This article originally appeared on the Family Care International Blog, available here: http://familycareintl.org/blog/2015/03/04/budget-calendar/
By Kathleen Schaffer, Family Care International
A dilapidated clinic, falling tiles, a never-ending leak. Barren and disorganized medicine shelves. An overcrowded maternity ward with desperate, soon-to-be mothers crying out for help. One nurse scrambling to meet the needs of the many patients who have come through the doors. When clients lament the clinic’s disrepair, or doctors request more supplies and personnel, they’re met with the same hopeless reply: “There’s no money.”
Through Family Care International’s (FCI) Mobilizing Advocates from Civil Society (MACS) project in Kenya, international, national and grassroots organizations as part of the Reproductive, Maternal, Newborn, and Child Health (RMNCH) Alliance are demanding better facilities, adequate and respectful maternity care, and especially, more health personnel. Kenya has only 11.8 health workers per 10,000 people–more than 40% fewer health workers than the World Health Organization’s minimum recommendation of 22.8 health workers per 10,000 people.
Of course any effort to increase the quantity and quality of health workers will have to be paid for, and that means dealing with the budget. For many of us, budgets seem abstract and intimidating, but it’s vital to engage with them since they reflect the government’s priorities and determine where the public’s money goes.
In order to make realistic demands, we need access to information about Kenya’s budget. However, over the last few years Kenya decentralized many decision-making processes, including budgeting, to the county-level. This recent decentralization has made it difficult for us to intervene effectively during the budget process.
But now, civil society organizations in Kenya can engage with budget decision-makers at the right moments thanks to a new Annual Budget Cycle Calendar, developed by the MACS project.
This new easy-to-read calendar shows the key dates for the Kenyan Annual Budget Cycle at both the national and county levels, enabling citizens to participate in both the setting of priorities and in accountability processes.
It is a great resource not only for maternal health advocates but also for the broader health community and county government officials, such as those from the Health and Finance Committees. The RMNCH Alliance will distribute the calendar in counties all over the country, and we hope to see it on many office walls as a constant resource for advocacy opportunities.
Ultimately, by being able to participate in and monitor the budget process more effectively, we will ensure that the government fulfills its commitments to maternal, newborn, and child health, and that the budget reflects the needs and priorities of the community and not just politicians.
By Aanjalie Collure, IntraHealth International
Today, March 8, when the global community comes together for International Women’s Day to celebrate the achievements of women around the world, we recognize women’s central contribution to the global health workforce: a contribution that sadly often goes unnoticed in global health policy discussions. When we take a moment to imagine what the world would actually be like without women working on the frontlines of global health, we realize how indispensable women are to the frontline health workforce we need to achieve global health goals.
If we were to imagine a world without female health workers, we would overlook the heroic efforts of Josephine Finda Sellu, a deputy nurse matron from Sierra Leone who has risked her life on the frontlines of the Ebola epidemic in West Africa this past year. In an interview with the New York Times in August 2014, Ms. Sellu – one of the last “nurse survivors” of Ebola at her hospital – cries while describing the tragic loss of her colleagues; yet, through her tears, bravely declares her commitment to fight the deadly disease until its complete eradication.
Similarly, if we were to imagine a world without female health workers, we would ignore the life-saving work of Dr. Shamail Azimi of the International Medical Corps, the first female physician to enter Afghanistan following the demise of the Taliban regime in 2001. After being inspired and encouraged by her father to complete her medical studies, Dr. Azimi led a team of female health workers to Afghan cities with absolutely no health workers to assist mothers in the safe delivery of their children. Dr. Azimi has not only provided these critical life-saving services, but trained hundreds of local physicians, community health workers, traditional birth attendants, and obstetricians throughout Afghanistan.
Tragically, if we were to imagine a world without female health workers, we would ignore the enormous contribution of Nepal’s body of 50,000 female health volunteers, who have bridged rural communities to the country’s formal health system since the 1990s. Their efforts have been integral to achieving universal coverage of vitamin A supplementation, drastically cutting maternal mortality rates, and slashing under-5 mortality rates by approximately 64%.
In fact, if we were to imagine a world without female health workers, we would be discounting the life-saving work of over 75% of the health workforce in many countries. Female health workers are the muscle behind the strong push to achieve global health goals around the world – whether it be providing maternal and child health services to rural communities in Nepal, fighting for an AIDS-free generation in South Africa, or providing critical services during periods of armed conflict.
Despite this, the World Health Organization notes that there are enormous gender disparities in health workforce management positions and higher-skilled cadres. Women constitute a much smaller proportion of management and other decision-making positions, and are also often poorly represented in higher paying cadres, including dentists, pharmacists and skilled physicians. Additionally, female health workers struggle with having their work recognized and legitimated by colleagues, families, and wider communities in many areas.
These gender disparities have been largely unaddressed by health workforce policy planners, argues Hilary Standing of the Institute of Development Studies at the University of Sussex. Poor data on the gendered composition of health workforces in different countries, and in the educational and other personal barriers women face in health workforce recruitment processes, mean that policymakers do not fully realize the extent of how important these considerations must be in health workforce policy planning processes.
On International Women’s Day, we not only celebrate the life-saving contributions of female health workers around the world, but call for additional action to ensure these women are safe, well-equipped, well-supported, and well-recognized in their roles. Men, like Dr. Azimi’s father, also play an important part in supporting and championing the efforts of female health workers around the world. Together, we can build the health workforce we need – underpinned by strong, intelligent and compassionate women and men alike – to achieve healthy, happy livelihoods for all of us.
This article originally appeared in the Center for Global Health Policy’s Science Speaks blog, available here.
By Rabita Aziz, Infectious Diseases Society of America
While the U.S. government has helped train more than 140,000 healthcare workers through the U.S. President’s Emergency Plan for AIDS Relief since the program was re-authorized in 2008, Africa still needs more than one million healthcare workers to address a critical shortage, U.S. Global AIDS Ambassador Dr. Deborah Birx said Monday at a Capitol Hill briefing. Speakers at the briefing, which was organized by the Frontline Health Workers Coalition, IntraHealth, and the Elizabeth Glaser Pediatric AIDS Foundation, said no disease requires more healthcare workers in Africa than HIV.
“HIV requires a highly trained, skilled, competent, sensitive health workforce to achieve prevention and treatment goals,” Kelly Curran, Director of HIV and Infectious Diseases at Jhpiego, said. Curran described meeting a nurse who works at the medical circumcision program at the Iringa regional hospital in Tanzania, who had received training through PEPFAR. “She herself has conducted over 5,000 procedures, as well as doing HIV testing and counseling,” Curran said.
“She does STI screenings, provides condoms, and has been one of many people leading an example of a whole community response,” Curran said. Without the support of PEPFAR, she added, the nurse could not have done all that she did.
Sheila Bandazi, Chief Nursing Officer for the Ministry of Health in Malawi, recounted how one of her students, who had received training through PEPFAR’s Nurse Education Partnership Initiative, noticed that a patient who was receiving care for a wound was not healing. The nurse urged the patient to get tested for HIV, which turned out positive. The patient was placed on antiretroviral therapy, and the student expressed to Bandazi how grateful he was for receiving HIV counseling training through NEPI.
Ninety-five percent of the healthcare workers trained by PEPFAR are in sub-Saharan Africa, Ambassador Birx said. “Having healthcare workers at the right place at the right time is key,” she said, adding that there’s a mismatch between where trained health workers are and where the burden is. Referencing the PEPFAR program in Kenya, where 98 percent of patients are located at 28 percent of PEPFAR sites, she said, “We have been working at sites where there’s no HIV. We have created inequities between programs by overwhelming healthcare workers at areas with high burden of disease.”
“We need to align our resources to where the disease is,” Birx said. “With current flat funding, we’re looking at how to do the right things, at the right places, at the right time.” She added that PEPFAR is looking at site level data to separate high-achieving and low-achieving sites. “If we find amazing nurses at high-achieving sites, we need to examine the attributes that make them effective,” she said.
Ambassador Birx added that if healthcare workers are trained in HIV care, they can deal with any other disease, including chronic noncommunicable diseases.
Dr. Address Malata, Principal of the Kamuzu College of Nursing at the University of Malawi, said the quality of healthcare workers is as important as the quantity. Every program in the nursing school has an HIV component, she said, and students are trained in prevention of mother to child transmission, testing, counseling, adherence, and other prevention. “Malawi has been able to increase the number of nurses and midwives through NEPI,” she said.
“Healthcare workers need support, it’s not only about the money,” Dr. Malata said. With the introduction of graduate level programs, more students are receiving their training in Malawi and staying in country once they graduate instead of going to Western countries for their education, she said.
“I don’t believe we should worry about retention,” she said. “We used to have international migration, but the moment we started introducing post graduate training and built housing for nurses, they stayed.”
Not able to attend this congressional briefing? Click below to view our speaker’s PowerPoint slides from the event:
WASHINGTON, March 2, 2015 /PRNewswire-USNewswire/ – An independent analysis released today and commissioned by the Frontline Health Workers Coalition (FHWC) finds that scaling up the local health workforce in West Africa is a cost-effective investment to help end the Ebola epidemic, restore essential health services and build the resilient workforce needed to tackle future threats.
The analysis, conducted by Eric Friedman of Georgetown University, utilizes publicly available data to estimate the cost—approximately$573 million over five years (or less than $115 million annually on average)—to double the skilled health workforce and ensure a comprehensive community health worker program in Liberia, Sierra Leone and Guinea.
“Frontline health workers’ heroic sacrifices must be honored with a fervent effort to end the epidemic and restore essential services,” saidVince Blaser, Acting Director of FHWC’s secretariat, housed at IntraHealth International. “This analysis underscores that investing in resilient and sustainable health workforces is a cost-effective and sound policy.”
Liberia, Sierra Leone and Guinea suffer from severe health workforce shortages that have hindered the Ebola response and ability to provide other lifesaving services. A lack of recent health workforce data in the region also limited the analysis.
“West African health workers have selflessly treated Ebola patients without proper equipment and worked grueling shifts, sometimes not knowing when their pay would come,” said Julia Bluestone, FHWC Chair and Senior Technical Advisor at Jhpiego. “Now that donors have committed to help end the epidemic and rebuild, meeting the needs of local frontline health workers must be front and center.”
The analysis is not officially authorized by the Liberian, Sierra Leonean or Guinean governments. Frontline health workforce investments should be made in close coordination with each country’s government. With a high-level Ebola forum on March 3 in Brussels and post-2015 discussions resuming, the analysis comes at a critical time to make such investments.
“We want to ensure world leaders turn their words on post-Ebola recovery into action,” said Erin Hohlfelder, Global Health Policy Director for ONE. “Starting tomorrow in Brussels and in the months ahead, leaders must commit the targeted investments needed to strengthen health workforces and systems to build a strong foundation for broader recovery.”
The Frontline Health Workers Coalition is an alliance of 40 United States-based organizations working together to urge greater U.S. investment in frontline health workers.
Read the published press release on PRNewswire here: http://www.prnewswire.com/news-releases/new-analysis-highlights-cost-effectiveness-of-health-workforce-scale-up-in-ebola-affected-countries-300043049.html
The Frontline Health Workers Coalition recommends that the U.S. Government and its partners address the public health emergency resulting for the Ebola virus epidemic in Liberia, Sierra Leone, and Guinea by investing in the training, retention, and support of frontline health workers.
Based on the assumptions, data and calculations in this paper, the overall cost of doubling the health workforce over five years in Liberia, Sierra Leone, and Guinea, and expanded coverage via a community health worker program comes to approximately $573.4 million, or less than $115 million per year on average.
It should be noted that the estimates for this costing analysis were not asked for and are not those of the governments of Liberia, Sierra Leone, or Guinea – and any investments made to increase the capacity of the local frontline health workforce in these three countries should be made in close partnership and coordination with the governments of each country.
A strong commitment by the United States and other donors could help assist the three countries most heavily affected by the Ebola crisis to not only build resilient workforces and systems capable of ending the Ebola epidemic but also to restore essential health services and build capacity to respond to future health threats.
Find these resources and more from our members at frontlinehealthworkers.org/ebola/.
By Susan W. Hayes, ReSurge International
Seven years ago, young Mohammed Hussein was playing with friends near his home in Bangladesh when an accident occurred that would change his life forever.
He and his friends were beside a road that was being paved, when Mohammed Hussein fell into a vat of hot tar. His right leg and both feet were severely burned, and without access to proper treatment for his injury, the skin on his leg began to scar and contract. The contracture of his skin became so severe that his calf became fused to the back of his thigh, leaving him disfigured and disabled.
When ReSurge’s Surgical Outreach Program director, Dr. Shafquat Khundkar, first met Mohammed Hussein six years later, he appeared to be an amputee. Dr. Khundkar learned that after his accident, Mohammed Hussein had stopped attending school and had resorted to begging as a source of income – one of the few and unfortunate choices left for an uneducated, disabled boy.
Fortunately, Mohammed Hussein was at last connected with health workers who could provide him with the surgical care he needed, and he will eventually walk again. He has had two operations with ReSurge to straighten his right leg and foot, and he will have another later this year to release the contracture on his other foot.
Mohammed Hussein’s burn injury should not have left him permanently on crutches. His disability was the direct result of a lack of access to the surgical care he needed at the time of his injury – and regrettably, his situation is not uncommon.
Approximately two billion people worldwide have no access to basic surgical care. This includes people of all age groups, not only with burn injuries like Mohammed Hussein, but also those with obstructed labor, birth defects, cataracts, cancer, diabetes, hernias and traumatic injuries from industrial and road accidents.
In fact, it is estimated that one in seven marginalized persons in the world is affected by a lack of basic surgical care, and that it contributes to 11-15% of the global burden of disease.
Yet of the 234 million surgical procedures performed each year, less than four percent of them are provided for the poorest third of the world’s population.
This represents a global crisis of enormous proportions, and an expanded and empowered health workforce in the fields of surgical care and anesthesia are needed more than ever in low and middle income countries.
Last Thursday, the World Health Organization’s Executive Board unanimously adopted a resolution on strengthening surgical care and anesthesia as a component of universal health coverage. The Resolution states that “inadequate investment in the infrastructure of health systems, inadequate training of the surgical care health workforce and the absence of a stable supply of surgical equipment and necessities in many countries impedes progress in improving delivery of emergency and essential surgical care and anesthesia.”
Back in Dhaka, Dr. Shafquat Khundkar is leading the way in expanding the number of qualified reconstructive surgeons in the country. He founded Bangladesh’s first plastic surgery residency program and says that of the approximately 40 plastic surgeons now in the country, at least 35 are his trainees.
“The inner self in me always wants me to train the next generation of humanitarians,” says Dr. Khundkar. “The need for reconstructive surgery [in Bangladesh] is immense… I am pleased that I have been able to build up a group of people who will be able to carry on my work.”
Dr. Khundkar’s work is an excellent example of the type of training that needs to be scaled up to develop the surgical skills of health workers—especially at the primary health care and first referral hospital levels.
With appropriate investment in health systems and in the surgical workforce at all levels, we will protect people like Mohammed Hussein and many others with neglected surgical diseases from death and disability, and from falling further into poverty.
The provision of essential surgical care represents a critical step toward ensuring universal health coverage—one that will require a coordinated global effort over the long term. The WHO Executive Board’s draft resolution represents a good stride in the right direction. We encourage the World Health Assembly to move forward with it and to support Member States in developing the strategies, policies, and funding needed to guarantee quality surgical care for all.
–On Wednesday, February 4, 2015, ReSurge International and the G4 Alliance, in collaboration with the Congressional Global Health Caucus, are holding a Congressional briefing on Capitol Hill on the need for surgical care in low-resource settings. Click here to learn more.
By Vince Blaser, Frontline Health Workers Coalition
If not well thought out or without a plan to garner support or how to implement, strategies can be boring, dry and ineffective in driving action. On the other hand, strategies with a clear vision backed by governments, civil society, the private sector and other stakeholders can be a galvanizing force that can and has driven enormous progress in relatively short time spans in global health and development.
As we noted on this blog last week, the World Health Organization has been tasked with creating a “zero draft” of a strategy that aims to drive and coordinate action to improve the global health workforce from 2016-2030. The Ebola epidemic in West Africa has tragically highlighted to the world that strong actions to bolster the health workforce, especially on the frontlines of care in developing countries, are desperately needed to secure progress on preventing needless deaths and enabling prosperity.
The Frontline Health Workers Coalition today sent feedback to the Geneva-based Global Health Workforce Alliance today to its Synthesis Paper of a year-long consultation it led that will inform WHO in the creation of the strategy. If you have a few minutes, read the Synthesis Paper and FHWC’s feedback over and let us know your thoughts by commenting below. More importantly, let the Global Health Workforce Alliance know your thoughts by e-mailing email@example.com by tomorrow (January 31).
We’re hopeful that this will not be the last chance for civil society to comment as this strategy is developed, but it is very important to advocate now for a strategy that can drive significant investment and support for frontline health workers in the coming 15 years. We hope you will join us.
By Deepanjali Jain, IntraHealth International
Early next week, 34 technical experts on health representing World Health Organization member-states will meet to set the agenda for the largest and most influential gathering of health ministers and civil society organizations of the year: the World Health Assembly. The WHO Executive board will decide the health policy agenda that the World Health Assembly will deliberate on in May, and consequently begin the conversation of which global health issues will be rallying points for the international community over the coming year.
We know that the Ebola epidemic in West Africa and the enormous human and economic toll it has taken on the region will be a focus at the WHO Executive board meeting. A new Frontline Health Workers Coalition statement issued ahead of the meeting emphasizes the need for greater investment and political attention to issues facing frontline health workers both in Guinea, Liberia, and Sierra Leone and around the world.
The Ebola epidemic has underscored the need for a well-financed and coordinated effort to address the perilous health workforce shortages in countries around the world, and the WHO Executive Board will also hear from the Global Health Workforce Alliance (GHWA) about progress on the creation of a broad-based global strategy on human resources for health.
In December, the WHO plainly stated that weak health workforce and infrastructure was a main contributor to the devastating spread of Ebola and its ripple effects of stalled economic growth and a complete breakdown of access to basic health services such as malaria, HIV and TB treatment and obstetric care in the region. To demonstrate a commitment to preventing another global health crisis on the scale of the Ebola epidemic, the creation and implementation of a global human resources for health strategy should be a focal point of discussion for member-state representatives during the WHO Executive Board meeting, and during the World Health Assembly in May.
We already know that health workers, and especially frontline health workers, are critical to save newborn lives, prevent malnutrition, increase the utilization of family planning, reduce the burden of HIV, TB and malaria and prevent, detect and respond to public health threats. What we lack is a global vision and strategy that sets clear targets and integrates what we know works in health workforce development and support from varied sectors. A global strategy that is comprehensive can help guide donor country investment and aid national level planners and policy makers to bolster the number and support for skilled health professionals, like frontline health workers, in the places where they are needed most.
Based on GHWA’s recently released synthesis paper, the FHWC strongly recommends that discussion around the global strategy address:
- Specific targets, timelines and commitments for ensuring that by 2030:
- All communities will have access trained and supported health workers with a minimum core set of competencies;
- All countries will have the health workforce and systems needed to stop Ebola and other existing and emerging public health threats.
- An implementation plan that includes clear delineation of responsibilities for country governments, regional bodies, and donors. This will help create accountability and support the sustainability of efforts to recruit, train, deploy, support and retain health workers, especially those on the frontlines.
- Synergies between the Global HRH Strategy and other global compacts and health strategies including the post-2015 Sustainable Development Goals (SDGs), Family Planning 2020, the Every Newborn Action Plan and the UNAIDS’ 90/90/90 strategy. Several global strategies set ambitious targets for improving health outcomes. A sustainable health workforce is critical to achieving the stated strategic outcomes, especially in poor, remote and other hard-to-serve communities.
We’ll be watching the discussions around the global human resources for health strategy at the WHO executive board meeting and in the next few months very closely. Do you have ideas for what should be included in the strategy? The consultation on the GHWA synthesis paper is open until January 31st. Share your thoughts, and learn more here: http://www.who.int/workforcealliance/media/news/2014/public_consultations_GHWA_Synthesis_Paper_Towards_GSHRH_21Jan15.pdf?ua=1
In a recent article with the Humanosphere Blog – a leading source for original commentary on major global health issues – the Frontline Health Workers Coalition (FHWC) highlighted the need for increased support for local health workers responding to Ebola. Although stories about the life-saving efforts of foreign health workers have dominated recent Ebola-related news coverage, policy recommendations recently released by the coalition remind us that the unique challenges facing local West African health workers must not be forgotten during this unfolding crisis.
“The biggest gap in what is going on now is there has been quite a bit of attention paid to the needs of foreign health workers and volunteers. There needs to be a lot more focus on what is happening in the local health work force,” said Vince Blaser, deputy director at the Frontline Health Workers Coalition, in an interview with Humanosphere.
The full article continues at: http://www.humanosphere.org/global-health/2015/01/support-needed-local-health-workers-responding-ebola-say-advocates/