How To Ensure Global Health Security? Frontline Health Workers, Of Course

By Vince Blaser, Director, Frontline Health Workers Coalition

During any three-day, high-level meeting of the global health leaders, some common refrains are inevitable.

But at the meeting I attended in Cape Town, South Africa, last week – the World Health Organization’s high-level meeting dubbed “Building Health Security Beyond Ebola” – one refrain seemed to reverberate louder than you might expect to hear in a conference ballroom, and it mostly came from West African country representatives. That refrain: the kind of health security envisioned by the International Health Regulations, Global Health Security Agenda and the One Health Initiative, cannot be realized without more focus on developing a stronger frontline health workforce where access to health services, disease surveillance and health systems are the weakest.

At the heart of the global heath security lies three pretty simple notions: detect, report and respond; all three very much needing local health workers trained, equipped to be the first line of defense against myriad potential infectious disease threats.

Cape Town Ebola meeting

Given that the current Ebola epidemic in West Africa and many other major infectious disease outbreaks in recent decades started in rural areas with very little access to health workers, it’s not surprising human resources (aka health workers) would be at the top of the priority list for West African countries in their recovery plans. In fact, they’ve been saying it for a long time – Guinea at a major WHO forum in November 2013 called attention to the lack of health workers in the exact province where the outbreak started, less than one month before patient zero of the epidemic was believed to be infected.

Yet, as I noted at this meeting, despite some great success stories we have not seen the kind of progress in addressing the most severe gaps in the world’s frontline health workforce than we have in a host of other issues, especially on the African continent where this meeting was held. A WHO and World Bank report out last month, in fact, found at least 400 million people on this planet do not have access to essential health services. This estimate is directly tied to another report published just three months ago by the International Labour Organization, which said 10.3 million more health workers needed today to provide essential services to all, and 7 million of that deficit comes from rural areas.

Nowhere has felt the devastating consequences of a thin frontline health workforce more than Guinea, Liberia and Sierra Leone. The compounded devastating effect of the loss of more than 500 health workers in the three countries was modeled in the Lancet this month by David Evans. He and colleagues found the loss of these health workers could lead to the loss of more than 4,000 women to childbirth who would not of otherwise have died – more new mothers dying who otherwise wouldn’t have than people who died in the Sept. 11, 2001, terror attacks.

I have yet to hear anyone – including the participants of “Building Health Security Beyond Ebola” – disagree with the notion that it’s an imperative to strengthen the global frontline health workforce. Yet, in the draft outcomes document from this meeting there wasn’t an explicit mention of the workforce despite its centrality during the discussion. To make progress in the coming decades it must be much higher on the priority investments for global health initiatives across the board – from the burgeoning Global Health Security Agenda discussed here this week, to the Every Woman, Every Child Campaign, to the global strategies to curb HIV/AIDS, tuberculosis and malaria.

These efforts should be guided by a robust WHO global strategy for the health workforce – a zero draft of this strategy is out for public comment until Aug. 31, so please join the Frontline Health Workers Coalition and other advocates by submitting your feedback to WHO. The biggest question looming remains in financial support. In Addis Ababa, Ethiopia on Friday, African finance and health ministers issued a call to “[s]ubstantially increase domestic financing for recruitment, development, training and retention of the health workforce” – including a focus on community-level workers. Increased domestic investments must be coupled with targeted and increased investments from donors.

The delegates in Cape Town rightly stated that we cannot yet move “beyond Ebola” – as frontline health workers continue to fight to end the epidemic in West Africa. The global development community must show equal dedication to supporting their efforts and to ensuring that we have the frontline health workforce that can detect, report and respond far swifter to the next threat comes our way.

 

Stronger Health Systems Could End Abuse during Childbirth

By Rebeccah Bartlett, UNC-IntraHealth Summer Fellow, IntraHealth International

Blog

When I volunteered in a maternity ward in the Philippines in September 2013, I had about 18 months’ experience under my belt as a midwife and a couple more years as nurse. I had done similar work in Papua New Guinea and was eager to return to a low-resource setting to sharpen my skills and develop my clinical thinking.

I hoped I would be of some help to the local frontline health workers. Lighten their load slightly. Maybe give them a chance to breathe a little by providing an extra set of hands. Within a day I realized this was not going to be the experience I had hoped.

It wasn’t the unsanitary conditions or the lack of resources that surprised me, though I admit I wasn’t expecting to see a litter of kittens running around the infectious diseases ward.

What troubled me most was the way the women were treated.

My public health instincts had me imagining new patient services flow charts, moving the literal dumping ground of rubbish and broken hospital equipment away from the wind tunnel that blew directly into the TB ward as I watched family members operate breathing equipment they’d had to purchase themselves to keep loved ones alive.

These were simple problems, though, compared to what I saw from the corner of the labor room, where I was instructed to “just watch”—women verbally abused, humiliated, mocked, shamed, and abandoned.

Of course, the nurses and doctors I worked with in the Philippines did not wake up every day with the desire to mistreat the women in their care. Many of the types of problems I saw are the result of failures within the health system. Short staffing, for instance, can lead health workers to take dangerous shortcuts, become exhausted, and burn out, with terrible consequences. According to the World Health Organization, there’s a shortage of 7.2 million doctors, nurses, and midwives worldwide.

Women Abused, Humiliated, and Abandoned

I witnessed more than one woman give birth by herself while the nurses gossiped behind the desk. I assisted once or twice when I couldn’t help myself, but when I did this the woman whose hand I held or whose baby I placed on her chest was chided for embarrassing herself or given an “obstetric slap” for not “being strong like a good Filipina woman.”

And it wasn’t just the physical and verbal abuse. Even the care the women received reflected the staff’s contempt and disregard.

I saw a doctor use the same syringe and needle on five different women as she administered medication, storing the other sterile needle kits—which each woman is expected to bring at her own cost—“for later.”

I saw another doctor use the same instrument to break two women’s amniotic sacs, merely rinsing the tool under the tap in between.

I was left with one woman for nearly an hour as she lay, slowly bleeding from a deep tear during childbirth, whilst the doctor suturing her left to see another client and the other on-call doctor slept behind the nurses’ desk. The nurses didn’t want to wake him. I was not yet confident in my suturing skills. All I could do was attend to her observations, increase her IV fluids, and watch for possible hemorrhage or shock.

Respectful Maternity Care Is Everyone’s Responsibility

Mistreatment during childbirth is not unique to this facility in the Philippines. According to a new report published in PLOS Medicine, many women around the world experience these and other abuses when giving birth.

“They are slapped and pinched during labor, yelled at, denied pain medicine, neglected and forced to share beds with other women who just gave birth,” the New York Times reports. “And that is just a partial list of the abuses and humiliations inflicted on women around the world as their babies are born.”

If a woman can’t be protected and cared for at the exact moment she brings life into this world, when can she expect it?

In addition to greater support and investment in the health system and workforce, health workers need strong role models. They need colleagues who not only demonstrate compassionate care in their own work but who demand accountability when women are mistreated under their watch. Respectful maternity care is everyone’s responsibility.

In nursing school, I found my purpose in Millennium Development Goal 5: to improve maternal health. I learned that between 1990 and 2013, the maternal mortality rate dropped by almost half, but that 289,000 women still die every year in childbirth or due to related causes.  Twenty times that will experience an acute or chronic disability.

For some perspective, this is the equivalent of three out of every four people in my hometown of Canberra, Australia, dropping off the face of the planet in just one year.

I remember the looks the women gave me when they were mocked and shamed and abused, and I knew they knew they deserved better. I silently begged them to forgive me for not being able to help more, for doing little more than witnessing their trauma. Two years on, I am still trying to help. Now instead of acting as a witness, I act as an advocate.

What I saw in the Philippines occurs throughout the world. As the report in PLOS Medicine points out, women from lower- and middle-income countries, from stigmatized backgrounds, and those who live within health systems in crisis all face greater risk of disrespect and abuse in childbirth.

By building stronger health systems, helping countries better support their health workforces, and advocating for equality for women and girls, we can end their trauma. And we can give mothers and babies the chance they deserve to thrive.

 

Advocating for Change: Empowering the Maternal Health Workforce We Need to Save Lives

By Lilia Carasciuc, White Ribbon Alliance

In Western Tanzania, Elvina Makongolo is the only midwife on staff at the Mtowisa Health Centre’s maternity ward. She works around the clock to give pregnant women the care they need. She knows all too well the risks these women face in giving birth so far away from the lifesaving equipment required in emergencies.

“We are too few midwives…so being understaffed, this leaves me to do everything: cleaning, preparing the instruments, preparing delivery kits, and still when a pregnant woman comes, I deliver her, keep her safe, record her information. If we were many, we would help each other to relief the burden,” Elvina said.

White Ribbon Alliance (WRA) is making sure the world knows how crucial midwives like Elvina Makongolo are in saving the lives of mothers and newborns. Yet all too often, midwives work in substandard conditions, for small salaries, and are trapped in a vicious circle of low public regard and poor performance. We are supporting midwives around the world to advocate for their profession, changing the public’s perception of their work and pushing for improvements in midwives’ pay and working conditions so that their vital role is recognized and justly rewarded.

Sadly, chronic health workforce shortages in Tanzania pose enormous barriers to women’s access to safe and reliable maternal and child health services. Women the Rukwa region must walk all day to see a skilled midwife at Mtowisa Health Centre, and must walk an even further 200 km to the nearest hospital in the event of an obstetric complication or emergency.

Time and time again, we have seen how powerful health workforce advocates can be in urging governments to recognize the indispensable role of health workers in achieving national maternal and child health goals. As a result of our campaign in Malawi, the Minister of Health committed to develop a strategy for increasing the number of professional midwives; to work with Malawi’s directorate of human resources to develop a career path for midwives; and to include in the next national budget funding for research to determine the number of midwives in the country.

Following our campaign in Tanzania, Prime Minister Pinda directed all district councils to allocate an adequate budget for human resources to support comprehensive emergency obstetric and newborn care. Because of citizen advocacy in Uganda, the government provided an 18% salary increase for enrolled midwives and nurses, as well as a 13% salary increase for registered midwives.

In many other countries, midwives still face extraordinary staffing shortages, inadequate medical supplies, and public scrutiny. To address these challenges, we are sharing our lessons learned in citizen empowerment and advocacy, hoping to help others spark change. Only then can we recruit, train, employ and retain the skilled frontline maternal health workforce so urgently needed to prevent deaths in childbirth.

White Ribbon Alliance formed over a decade ago to give a voice to the women at risk of dying in childbirth. Our mission is to inspire and convene advocates who campaign to uphold the right of all women to be safe and healthy before, during and after childbirth. We help citizens recognize their rights and hold their governments to account for commitments made to maternal and newborn health. 

A Call to Scale-Up Community Health Workers


This post originally appeared on the Huffington Post Impact Blog. 

By Jeffrey Sachs, Earth Institute at Columbia University

This post is co-authored with Sonia Sachs on behalf of the 1 Million CHW Campaign.

Public health officials and practitioners from around Africa and from international public and private organizations, businesses, and universities, met in Accra, Ghana June 9-11 to consider ways to scale-up the coverage of high-quality community health worker (CHW) systems in our countries to achieve universal health coverage (UHC). In the meeting they pledged to work together to speed the scale-up of CHW systems in sub-Saharan Africa, and issued the following urgent appeal.

Joint Call to Action

We have reviewed the national experiences and the scholarly evidence demonstrating that CHW systems are a critical, integral, cost-effective, and long-term part of effective overall health systems. CHWs save lives, promote public health and wellbeing, bridge health system gaps, improve the quality of life, and help to prevent and end epidemics like Ebola. As members of the communities they serve, CHWs are the health workers closest to households. CHW systems offer high-quality, meaningful employment for young people.

We know that effective national-scale CHW systems start at home. We urge all African governments, including Ministers of Finance and Health, to recognize the indispensable role of CHWs in public health and epidemic control, by taking the following steps:

  1. Making and implementing plans for national-scale CHW systems;
  2. Expanding the domestic funding available for CHW systems;
  3. Ensuring that CHWs are properly trained, remunerated, supported by cutting-edge information systems, and empowered with the proper supplies, equipment, and training needed to provide both preventive and curative care with professional skills and to empower communities in their own health;
  4. Preparing CHW systems to address the non-communicable disease challenges that will be central to the new Sustainable Development Goals (SDGs);
  5. Supporting CHW systems with state-of-the-art information and communications systems made possible by breakthroughs in mobile broadband, telemedicine, remote monitoring, remote diagnostics, and other recent ICT innovations of great promise and significance;
  6. Empowering communities to work effectively with CHW systems;

On the international side, we underscore the urgent need to scale-up international support for CHW systems, and to convert the fragmented global CHW funding into pooled financing that supports national CHW systems. We are concerned about donors supporting parallel programs rather than national programs. Because of such parallel programs, CHW systems are scattered across many projects, each with its own protocols, ICT systems, if any, varied durations, and inconsistent approaches on training and the range of activities of the CHWs.

We strongly urge donors to pool their CHW resources into a few pooled global funds, including the Global Fund to Fight AIDS, TB, and Malaria, GAVI, the new Global Finance Facility, and possibly a new Global Fund for Health Systems. These pooled funds should provide additional financing for CHWs in a flexible and timely manner. We call on the donor partners to end the donor fragmentation and the long delays in disbursements. The time for scale-up has arrived.

We note that two countries in Africa, Guinea and Sierra Leone, are still battling Ebola, while Liberia has succeeded in ending their Ebola epidemic in part through the successful deployment of community health workers. Ebola is a scourge that takes hold in places with under-financed and fragmented health systems that lack effective CHW system support. We call on the international community to support the Ebola-affected countries to scale-up their national health systems, including high-quality CHW systems, with full urgency.

We note that the world is on the verge of adopting the new SDGs, calling among other things for UHC as part of SDG 3. We also note that world leaders will assemble in Addis Ababa, Ethiopia next month to take steps to finance the new SDGs. We firmly believe and declare that success in universal health coverage will require the proper funding and scale-up of CHW systems in our countries and throughout Africa. We call on world leaders to heed the exciting opportunities at hand to save lives by the millions in the coming years through professionalized, high-quality CHW systems linked to overall high-quality health care systems.

We address this appeal to the leaders of national governments and the international health organizations. We kindly request the One Million Community Health Workers Campaign report back to the participating governments in advance of the UN SDG Summit in September 2015, so that we can move forward effectively and confidently together in an urgent and timely manner.

Accra
June 11, 2015
Government representatives from:

Ministry of Health, Burkina Faso
Ministry of Finance, Burkina Faso
Ministry of Health, Congo-Brazzaville
Government of Ghana
Ministry of Health, Ghana
Ministry of Finance, Ghana
Ghana Health Services
Ministry of Local Government and Rural Development, Ghana
Ministry of Health and Public Hygiene, Guinea
Ministry of Health, Kenya
Ministry of Health and Social Welfare, Liberia
Ministry of Finance, Liberia
Ministry of Health, Malawi
Ministry of Finance, Malawi
Ministry of Health, Mozambique
National Primary Health Care Development Agency, Nigeria
Ministry of Health, Rwanda
Ministry of Health and Social Action, Senegal
Ministry of the Economy, Finance, and Planning, Senegal
Ministry of Health and Sanitation, Sierra Leone
Ministry of Finance, Sierra Leone
Ministry of Health, Uganda
Ministry of Finance, Uganda
Ministry of Health and Social Welfare, Tanzania
Ministry of Finance, Tanzania
Ministry of Community Development, Zambia
Ministry of Health, Zambia

Representatives from:

BRAC
Brandeis University
Earth Institute at Columbia University
Moi University
Clinton Health Access Initiative, Zambia
Columbia Global Center East & Southern Africa
Columbia Global Center West & Central Africa
Global Health Workforce Alliance (GHWA)
Harvard University
Tanzanian Training Centre for International Health
Johns Hopkins University
Last Mile Health
Living Goods
Management Sciences for Health, USA
Management Sciences for Health, Ghana
Management Sciences for Health, Rwanda
Millennium Development Goals Health Alliance
Millennium Promise Inc.
Millennium Villages Project, Ghana
CORE Group
National Health Insurance Fund, Ghana
Sanford International Clinics, USA
Sanford International Clinics, Ghana
Save the Children, Sierra Leone
Sustainable Development Solutions Network
University of Ghana School of Public Health
University of Washington
WHO AFRO
WHO Ghana
World Vision International
World Vision, Ghana

 

Statement Submitted at World Health Assembly 2015 on Ebola

This statement was submitted by IntraHealth International on behalf of the Frontline Health Workers Coalition for World Health Assembly 2015 on Agenda Item 16.1: 2014 Ebola virus disease outbreak and follow-up to the Special Session of the Executive Board on Ebola. The statement can be found here: https://apps.who.int/ngostatements/meetingoutline/6

I speak on behalf of IntraHealth International, a US-based NGO partnering with the World Health Organization and global health community to empower health workers and foster sustainable solutions to health care challenges, and the Frontline Health Workers Coalition, representing 41 member organizations, whose secretariat is housed at IntraHealth.

The Ebola epidemic in West Africa has highlighted an urgent need for increased support for frontline health workers and the systems that support them in this region and around the world. WHO reported that as of May 6, 2015, 868 health workers were infected with Ebola since the onset of the epidemic, and 507 of them died caring for the 26,593 people confirmed or suspected to have been infected with the virus. Nearly all of these lives have been lost in three countries–Guinea, Liberia and Sierra Leone–that all had less than 3 doctors, nurses or midwives per every 10,000 people before the Ebola epidemic even took hold, far less than the 22.8 per 10,000 ratio WHO has stated is the minimum needed to deliver basic health services. As we continue to battle and move forward from this epidemic, IntraHealth urges the WHO and member states to focus investments on building a resilient, sustainable health workforce in Guinea, Liberia, Sierra Leone and the other 80 countries around the world that do not meet the minimum WHO threshold. We must increase support for local health workers on the frontlines of care, build strong and sustainable supply-chain management system, address stigma, and invest in long-term training programs. IntraHealth also urges member states to support the development, financing, and implementation of a robust Global Human Resources for Health Strategy, as agreed upon during last year’s WHA, to ensure lessons from the Ebola epidemic do not go unlearned, and that global health security for all is no longer threatened by chronic under-investment in health workers and systems.

Midwives For a Better Tomorrow, For Every Woman and Every Child

By Toyin Ojora-Saraki, Founder/President, The Wellbeing Foundation Africa

[This blog originally appeared from the Huffington Post Global Motherhood Blog]

Celebrated on May 5th each year, the International Day of the Midwife recognises the invaluable role of midwives in health. As the Global Goodwill Ambassador for the International Confederation of Midwives (ICM), I would like to personally thank midwives for their inspiring work in delivering quality care to women and newborns.

Around the world, skilled midwives keep expectant mothers informed throughout their pregnancy and labour, empower all women of childbearing age to make healthy choices for their family and provide medical assistance for newborns in the fragile first days of their life. However, access to midwives varies considerably across sub-Saharan Africa, with rural communities bearing the brunt of the inequity of access. For example, in Nigeria, 14% of pregnant women give birth completely alone, and in 2013, only 40% of women gave birth with a skilled birth attendant present. And the shortage of midwives is not just a Nigerian problem. The ICM have found that if women are to receive the quality care that they need before, during, and after birth, the world needs 350 000 more midwives.

At the Wellbeing Foundation Africa (WBFA), we believe that an investment in the access to midwives and the training of midwives is crucial to the survival of mothers and babies around the world. This is why I am pleased to announce – on the International Day of the Midwife – that WBFA has forged a new partnership with Johnson & Johnson and the Liverpool School of Tropical Medicine (LSTM) to deliver an innovative global training package for local health workers in Kwara State, Nigeria, that has the potential to reduce maternal mortality by 15% and still birth rates by 20% in the state.

As First Lady of Kwara State for eight years, I have long worked to save Kwaran mothers and babies at the most vulnerable juncture of their life. To achieve this, we have instigated frontline programmes such as the Alaafia Universal Health Coverage Fund (AUHF), which draws on innovative financing mechanisms to enable Kwaran families to access affordable health insurance and supported the commissioning of the state-of-the-art Maternity Referral Centre in Eruku, Kwara. All of our frontline interventions have been designed to allow them to be scaled up and replicated in communities in Nigeria and across the African continent. Yet, progress cannot occur in silos, and we are glad to have partners to work with that can bring further global innovations back home to Kwara with us.

I am proud that this new project will bring a world-renowned ‘skills and drills’ training package for Emergency Obstetric Care and early Newborn Care (EmONC) from LSTM to Kwara. In 2013, a report by the African Journal of Reproductive Health found that 6 out of the 16 Local Government Areas in Kwara State did not meet UN standards for emergency obstetric and newborn care. To combat this service provision gap, LSTM’s Centre for Maternal and Newborn Health (CMNH) has designed, implemented, and evaluated an innovative EmONC package to improve the quality and availability of skilled birth attendants (SBA) and provide a measurable increase in the knowledge and skills of healthcare providers.

Midwives are central to the project in Kwara, as the training programme will include support to pre-service midwifery institutions to improve the competency based EmONC training components of their curriculum. The programme will include in-service training for 80-100% of midwives, doctors and community health extension workers who provide maternity services in the state’s public sector hospitals, setting up skills labs in three general hospitals, and upgrading the capacity of one skills lab in a pre-service midwifery institute. With the help of our team on the ground in Kwara, WBFA has been able to support the local operation of the project and ensure stakeholder engagement at every stage.

As we near the end of the Millennium Development Goals (MDGs) process, the International Day of the Midwife is more important than ever. Experience from the MDG process has made it abundantly clear that midwives should be placed at the very heart of the post-2015 development agenda, and access to midwives should be specifically indicated within the targets of the Sustainable Development Goals (SDGs) related to reproductive, maternal, newborn and child heath. Without this provision, the international community may fail to meet their promises to women and their families.

Therefore, we urge governments to invest in midwives now so that by 2030, birth can be safe for all, no matter where they live. Placing midwives at the heart of maternal, newborn and child health policies and programmes will ensure that there are more health professionals with midwifery skills, in the right place, at the right time, with the right education, the right support and the right pay. We know that more midwives and more access to midwives will ensure a better tomorrow, for every mother and every child. We must act now for a better tomorrow, for every mother and every child.

New ILO Report: The World Needs More Rural Health Workers, A Lot More

By Aanjalie Collure, IntraHealth International


Photo from ILO Report: Global Evidence on Inequalities in Rural Health Protection (2015)

On April 27, a new report released by the United Nations International Labor Organization (ILO) made a distressing finding: without adequate numbers of health workers, especially in rural areas, more than half of the world’s rural population – and more than three-quarters of the rural population in Africa – will go without access to effective health care in 2015.

The report, entitled Global Evidence on Inequities in Rural Health Protection, was the ILO’s response to observable trends in economic dis-investment and neglect in rural health systems around the world. Now, with this report indicating that nearly 56% of the world’s rural population – and 83% of Africa’s rural population – live without critical healthcare access, the ILO has provided powerful evidence to demonstrate why strengthening the rural health workforce is imperative to filling this gap.

According to the report, inadequate numbers of rural health workers is one of most crippling determinants of poor access to health services in rural areas across the globe. While approximately half of the world’s population resides in rural areas, only 23% of the health workforce is stationed here. This amounts to a deficit of approximately 7 million health workers in rural areas, comprising the vast majority of the ILO’s estimated 10.3 million global health worker deficit.[1]

“Health workers are a prerequisite for access to health care. Without skilled health workers, no quality health services can be delivered to those in need,” asserts this report.

So, what do the recorded health workforce shortages mean for people’s access to life-saving health services? ILO research provides a grim response to this question: precisely because of these health workforce deficits, 50% of rural areas and 24% of urban areas lack access to the essential health services they need.  In Africa, the impact of health workforce shortages is even more acute: half of urban residents lack access to health care due to health worker shortages, and a staggering 77% of rural residents lack essential health coverage, precisely because they are devoid of the health workers needed to serve their communities.

Even more striking is evidence that shows that these health worker shortages not only impede accessibility to health services, but have a direct and real impact on health outcomes as well. Data collected by the ILO demonstrates that the maternal mortality rate in rural areas is very strongly correlated with the degree of health workforce shortages in that area: “with decreasing levels of health workers, particularly midwives, the maternal mortality rate increases significantly,” warns the report.

In this context, the ILO makes a powerful assertion: national and global health policies must prioritize investments needed to “train, employ, renumerate and motivate” the rural health workforce we need to bridge inequalities in access to basic health services, and accelerate progress in meeting global health goals. In rural areas especially, improvements must be made in guaranteeing safe and decent working conditions in rural facilities, appropriate wages, and additional incentives to recruit and retain staff.

Improving the infrastructure of rural hospitals and guaranteeing the provision of much-needed equipment, supplies and transport services for rural health workers can also go a long way in building this rural health workforce. With the international community now coming together to strive for universal health coverage (UHC) as a major global health priority, we must acknowledge how these critical investments in frontline health workforce strengthening are central to achieving this goal.



[1] The ILO has calculated the 10.3 million global health workforce shortage based on a threshold of 41.1 health workers per 10,000 people.

World Health Worker Week 2015: A Catalyst for Further Advocacy

By Aanjalie Collure, IntraHealth International 

WHWW

Last week, diverse organizations came together to honor the heroic and lifesaving work of frontline health workers in their communities and beyond, and advocate for health workforce strengthening to be a central priority in the global health agenda moving forward. Our common, heartfelt gratitude and respect for frontline health workers was undoubtedly the mobilizing force behind these passionate and concerted advocacy efforts, and World Health Worker Week 2015 provided the unique opportunity to collectively share our sentiments and work together towards these shared goals.

The first World Health Worker Week in 2013 was built on mobilizing a shared recognition that improving access to skilled, motivated, and supported health workers was absolutely central to achieving universal health coverage (UHC). Two years later, World Health Worker Week 2015 further built on this theme to stress how health workers were “the backbone of all global health goals” – from achieving an AIDS-free Generation, combatting maternal and child mortality, defeating Ebola and other infectious diseases, and, indeed, underpinning the resilient health systems we need to achieve universal health coverage. This year’s official poster for World Health Worker Week, designed by Karen Melton at IntraHealth International, creatively illustrated the foundational role health workers play in achieving these goals.

Numerous articles published by partners in recognition of WHWW highlighted the tenacity of health workers in accelerating progress towards achieving critical global health priorities. In Health Workers on Ebola Frontlines Serve Countries, Risk Own Lives, a feature story published by the World Bank for WHWW, we learned about the tireless efforts of local West African health workers in helping their countries reach zero Ebola cases, despite enormous risks, poor motivation, and ongoing shortages in essential protective equipment and training. To overcome these challenges and rebuild, the article emphasized the need for investment in “developing a national health workforce as part of a more resilient system.”

Similarly, in Health Workers Spotlight: Heroes in the Fight for an AIDS-Free Generation, The Elisabeth Glaser Pediatric AIDS Foundation (EGPAF) acknowledged how critical health workforce shortages have hindered efforts to prevent and treat pediatric HIV/AIDS, and highlighted how investments in bolstering the health workforce in Kenya, Malawi and Rwanda have had a huge impact on bolstering sexual reproductive health services in these regions.

Finally, in 289,000 Reasons Why Health Workers Count for Mothers, IntraHealth International’s President and CEO Pape Gaye advocated for investments in helping developing countries “to train and deploy health workers where they are needed most” – especially in rural areas where health workers are largely inaccessible to women like Lala, Gaye’s sister who tragically lost her baby when she could not reach a hospital nearly 20 miles away during an emergency pregnancy complication.

We also learned during this week that health workers are not only the underpinning backbone of global health goals, but also a fervent voice on behalf of the communities they serve. In Health Workers Speak, a Humans of New York-esque gallery featuring over 40 photos and quotes from health workers around the world, health workers themselves spoke passionately on their commitment to providing life-saving services at all odds. Beautiful stories were also shared in A Day in the Life, an interactive map produced by the One Million Health Workers Campaign, Esri, and Direct Relief, showcasing the diverse roles community health workers play in improving health outcomes across Africa.

Inspired by these stories, leaders and health workforce advocates took to social media to express their deep appreciation for frontline health workers. In a WHWW twitter chat organized by Johnson & Johnson on April 9th, over 300 organizations and individuals used the hashtag #HealthWorkersCount to express their gratitude for the indispensable role health workers play in communities they live and work in. Throughout the week, USAID and other US government agencies celebrated the contributions of health workers, and shared blogs highlighting what still needs to be done to achieve a sustainable and resilient global health workforce.

As a perfect capstone to this week, Save the Children Pakistan and partners hosted an awards ceremony honoring 36 lady health workers from different Pakistani districts for their life-saving work in improving maternal and child health outcomes in rural regions. Yasmeen Shahzad, a lady health worker from the Rawalpindi district, said that she felt incredibly motivated and “encouraged to work harder” after receiving her award.

With World Health Worker Week 2015 now come to a close, we feel inspired and energized to continue building the momentum we need to ensure health workforce remains a core priority of the global health and development agenda. We hope that organizations and individuals will use what they have learned from this week as a catalyst for the ongoing engagement and advocacy we need to ensure health workers around the world have the support they deserve.

Exploring A Day In The Life Of Community Health Workers

By Andrew Schroeder, Direct Relief

[This blog was originally appeared on the Direct Relief site.]

Celebrating World Health Worker Week (April 5 -11, 2015), a new story map from Esri, The Earth Institute at Columbia, and Direct Relief, aims to raise support and awareness for the life changing contributions of community health workers.

story_map_1

In dozens of countries, tens of thousands of women and men get up each morning to travel miles over rough roads and across rivers and streams to provide primary health care in some of the world’s most remote, vulnerable, and hard-to-reach places. At any given moment, these people, known as Community Health Workers (CHWs), are monitoring Ebola contacts, counseling an HIV-positive person, surveying basic health needs, or helping a newborn at risk of pneumonia.

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When the Ebola epidemic swept through West Africa last year, international organizations had difficulty establishing and maintaining community trust. Community Health Workers, many of whom are from the communities they serve, stepped in to bridge the gap. Not coincidentally, the organizations with the most durable results to show also relied extensively on CHWs for case tracking, diagnosis, sensitization, referral, and follow up. Such groups include Partners in Health and Last Mile Health in Liberia, UNFPA in Guinea, andMedical Research Centre (MRC) and Wellbody Alliance in Sierra Leone.

Arguably, CHWs are the key for the countries now rebuilding their health systems to be more comprehensive, effective, and resilient following the shock of the Ebola epidemic. They may also be the best defense against a repeat of these events in the future.

Beyond Ebola: One Million Community Health Workers

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While the Ebola epidemic spotlighted the crucial work of CHWs, their value extends far beyond Ebola and West Africa. The One-Million Community Health Workers (1mCHW) Campaign was formed by the Sustainable Development Solutions Network (SDSN) and the Earth Institute at Columbia University to advocate for CHWs and document their far-reaching value.

Direct Relief and Esri teamed up with the Campaign last year to build the Operations Room; a suite of mapping applications that track the scope and enable a detailed comparison of CHW activities.

29 Stories. 24 Hours. 13 Countries

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A Day in the Life: Snapshots from 24 Hours in the Lives of Community Health Workers is the latest map in the 1mCHW Campaign. It aims to convey not only the importance of the work that CHWs perform, but the everyday texture and genuine beauty of the lives they improve. This map is a guided tour of 29 CHWs in action during one long day across 13 countries in sub-Saharan Africa. Through the CHW story map, people can learn about and become more deeply engaged in one of the great causes of our time — ensuring that every person on Earth has access to health care.

Using Basic Mobile Phones to Train Thousands of Healthcare Workers in Kenya

By Annie Geraghty, Accenture Development Partnerships  

George Ngamia has been selected by his clan as a Community Health Worker (CHW) in Kenya’s Samburu District. The Samburu lead a semi-nomadic lifestyle in a remote area of northern Kenya with little to no access to the formal healthcare system. Trained in the basics of preventative healthcare by the African-based health development organization, Amref Health Africa, George provides advice, education, referrals and frontline health services to his community, wherever it goes. But all this travelling means he has little opportunity to catch up with the other CHWs in his unit, or to visit the nearby health facility.

George’s situation is not uncommon. There is a critical shortage of all types of health workers in Africa. CHWs fill this gap remarkably well, and in many places provide the first line of healthcare. While many health ministries in Africa have a community health strategy, with a core curriculum, they lack the capabilities to train a qualified health workforce, especially in remote areas. And, at the moment, there is no scalable, sustainable method of CHW training. This means the recruitment and deployment of these workers is much slower than it could be. Indeed, of the CHWs that have been trained, most have only received a fraction of the training and tools they need; training is inconsistent and retraining opportunities are thin on the ground.

But here’s the good news. The ongoing mobile technology “revolution” in Africa has provided us with an opportunity to reach CHWs with tailored content specific to their needs. Of the 97 percent of CHWs who own a mobile phone, the majority have basic or feature (not smart) phones, and so our new Health Enablement and Learning Platform (HELP) has been developed to work precisely on these basic phones, to provide access for as many CHWs as possible.

In Kenya, HELP provides the Ministry of Health-approved training content to CHWs using a sophisticated mobile learning methodology through any mobile phone (both basic and smart phones), empowering health workers through learning opportunities and enablement tools.  It has been developed through a cross-sector collaboration between Amref Health AfricaAccenture, Mezzanine, Safaricom and the M-Pesa Foundation. HELP also provides ongoing, personalized training and productivity tools such as job aids and decision trees, developed in collaboration with the Ministry of Health.

HELP allows George to update his own knowledge on a regular basis and keep in touch with his fellow CHWs and his supervisor (a Community Health Extension Worker – CHEW) through a free group chat function available on his basic mobile phone.

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“I never knew a phone could be used to learn. It provides more in-depth and detailed information than face-to-face interaction, and will help me to deliver a high quality service.” George Ngamia, CHW, Samburu, Kenya. Photos courtesy of Amref Health Africa.

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Following a tailored education model, training is delivered through SMS and interactive voice response (IVR) and controlled with an advanced scheduling system. Randomized quizzes keep CHWs on their toes and automated reports keep supervisors informed of their progress.

 

May 2014 saw the successful completion of a 12-month pilot, where HELP was rolled out to 318 CHWs in three regions across Kenya – urban, rural and nomadic. A total of 215,000 SMS messages and 140,000 minutes of IVR audio were delivered to CHWs and 8,500 health-related group chat messages were sent. Seventy-eight percent of CHWs fully completed all nine training topics with an average quiz score of 80 percent and an overall satisfaction rating of 4.7 out of five possible. Furthermore, after four months we found that the knowledge retention level was 12 percent higher in the pilot groups.

We are now rolling the program out to 3,000 CHWs, reaching 300,000 people, and partnering with other NGOs to enable greater scale through collaboration. Together, as a coalition of NGOs and implementers, the private sector, Ministries of Health, donors and foundations, our ultimate goal is to train hundreds of thousands of health workers across Africa. We are also evolving the platform towards smart devices and richer content.

With sub-Saharan Africa expected to have 930 million mobile subscriptions by the end of 2019 – nearly one for every resident – you can be sure that mobile devices will play a critical role in changing and improving healthcare delivery across Africa, especially in remote areas where most people don’t have access to quality health facilities or providers.

For George, with such accessible training materials and support tools delivered through his basic mobile phone, that era has already begun.