or a baby stuck in their pelvis, or who were convulsing from unmanaged high blood pressure in pregnancy. The losses are painful, but they press on, determined to save another mother, another baby.

Young women graduating from the Community Health Officer program in Ghana have shared their fears with me. They’re afraid of being posted in remote health clinics far from everything and everyone they know. Blushing, looking down, they confess they’d rather stay in the city to meet someone and get married. But when they’re posted, many go.

Frontline health workers make profound sacrifices to do what they do.

But there are simply not enough of them. The 2011 State of the World’s Midwifery report surveyed 58 countries where 91% of the world’s maternal deaths and 82% of newborn deaths occur. The report found that the majority of these countries suffer from a severe lack of frontline health workers: a human resources for health crisis.

Among the 38 countries with the most severe shortages, 112,000 more midwives are needed to meet the Millennium Development Goals target of 95% of deliveries seen by a skilled birth attendant. Because of this severe lack of midwives, pregnant mothers have paid the price. Approximately 800 women and girls die every day in pregnancy and childbirth due to complications like infection and bleeding; enough to fill four movie theatres.

When we at the Frontline Health Workers Coalition say “health workers count,” we mean it. Every report, case study and anecdote affirms that health workers are vital to the health and well-being of a country.

I am reminded of Jhpiego’s work in Kenya, which is supported by the U.S. Agency for International Development. Mary Johnson, a community health worker (CHW) in Kitui County, goes door-to-door advocating for hospital deliveries in the Matinyani area.

“It was challenging [initially],” said Johnson. “Doors were closed on our faces most of the time. However, we did not give up. We talked to expectant mothers and emphasized the importance of delivering with a skilled birth attendant.”

Fourteen year-old Kalekye was one of the young mothers Mary discovered during a home visit.”Kalekye was in denial of her pregnancy and ran away each time I brought up the topic,” said Johnson. “But I never gave up. After several visits to her home, the results were significant! She agreed to attend her antenatal clinics as long as I accompanied her. She delivered in a hospital a few weeks later.”

“Mary is a lifesaver,” Kalekye explained. “If she had not intervened I would have delivered at home. I could not have had the courage to go to the hospital as I was too embarrassed to be pregnant at my age. After Mary talked to me, I was able to deliver in a hospital with a nurse, exclusively breastfeed my baby and ensure she gets all her immunizations.”

Health workers inspire courage, spur action and save lives.

As we honor frontline health workers this month, let us together advocate for nurses, midwives and other health workers serving to keep a mother alive, a community healthy and a country strong.

Nurses and midwives comprise 87% of the health workforce but lack a strong voice in ministry-level positions globally. Community health workers are similarly underrepresented.

Stand with the Frontline Health Workers Coalition - an alliance of 37 United States-based organizations including Johnson & Johnson and the organization I work for, Jhpiego – to educate our policymakers about the massive impact of investments in health workforce strengthening, and to advocate for continued strategic investment by the United States and our partners in human resources for health on the frontlines of care in developing countries.

Follow Julia Bluestone on Twitter:

World Health Worker Week Delivers Strong Call To Center Focus on Access

By Vince Blaser, Frontline Health Workers Coalition

NOTE: This piece was originally posted in the Healthy Newborn Network Blog.

WASHINGTION, DC – At the close of a week where I witnessed one of the first plastic surgeons in Bangladesh captivate Capitol Hill with accounts of saving lives of women and children accidentally or deliberately burned in his country and pleas to support deployment of more frontline health workers to prevent those burns, I sat in the World Bank listening to major power brokers in global health policy discussing what can and might be in 2030. I wondered: will we look back at this time as a key moment in a powerful and sustained drive toward ensuring every person has access to quality health services, or will weak support of health workers continue to entrap at least 1 billion people with little to no access?

It’s easy to be a sceptic and pick the latter, but in the last decade working in global health I’ve already seen such sea changes happen. From slashing early annual childhood deaths in half since 1990 to having an AIDS-free generation within our sights – the combination of strong advocacy, political will and investment from public donors, and private sector commitment has been a powerful force to save and improve the lives of millions in this century.

But with the target date to achieve the health Millennium Development Goals (4, 5 and 6) approaching next year, where does the focus need to go to make the most impact? The World Bank made its view clear Friday – the focus should move squarely to ensuring that by 2030, everyone has access to health services that do not push them or keep them in poverty under the framework of universal health coverage (UHC).

This expansion of access to services from maternal care to malaria prevention simply cannot happen without major efforts to strengthen the health workforce to deliver services.  The World Health Organization and the Global Health Workforce Alliance recently reported that 7.2 million more doctors, nurses and midwives than are currently serving are needed for everyone to have access to essential, lifesaving health services – a gap which could reach 12.9 million by 2035 if we keep with the status quo.

World Health Worker Week – during which leaders and advocates came together both in person and on social media to pay tribute to those who serve to make our lives healthy and prosperous – brought to the fore just how necessary it is to strengthen the global health workforce, especially on the frontlines of care.

From the inspirational stories shared by the health workers honored by The REAL Awards in Washington, to advocates in Malawi visiting health workers and taking their concerns to their government, to story after story virtually shared of how a frontline health worker safely delivered a newborn to a healthy mom,  administered a lifesaving vaccine, or provided knowledge on how to keep a child from dying from malaria or pneumonia – World Health Worker Week left no doubt on the impact frontline health workers have in delivering the health outcomes we seek. United States Agency for International Development global health chief Dr. Ariel Pablos-Mendez stated it this way in an opinion piece: the health workforce gap “presents a major development challenge and barrier to meeting the health goals of ending preventable child and maternal deaths and reaching an AIDS-free generation.”

So, how do we do it? The Frontline Health Workers Coalition, Global Health Workforce Alliance and Health Workforce Advocacy Initiative in a joint World Health Worker Week statement wrote that we can start by “strong and swift implementation” of the 83 concrete commitments to support the Recife Declaration on Human Resources for Health, “backed by sufficient resources and clear health workforce targets included within the post-2015 global development framework.” IntraHealth International President and CEO Pape Gaye in an opinion piece outlined five key steps to ensure health workers are centered in the world’s post-2015 commitments.

I am optimistic that in 15 years when we’re knocking at the door of the 2030 date discussed Friday at the World Bank, we will see many more frontline health workers like Anniekie Nkhumeleni and her team of community health workers Lwamondo, South Africa, delivering services and referrals across the gamut of health issues. If that happens, we should also be knocking at the door of fulfilling the ideals encapsulated by the MDGs of healthy mothers, newborns and families the world over.

Thank a Health Worker – Unsung Heroes of Global Health

By Dr. Ariel Pablos-Méndez, Assistant Administrator for Global Health, USAID

NOTE: This post originally appeared in the Huffington Post.

When was the last time you thanked your health care provider? We often forget how much care, guidance and support they give, and the sacrifices they make to restore us to good health. Health workers — whether a doctor, nurse, midwife or physician’s assistant — are an integral part of a well-functioning health system and necessary for the delivery of quality health care not only in the United States, but all around the world. As the world comes together to celebrate World Health Worker Week, we are reminded of the critical role health workers play both in the developed world as well as some of the poorest countries plagued with an unimaginable shortage of health services and limited access to care.

The World Health Organization (WHO) estimates that more than 1 billion people have little to no access to health workers. This is due to a global shortage of skilled, motivated and supported health workers. The entire continent of Africa has only 4 percent of the world’s health workforce, yet shares 25 percent of the world’s disease burden. Shortages are coupled with severe imbalances in geographic distribution of health workers. Skilled health workers are disproportionately located in urban centers and wealthier regions of countries, limiting access to quality health care for millions of people who live in rural and poor areas worldwide. This presents a major development challenge and barrier to meeting the health goals of ending preventable child and maternal deaths and reaching an AIDS-free generation, two major global health priorities at the U.S. Agency for International Development (USAID).

Dr. Ariel Pablos-Méndez, Assistant Administrator for Global Health at the United States Agency for International Development, speaks at a frontline health workers event sponsored by Johnson & Johnson last week in New York City. Courtesy Johnson & Johnson.

Dr. Ariel Pablos-Méndez, Assistant Administrator for Global Health at the United States Agency for International Development, speaks at a frontline health workers event sponsored by Johnson & Johnson last week in New York City. Courtesy Johnson & Johnson.

Human Resources for Health (HRH), considered a core building block of a health system and defined by the WHO as “all people engaged in actions whose primary intent is to enhance health,” is a relative newcomer to the field of global health and development. The health worker challenges that countries have faced and continue to face today were first recognized and brought to light by the 2004 Joint Learning Initiative for Human Resources for Health. Commitment of countries to address health worker challenges has been paramount to countries’ ability to make progress in improving the availability, accessibility and quality of their health workers over the past decade. In 2013, country governments and other stakeholders and partners gathered at the 3rd Global HRH Forum in Recife, Brazil to announce a new and re-energized commitment to HRH that is critical as we move into the post-Millennium Development Goals (MDGs) and Universal Health Coverage (UHC) agendas. Working with WHO and the Global Health Workforce Alliance (GHWA), USAID is co-leading a consultation to help drive forward a re-energized agenda for HRH that builds upon dialogue in Recife.

USAID’s leadership in the field of HRH advances our goals by building foundational components for a health system. Our work in HRH builds on a history of investing in the education and training of a wide range of health care professionals since the mid-1980s. Our work has continually evolved and is focused on expanding evidence for the impact of comprehensive investments in HRH systems and developing innovative approaches for addressing challenges in health worker deployment, retention and management that are helping countries build health systems that are able to sustain and advance improvements made in health. In Ethiopia, USAID is working with their government to implement the National Human Resource Strategic Plan, which aims to improve the quality of health workforce education and training, and strengthen management capacity to increase retention and productivity of health professionals.

By collaborating with U.S. government sister agencies and engaging in public-private partnerships, USAID strives to ensure our collective U.S. government support in HRH is well-coordinated and producing the best value for our investment. For example, the Saving Mothers, Giving Life program, a public-private partnership between the U.S. Government, the Governments of Norway, Uganda and Zambia, Merck for Mothers, Every Mother Counts, Project CURE and the American College of Obstetricians and Gynecologists, makes training health professionals in emergency obstetric and newborn care a core objective of the program. In FY13 alone, Saving Mothers trained 147 new doctors, nurses and midwives in Uganda, and 199 providers in Zambia.

As we look ahead, USAID wants to make sure we continue to recognize those health workers who go above and beyond each day. In 2013, Save the Children and the Frontline Health Workers Coalition created The REAL Awards, a first-of-its-kind annual global awards program designed to develop greater respect and appreciation for the lifesaving care that health workers provide in the U.S. and around the world. The 2014 honorees are receiving their awards in a series of ceremonies held in Washington, D.C., and abroad this week.

These honorees are just a snapshot of the many dedicated professionals who provide health. There are countless other health workers who have made an enormous impact in both the lives of individuals and communities on a daily basis. Continued investment in strengthening and supporting these workers and generations of new workers is integral to advancing our health agenda across the globe. As part of this effort, we must support the development of a cadre of HRH leaders who can be effective stewards of HRH and who are integral in driving effective HRH strategy development and implementation that impacts the delivery of quality care. By developing the leaders of tomorrow, we can work on strengthening health systems and carry the health workforce agenda forward.

So please, if you have an encounter with a healthcare provider this week, remember to thank them for the work they do.

Follow Dr. Ariel Pablos-Mendez on Twitter:

Health workers not only count – they are the frontline of health systems improvement

By M. Rashad Massoud, USAID ASSIST Project & University Research Co.
and Diana Frymus, USAID

NOTE: This post originally appeared in the USAID ASSISST Project Blog.

M. Rasahad Massoud and Diana Frymus at the International Forum for Quality and Safety in Healthcare in Paris on April 10, 2014. Courtesy URC.

M. Rasahad Massoud and Diana Frymus at the International Forum for Quality and Safety in Healthcare in Paris on April 10, 2014. Courtesy URC.

This week we appreciate and celebrate those at the frontline of our health systems.  With that, let us recognize that there are critical health workforce shortages (7.2 million) which are set to increase to an even higher level of 12.9 million in 20 years.  Although many countries have made progress in setting national policies and plans to strengthen the workforce, implementation has been weak and progress has not kept pace with expectations, manifesting in low health worker morale, absenteeism, and high turnover.

During this week, let’s also reflect on the fact that we have proven high-impact interventions to reduce mortality – such as Option B+ to treat the HIV-infected pregnant woman and prevent transmission to her infant – and yet many countries are not on track to meet the maternal health Millennium Development Goals because these are not being implemented reliably.  Clearly, beyond 2015 the needs and demands of health systems will only grow.

Let’s get the message out this week that health workers are the change agents of our health systems. They are the best shot we have for getting health systems on track to provide better care, and we have the evidence now to prove it.

By empowering and strengthening health workers to be at the forefront of brainstorming, testing and implementing changes, they can strengthen their systems to achieve better results despite the challenges they face in low resource settings.  We’re talking here of building the capability of health workers to apply the science of improvement to improve health care.  What have we learned from decades of doing this in low- and middle-income countries, including through the USAID ASSIST Project?

Lesson #1: Health workers perform better when they can define their own roles and responsibilities, organize the way they do their work and determine who does what.

Through our early improvement work, we found that many health workers did not have job descriptions which contributed to a lack of clarity on what they were supposed to do and how they were to engage with their team members in delivery of care.  As part of the improvement work, teams of health workers ended up defining their own roles, responsibilities, performance areas and processes.  We found that workers became much more aware of what they should be doing, performed better, and as a consequence, the quality of care also improved.

Lesson #2: One stone, many birds:  Applying improvement science not only leads to better performance and health care – it improves team work, employee engagement and productivity.

We’ve expanded our focus in this area and now are investigating the effects of applying the science of improvement on health workforce performance, productivity and engagement. It seems that the factors that affect health worker engagement and performance are those that can be addressed through applying improvement approaches.  We have seen that the role of the health workforce in improving quality of health care and the role of improvement in addressing common health worker challenges are inextricably intertwined.  With USAID and PEPFAR support, ASSIST has conducted multiple studies and developed hands-on tools on health workforce development.  A recent study we did in Tanzania found that health facilities with more engaged health workers perform better and are more productive in health and other sectors.  Another project in Uganda showed that health workers found ways to improve client waiting times and tracking of active patients by changing the way records are stored. An evaluation of a project in Tanzania  found that the average waiting time for HIV services reduced from 76 minutes to 32 minutes, and the time health workers spent in social visits and unexplained absences was eliminated, when previously it was 14% of the working day.

Lesson #3: Empowering health workers through applying improvement science works for all types of health workers, at all levels of the system.

We are now integrating what we learned from the work we have done in improvement at every level of the health system – from the national to sub-national management levels, local facilities, and communities.  Using improvement science, we have seen how you can strengthen the capacity of managers, frontline providers, community health workers, and volunteers to manage their own performance, identify strategies for improving care, and monitor and evaluate best practices and health outcome results.

Lesson #4: We have much more to learn: let’s spread and share.

In working with health workers over the years we have generated evidence of what works and doesn’t in order to inform decisions and shape policies.  However, there is still a lot to learn from how to improve provider performance within resource-constrained settings.  This is where global learning comes in: sharing our own best practices and lessons learned from country experiences; and learning from others through URC and USAID participation in international fora such as the Global Symposium on Health Systems Research and in the development of strategic frameworks like the new PEPFAR FY2014 Quality Strategy.  We’d love to hear from you about the work they are doing – why not submit your own improvement story.

As we honor and celebrate health workers worldwide during World Health Worker Week, we do well to keep in mind that empowering and strengthening health workers as change agents at all levels, results in strengthened systems and sustained quality of care.

World Health Worker Week: Recognizing the Work of Laboratory Professionals

Jarret Cassaniti, Johns Hopkins University Center for Communications Programs (JHU-CCP)

Note: This blog originally appeared on the Knowledge for Health (K4Health) Blog.

Since I joined K4Health almost two years ago, I have had the privilege of working with the Association of Medical Laboratory Science of Nigeria (AMLSN) and the Medical Laboratory Science Council of Nigeria (MLSCN). They represent a category of health professionals who I scarcely knew existed before.

In The hidden profession that saves lives Rodney Rohde, Professor & Associate Dean for Research at Texas State University, describes the role that medical laboratory professionals play:

Have you ever wondered who conducts the detailed laboratory testing for your annual exam, such as cholesterol and glucose levels, and analyzes the results? Or who conducts specialized testing for genetic disorders like sickle cell disease? How about those who identify an antibiotic resistant infection like Methicillin Resistant Staphylococcus aureus (MRSA) and determine which antibiotic is required to save someone’s life? Well, if you thought that it was your physician, or perhaps a nurse or someone else you see at your doctor’s office or in the hospital, you would be incorrect

AMLSN’s Mission is to encourage the study of medical laboratory science and advance its practice, which they do through programming via radio, television, and social media. Their dedication to the profession, the services they provide, and the communities they serve has been on constant display through my work with them. Together with K4Health, AMLSN has developed six eLearning modules focused on helping Medical Laboratory Scientists stay up-to-date on the latest information, guidelines, and techniques as required to maintain their license to practice.


Nigerian Medical Laboratory Scientist Anthony Edika performing a test. Photo Credit: Anthony Edika.

Nigerian Medical Laboratory Scientist Anthony Edika performing a test. Photo Credit: Anthony Edika.

In addition to authoring accredited eLearning courses, AMLSN also holds an Annual Scientific Conference and General Meeting (this year marks the 50th Anniversary), publishes a Journal, and is developing a West Africa Postgraduate College of Medical Laboratory Science.

They are an affiliate of Federation of African Associations of Medical Laboratory Scientists (FAAMLS) and the International Federation of Biomedical Laboratory Scientists (IFBMLS).

AMLSN is working hard on the goals of Health Worker Week: to ensure that everyone has access to a skilled, motivated, supplied and supported health worker within a robust health system. They have also opened my eyes to a “hidden profession.”

Five Key Steps to Making the Health Workforce a Post-MDG Priority


By Pape Amadou Gaye, IntraHealth International

NOTE: This blog first appeared in IntraHealth International’s blog VITAL.

This is a pivotal year for the international development community.

Fourteen years ago, world leaders gathered at the United Nations headquarters and set eight major goals to reduce extreme poverty and improve lives around the world. Those Millennium Development Goals provided a shared blueprint that unified the global community and accelerated progress like never before. The deadline for the goals is 2015—just around the corner.

The big question now is this: What development goals will we set next? And how can we make even faster progress toward global health and well-being?

These questions are very much in my mind as we celebrate the second annual World Health Worker Week, April 7-11. The answer, I believe, lies with the health workforce.

We missed the opportunity to make health workers part of the Millennium Development Goals in 2000. We should not miss it again.

There is a global shortage of 7.2 million doctors, nurses, and midwives, according to new estimates by the World Health Organization. By 2035, that number could reach 12.9 million. We missed the opportunity to make health workers part of the Millennium Development Goals in 2000—we should not miss it again.

We cannot achieve greater global health without stronger health systems, and for that we must strengthen the health workforce—both adding to its worldwide ranks and making the most of the health workers that already exist.

Here are five key steps we in the global health and development field can take to make sure health workers are part of the world’s post-2015 commitments:

  1. Give health workers a voice. Health workers are the central pillar in any health system, yet we rarely we hear directly from them. We should ask health workers for their opinions, and hear their proposed solutions to on-the-ground challenges. After all, they know the social and cultural dynamics of their communities better than anyone. Health workers’ needs are complex, their environments fast-changing. Mobile technology—and the crowdsourcing and peer networking it makes possible—holds great promise in this field. Let’s use the tools we have to amplify health workers’ voices, make them part of health sector planning processes, and create systematic policies to support them.
  2. Ramp up domestic investments in health care. While some low-income countries have increased their own investments in their health sectors, many have left the issue to outside donors. Of course, governments face any number of competing priorities when it comes to their budgets, but we must do a better job of advocating to them that an investment in the health workforce is one of the fastest, most effective ways to improve health. Let’s encourage national governments to increase domestic investment in human resources for health and to create policies that benefit health workers.
  3. Advocate for frontline health workers. Many frontline health workers around the world are still expected to work on a voluntary basis. They are not recognized as a cadre of workers, they are often not paid, and many countries do not have systematic policies that deal with them. We can change this by improving health information systems to allow countries to collect data on community health workers who are seen as informal providers, and make those workers a more formal part of the health system. We must also promote greater south-to-south collaboration. The world could learn a lot from India, for example, which has developed some very advanced strategies for frontline health workers and, through them, has improved health in some of its most impoverished regions.
  4. Set our sights on universal health coverage. To achieve universal health coverage, we need clear, articulated strategies and plans at the country level, and even stronger global governance of human resources for health. Making basic health services available to all is a tall order—but it’s the right thing to do. High-quality health care has the power to help lift those who live in extreme poverty and aid them in becoming healthy, contributing members of society.
  5. Embrace a systems-thinking approach. The focus in creating the health-related Millennium Development Goals was largely on specific diseases and health issues. As we look beyond 2015, let’s widen the scope of our ambitions. Let’s aim for sustainable development goals. To achieve that, we who work in global health must integrate our efforts with the fields of education, food security, women’s rights, and many others. We must set indicators to measure our progress in strengthening health systems the way we did for measuring progress in maternal health and reducing child mortality in 2000. At IntraHealth International, we often say we want to see health workers who are present, ready, connected, and safe—what we really mean is that we believe in a comprehensive approach to health workforce strengthening.

If we take these steps and work together toward our common goals, we could make even faster worldwide progress over the next 15 years.

Universal access to health coverage—and to health workers—is almost within our sights. During this pivotal year, let’s come together, clarify that vision, and pave the way to even greater global health.

Celebrating Heroes in Health

Joint World Health Worker Week Statement by the Frontline Health Workers Coalition, Global Health Workforce Alliance, Health Workforce Advocacy Initiative

Every year on April 7, people from around the world celebrate World Health Day, designed to mark the anniversary of the World Health Organization, established in 1948, and to call attention to global health priorities. For the past two years, this day also has marked the start of World Health Worker Week, a weeklong celebration of the inspiring health workers who make health care possible.

From risking their lives to quell an Ebola outbreak in Guinea or to stamp out polio in Pakistan to delivering millions of healthy babies from healthy mothers, health workers protect us, inspire us and enable us to thrive. Health workers have been central to the remarkable progress we have seen in global health in recent decades – including eliminating smallpox, putting polio on the brink of eradication and, since 1990, slashing annual early childhood deaths in half.

Bold new targets have been set to end preventable maternal, newborn and child deaths, eliminate mother-to-child transmission of HIV and usher in an AIDS-free generation, eliminate tuberculosis and malaria as major killers,  achieve universal access to family planning, and to ensure universal health coverage. Renewed global and developing country commitments have been made to achieve these targets.  However, a severe lack of trained and supported health workers, especially on the frontlines in the world’s hardest-to-reach areas, stands as a major hurdle to achieving this vision in the coming decades.

The Global Health Workforce Alliance and the World Health Organization estimate the world is short at least 7.2 million doctors, nurses and midwives needed to provide essential health services – a shortage that could climb to 12.9 million by 2035[1] if we do not focus on building the health workforce we need for the 21st century. Thankfully, leaders around the world have committed to putting an end to this crisis.

In November 2013 at the Third Global Forum on Human Resources for Health in Brazil, WHO member states in the Recife Declaration committed to “an ambitious agenda for health workforce development at all levels, in particular at country level,” working toward a shared vision that “all people, everywhere have access to a skilled, motivated health worker, within a robust health system.” Fifty-five WHO member states and 27 other constituencies in Recife made concrete commitments toward achieving this vision.

We need to ensure strong and swift implementation of these commitments, backed by sufficient resources and clear health workforce targets included within the post-2015 global development framework. Health workers must also be better equipped and trained; we must make investments in their security, social and economic welfare; and countries must abide by the WHO Code of Practice for Health Worker Migration.

During this World Health Worker Week, we resolve to work together to listen to, support and honor health workers throughout the year, ensuring their contributions to healthy and prosperous societies are recognized and celebrated.

Empowered Health Workers Improve Health Care, One Facility at a Time

By Sarah Dwyer, IntraHealth International

Uganda strengthens health service delivery by focusing on the people who provide quality care

Agnes Masagawyi provides integrated HIV and family planning counseling to a client in Mbale, Uganda. Courtesy Carol Bales, CapacityPlus/IntraHealth International.

Agnes Masagawyi provides integrated HIV and family planning counseling to a client in Mbale, Uganda. Courtesy Carol Bales, CapacityPlus/IntraHealth International.

“What inspires me is when I see patients critically ill and then recovering, laughing, smiling—I feel great,” says Agnes Masagwayi, a senior clinical health officer in Mbale District, Uganda. “I love my job with all my heart.”

But her health facility, she admits, was in “a bad state.” Running water was sporadic. Essential drugs ran out. Space for maternity care was so limited that many women delivered babies on the floor. Infection control was poor. And there weren’t nearly enough health workers to meet the demand.

In Mbale District only 337 of 708 health worker positions were staffed. Throughout the country, all districts faced similar shortages.

Two USAID-supported projects led by IntraHealth International—the Uganda Capacity Program and CapacityPlus—lent a hand. They partnered with the Ministry of Health to strengthen district-level health workforce leadership and management, use data to make evidence-based decisions, and advocate for increased funding for the health sector.

Nineteen districts participated in the six-month Human Resources for Health (HRH) Leadership and Management Program. The experience empowered Agnes, who realized that “really it is ourselves who need to plan, prioritize, and know what problems we have—and the available opportunities for addressing them.”

She and her colleagues learned how to plan using a bottom-up approach: “You team up, identify issues by department, [determine] the priorities,” Agnes recounts. “With the management committee we sit together and come up with a workplan.” After prioritizing their needs and coming up with solutions, they put plans into action.

“We acted as a team and lobbied with the district and partners,” Agnes says. Now, running water is always available thanks to new large tanks. Her facility prioritized the construction of a building to accommodate mothers, and now this new maternity ward provides space for women to deliver. A new drug management system helps prevent stockouts.

And there’s more. Infection control measures are in place, and health workers are upgrading their knowledge on their own initiative. “Now we have CMEs [continuing medical education] in this unit monthly,” says Agnes. “We set topics and discuss ways of managing cases.” Her facility places a new emphasis on recognizing staff for a job well done. “Some excelling midwives have been given certificates,” she notes. “They were very motivated, and we shall carry on with this.”

All in all, Agnes reflects, “We realized our patients are our customers. Client care has improved in this facility so much.” Out-patient services doubled in Mbale, and the district rose from 22 to 6 in the national rankings for health service delivery.

At the same time, the Ministry of Health used data from Uganda’s customized HR information system to identify vacancies and needed health workers, gained further information from a retention and costing study, and successfully advocated to Parliament for a $19.8 million recruitment fund. This enabled Uganda to hire more than 7,000 new workers to join Agnes.

Meet Agnes and learn more in this short video.

Julia Bluestone of Jhpiego Elected as New Chair of Frontline Health Workers Coalition

Press Inquiries contact: Vince Blaser
+1 202-407-9444 or

WASHINGTON, DC, March 31, 2014 – The 37 member organizations of the Frontline Health Workers Coalition (FHWC) – an alliance working together to urge greater and more strategic U.S. investment in frontline health workers in developing countries – are pleased to announce the election of Julia Bluestone, CNM, MS, as the new Chair of FHWC effective April 1, 2014.

Julia Bluestone

Julia Bluestone

Ms. Bluestone, a nurse-midwife and senior technical advisor at Jhpiego, replaces Mary Beth Powers of Save the Children, who completed her two-year term as Chair of FHWC. Bluestone has more than a decade of experience working with national ministries of health and professional associations in low- and middle-income countries to improve national education and training efforts. At Jhpiego, she provides leadership and technical assistance for pre-service education and in-service training programs for medical, nursing, and midwifery schools, including national nursing and midwifery curriculum revisions, tutor and preceptor skills training, and evaluation.

“During my time at Jhpiego improving health worker education and training efforts around the world, I have seen firsthand how access to properly trained frontline health workers can save lives and foster healthier, safer and more prosperous communities,” Bluestone said. “American leadership in increasing the health workforce on the frontlines of care is a must for the U.S. to achieve its global health goals, and passionate advocates are needed to make this case. We are fortunate to have many of these advocates in our Coalition, led by our founding Chair Mary Beth Powers. I look forward to working with our members to build on the tremendous passion for supporting frontline health workers that Mary Beth has infused in our movement over the past two years.”

“Two years ago, our members founded this Coalition to highlight the tremendous impact that U.S. investment and leadership in supporting frontline health workers has in saving lives and improving health outcomes for the world’s poorest and hardest to reach,” Powers said. “We have been thrilled with the existing commitments and the new directions outlined by the U.S. government and the broader global health community in addressing the global health workforce crisis, including the greater focus on frontline health workers. Our task now is to advocate for those commitments to be translated into concrete action.”

As Chair of the Coalition, Ms. Bluestone will lead the eight-member FHWC Steering Committee, which guides the work of FHWC’s secretariat led by Director Mandy Folse.

“The Frontline Health Workers Coalition is unique in that our members truly drive our advocacy work,” Folse said. “With the Millennium Development Goals set to expire next year, we are at a crucial period to ensure we have the political will to build the health workforce to achieve healthy and prosperous societies in the decades to come. FHWC looks forward to continuing to bring our collective expertise and voice to bear for the inspirational health workers on the frontlines of care.”

The Frontline Health Workers Coalition is an alliance of United States-based organizations working together to urge greater and more strategic U.S. investment in frontline health workers in developing countries as a cost-effective way to save lives and foster a healthier, safer and more prosperous world. Learn more at



Images Save Lives: Frontline health workers improve maternal health outcomes using illustrations

By Julia Nakad, Hesperian Health Guides

Hesperian 1High in the Andes, the organization DESEA Peru has relied on images to improve local health outcomes. The group found creative ways to use images as a training resource with community health workers locally known as “qhalis” – from the Quechua expression “qhali’kaypac llank’sun,” meaning “working for health.” During the last six years, the qhalis have transformed their community, struggling against a higher-than-average infant mortality rate to successfully eradicate maternal and child deaths caused by preventable illnesses.

A qhali teaches schoolchildren about vitamins Photo credit: Vitamin Angels

A qhali teaches schoolchildren about vitamins
Courtesy Vitamin Angels. Courtesy Hesperian Health Guides.

The qhalis are the frontline health workers in the region. In this role, qhalis are expected not only to assist during obstetric emergencies, but also to provide preventative health training to school children and expecting parents through home and school visits.

Creating effective educational materials for the qhalis was a challenge. Since 95% of the local population speaks only Quechua, and literacy is low in the region, Sandra McGirr and Sandy Hart – founders of DESEA Peru – decided to build a health program tailored to the community’s culture. Drawing upon the strength of the Quechuan oral tradition, they worked with the qhalis to create image-based materials to trigger the qhalis incredible recall of orally instructed information.

Inspired by the images in Hesperian’s Where There is No Doctor, they drew images that referenced the people and places of their own communities and combined them with health messages. These images were then also used to make informative coloring books that were handed out to families, covering prenatal health, postnatal health and pneumonia. The qhalis taught families that images in the book were “warning signs” – if one warning sign was present, family members should remain vigilant; if two signs were present, they should find a community health worker who could help them carry out their emergency plan.

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A simple diagram illustrates the relationships between routine activities and effects on environment and sanitation. Courtesy Hesperian Health Guides.

This inspiring work highlights the vital role of frontline health workers in improving health outcomes as well as the key role that images and illustrations can play in health education. For years, Hesperian’s image library did not exist and frontline health workers around the world have had to literally photocopy, cut, and paste pictures from Hesperian’s publications to use in educational and training programs. This process became much easier in 2011 when Hesperian created Hesperian Images, an online library of more than 12,000 illustrations from 20 publications. A gallery of male and female “talking heads” from a rainbow of ethnicities, “how-to” illustrations for creating mobility aids or water filters, anatomical diagrams, social and contextual images of frontline health workers  successfully leading community discussions – these are only a part of the wide variety of drawings now easily accessible online.

And instead of paging through a book to find the drawing you want; images in the database are tagged with searchable descriptors including medical problem shown, gender, age, and setting. Users can collect and purchase images online, or they can apply to have images donated to their projects. The images can be downloaded in various file formats and then be further cropped, adjusted and adapted. Health workers often modify the images to incorporate local dress, symbols, and landscapes.

An image from Hesperian’s A Community Guide for Environmental Health, which was later adapted by a Mongolian group in their translation of the book, as shown below.

An image from Hesperian’s A Community Guide for Environmental Health, which was later adapted by a Mongolian group in their translation of the book, as shown below. Courtesy Hesperian Health Guides.

For the Mongolian translation of the book, the illustrator adapted the image to suit local conditions by altering the houses, religious building, and dress of people in the images.

For the Mongolian translation of the book, the illustrator adapted the image to suit local conditions by altering the houses, religious building, and dress of people in the images. Courtesy Hesperian Health Guides.

The success of the qhalis of rural Peru demonstrates how appropriate materials can build on the pre-existing strengths of community members to both respond to and anticipate medical problems with impressive outcomes. The uses of Hesperian’s images worldwide also has demonstrated their utility and relevance across myriad cultural contexts and situations. Frontline health workers have used Hesperian Images on hand-washing signs at birth centers in India, on informational flyers about gender-based violence in South Africa, and on community mobilization flyers for the constructions of latrines in Haiti. We hope these images will continually be reused and redrawn to support the educational and preventative efforts of frontline health workers around the world.