New Analysis Highlights Cost Effectiveness of Health Workforce Scale Up in Ebola-Affected Countries


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

 

Cost of Scaling up the Health Workforce in Liberia, Sierra Leone, and Guinea Amid the Ebola Epidemic: FHWC Costing Analysis (March 2015)

costingcoverThe 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.

Read the full costing analysis here. 
Read our Ebola policy recommendations here. 

Find these resources and more from our members at frontlinehealthworkers.org/ebola/.

Bridging the Gap: Surgical Care in Low-Resource Settings

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.

Mohammed Hussein with his mom before his second surgery. Courtesy ReSurge International

Mohammed Hussein with his mom before his second surgery. Courtesy ReSurge International

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.”

Mohammed Hussein with his dad after the second surgery. Courtesy ReSurge International

Mohammed Hussein with his dad after the second surgery. Courtesy ReSurge International

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.

A Bold Strategy and Clear Vision to Improve the Global Health Workforce

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 ghwa@who.int 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.

FHWC Urges WHO Executive Board to Put Frontline Health Workers at Center of Ebola Discussions

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

More Support Needed for Local Health Workers Responding to Ebola, Advocates Say

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/

5 Ways to End AIDS by 2030

This article originally appeared in Devex.

By Margarite Nathe, IntraHealth International

When it started in the early 1980s, everyone was scared. No one knew how to help the people who were filling U.S. hospitals and then swiftly dying, or what to do for others suffering the same fate around the world. It was 1984 when one U.S. health official expressed hope for a vaccine within two years.

Now, over three decades and 39 million deaths later, we finally know how to treat, prevent and control HIV, although a vaccine remains elusive. But knowing is different from doing. The real challenge is scaling up what we’ve learned to stop new infections for good.

Last month, UNAIDS announced its new fast-track strategy to end the AIDS epidemic by 2030. “If the world does not rapidly scale up in the next five years, the epidemic is likely to spring back with a higher rate of new HIV infections than today,” officials from the U.N. agency said. That’s partly because half of the 35 million people who live with HIV today don’t know they’re HIV-positive, so they don’t know they’re in danger of passing the virus on to others.

By 2020, if the fast-track approach goes to plan, 90 percent of people who live with HIV will know their status, 90 percent of people who know they are HIV-positive will be on treatment, and 90 percent of people on treatment will have suppressed viral loads, making them less likely to transmit the virus. And by 2030, AIDS will no longer be a threat to our public health.

The goal is ambitious. There are still a lot of global problems and prejudices to overcome. But today experts can see what once seemed impossible — ending the epidemic — is finally within reach, and these five focus areas are going to help make it happen.

1. More health workers, ready for anything.

Lab technicians, doctors, nurses, even the truck drivers who deliver antiretroviral therapies and other meds to clinics around the world are all health workers, and they’re at the heart of health and well-being in any community.

HIV demands all different types of health workers and skill sets, including palliative care, counseling, research, pharmacology and obstetrics, to name just a few. Pediatrics is another big one, as one of our greatest challenges ahead will be making sure all HIV-positive infants and children are on treatment.

According to the World Health Organization, we need some 7.2 million additional doctors, nurses and midwives worldwide. And unless we invest in the global health workforce, that number will grow to 12.9 million by 2035.

To end the AIDS epidemic, the world needs more health workers who are trained and ready to do the job, stationed in the right places, connected to the right technology, and safe from infection and violence. Countries also need to make better use of the health workers they have. Without health workers, we can’t test or treat even a single person — much less end an epidemic.

But it’s not just health workers’ skills the world needs. It’s also a commitment to equitable, unbiased health care for all.

2. Focus on key populations.

Members of key populations — something of a euphemism for sex workers, men who have sex with men, transgender people and injectable drug users — are marginalized and stigmatized. Their isolation and high-risk behaviors mean these groups have much higher HIV prevalence rates than others and they suffer the bulk of new infections.

Not so long ago, U.S. policy tried to prevent global health organizations from working with certain key populations. And when we did, we were often required to first document our moral indignation by proclaiming our opposition to, for example, prostitution.

Today this policy has changed. But that doesn’t mean that these key populations are getting the HIV services they need. Take Uganda’s infamous anti-homosexuality law — enacted and then repealed this year — which made it difficult for many to seek or even provide care without risking life in prison. Similar laws are still on the books in some countries.

Many members of key populations have been turned away by health workers. And many more have been socially outcast for so long that health care doesn’t even seem like an option anymore. So they fall through the cracks of health care systems around the world.

One example is in South Sudan. The HIV rate among the general population is relatively low, only 2.2 percent among adults. But among female sex workers — and there are many, particularly wherever there’s a strong military presence — the rates are much higher. The ongoing war and all its effects on the health system have turned the country into a tinderbox for potential HIV infections.

That’s why IntraHealth International, in partnership with the South Sudanese government, reaches out to sex workers at brothels and lodges, trains peer educators (that is, other active female sex workers), promotes and distributes condoms, provides testing and counseling for HIV and syphilis, and links women to other critical health services. Of the 546 sex workers we tested between July and September of this year, almost 32 percent were HIV-positive. Fortunately, most are now enrolled in treatment and getting the care they need.

3. Rock-solid health systems.

Over the past 35 years, we’ve seen what a strong health system can do to help countries respond to HIV. And in the past year, we’ve seen another virus, Ebola, spread out of control in West Africa. It’s clearer than ever that vulnerable health systems around the world have a long way to go.

Strong health systems are the bedrock of any healthy population. They lay a foundation built on governance, financing, technology, research, service delivery, and the health workforce (also known as human resources for health). To successfully address an epidemic such as HIV requires focus on each of these things, not just a few.

One way to make these systems stronger — and to lower rates of HIV — is to ensure systematic HIV testing and counseling. Integrating different types of services (HIV and tuberculosis, for example, or HIV and family planning) is a way to reach those at greatest risk.

Starting this year, a new USAID-funded global project called Linkages will play a big role in strengthening health systems around HIV. The project will build capacity within governments and civil society to offer high-quality HIV services that are sustainable, evidence-based, and comprehensive, specifically to key populations.

4. Strange bedfellows, unexpected results.

What do you get when you gather motorcycle taxi drivers, local traffic police, and a regional health management team in rural Tanzania? Hundreds of men and boys eager to lower their chances of contracting HIV and want to learn road safety tips all in one place.

It happened this year as part of a drive to offer voluntary medical male circumcision to men and boys in hard-to-reach areas. IntraHealth worked with the union of Kahama’s motorcycle taxi drivers to gather hundreds of community members together to offer the service, which lowers a man’s risk of contracting HIV through heterosexual intercourse by 60 percent.

Everyone had a great time, especially when a popular Tanzanian comedian showed up and talked about his own circumcision. And hundreds of men and boys opted for the procedure during the event.

Global health needs more strange bedfellows — that is, innovative partnerships — like these if we’re going to end the HIV epidemic.

5. ARVs to treat and prevent.

It was 2011 when U.S. scientist Myron Cohen and his team at the University of North Carolina at Chapel Hill discovered that treating HIV-positive patients with antiretroviral therapy while their immune systems are still strong significantly lowers their risk of transmitting the virus. His study proved the concept of treatment as prevention.

Today, some 13.6 million people (of the total 35 million who live with HIV) have access to antiretroviral therapy. We’ve come a long way. But the final push will mean making sure as many people who live with HIV as possible are taking these medications to reduce their viral loads — and their chances of transmitting the virus.

It will also mean honing our overall approach. Think community-based testing campaigns, provider-initiated testing and counseling, and even self-testing. But countries need health workers and strong health systems to support these approaches.

The endgame

PEPFAR, the Global Fund and UNAIDS are all changing their programming priorities,” says Karen Blyth, director of East Africa programs at IntraHealth.

The new focus: key interventions that save lives.

“That’s because we know now that a generalized approach often doesn’t work,” Blyth explained. “In Uganda, for instance, new HIV infections are now rising, after dropping for 15 years. So from this point on, it’ll be about targeting the hotspots of the epidemic — reaching exactly the right people in the right places with the right treatment and services.”

The next 15 years are going to make global health history. They may mark the end of the most damaging epidemic in our lifetimes, during which countries around the world rallied together to face a unifying threat. Of course, these five approaches alone won’t be enough to bring this chapter to a close. But each one is vital to reaching our goal.

We’ve got just 15 years to make it happen. Let’s get to work.

[IntraHealth’s work in Tanzania is funded by the US Centers for Disease Control and Prevention (CDC) and in South Sudan by the CDC and the US Agency for International Development.]

Health Workers in Many Kenyan Clinics Brave Community Health Care Alone

By Melissa Wanda, Family Care International, Kenya

In a village in rural Kenya, a woman in labor travels miles along rutted dirt roads to get to the nearest health center. She wants to give herself and her baby the greatest possible chance of surviving childbirth and returning home to begin new and healthy lives. When she arrives however, the gates are locked; the nurse has gone home.

Kenya, with only 11.8 health workers per 10,000 people (more than 40% below WHO’s recommendation of 22.8 per 10,000), is one of 57 countries — including 36 in Sub-Saharan Africa — with a critical shortage of health workers.

Many local health facilities have only one health worker, often a nurse, to provide all patient care. This puts a heavy strain on the health worker, and means that many intended 24-hour health facilities are often closed for extended periods of time. Kenya’s news media has also reported recent health worker strikes in reaction to late or non-payment of wages.

Kenyan health workers share frustrations and challenges of working at understaffed health centers. Photo courtesy Family Care International.

Kenyan health workers share frustrations and challenges of working at understaffed health centers. Photo courtesy Family Care International.

The Government of Kenya has committed to strengthening human resources for health in the public health system. Several civil society organizations (CSOs) working to improve reproductive, maternal, newborn, and child health (RMNCH) have come together to advocate for the fulfillment of this urgently important promise. This alliance, co-led by Family Care International (FCI) and the African Women’s Development and Communication Network (FEMNET) under FCI’s Mobilizing Advocates from Civil Society (MACS) project, is conducting advocacy at the county level in Kenya, since counties are responsible for making many health spending decisions in Kenya’s recently decentralized administrative structure and health system.

With support from the MACS project, Deutsche Stiftung Weltbevoelkerung (DSW), a member of the advocacy alliance in Kenya, has surveyed community perceptions of the need for more health workers, and explored how effectively county governments have invested in addressing those needs. Working in two urban and two rural counties, DSW conducted research at various levels of the health system, including outpatient dispensaries, health centers, and hospitals. DSW found that counties are not budgeting or investing spending adequately enough to ensure that facilities have enough health workers to provide high-quality services. Although special funding has been set aside nationally to hire new health workers, counties have mainly been spending this money to pay current staff. DSW is sharing these findings with MACS and county health authorities, leading to one county already committing to hire an additional 72 nurses.

DSW also brought together community members and health facility staff to discuss the state of care at local health facilities. Community members complained that lack of staff meant an absence of essential services, especially at night and on weekends. Health workers expressed the frustrations of working alone, often lacking the drugs and supplies they need to treat their patients, and the low morale that comes from working under those conditions. For example, one nurse described a recent evening when she was the lone nurse caring for six women in labor!

These community meetings opened new channels of communication, fostering greater understanding and accountability between health workers and the communities they serve. This enabled health system users and health workers to join together in search of practical solutions.

Peter Ngure, DSW’s project lead, shared with me a story about one community in which participants said they prefer to come to the hospital — a long distance from their homes —in the afternoon, so they have time in the morning to travel there. In response, the hospital rearranged staff work schedules, deploying more nurses in the afternoon than morning hours. Similarly, community members learned that the hospital holds Monday afternoon staff meetings, helping to explain why appointments are often unavailable at that time, which had been a repeated source of frustration and confusion.

“This dialogue between community members and health workers helped to build much-needed goodwill during these very challenging times,” said Mr. Ngure.

FCI, DSW and the members of the civil society advocacy alliance will use these findings and experiences to hold county governments accountable for addressing the health worker shortage. When the Kenyan Ministry of Health releases its upcoming human resources for health strategy, which will provide specific guidance on exactly how many health workers should be assigned to each health facility, alliance members will work to make sure that counties follow that national policy, so that every Kenyan mother, seeking care for herself and her baby, will be greeted by open gates and a health worker with the skills and resources to ensure their survival and good health.

Chiapas Health Workers Improve Maternal Health with mHealth

By Julia Nakad, Hesperian Health Guides

Rural Chiapas might appear to be an unlikely place for mHealth initiatives to gain traction – with one person in four unable to read, and little cell phone reception or internet connectivity in the mountains, it would seem that accessing understandable information through mobile technology would be a challenge for health workers and patients alike. Yet the community health workers of Compañeros en Salud (CES) have found unexpected ways to make innovations in mobile health technologies work for them and strengthen their programs.

CES, a sister branch of Partners in Health, started training frontline health workers in 2012, who in turn began outreach initiatives to treat patients who previously had to travel long distances and pay exorbitant prices to receive care. In the two years since the project’s start, CES has managed to provide affordable care to tens of thousands of patients. This reach is in some part due to their incorporation of mHealth apps (which function offline once downloaded) to better manage their patient information, minimizing the “time consuming and error prone process” of using and maintaining paper health records. Within just one year, the team was able to use this technology to collect health information from over 5,000 patients.

A CES health worker field tests the app with a patient. Courtesy Hesparian Health Guides.

A CES health worker field tests the app with a patient. Courtesy Hesparian Health Guides.

More recently, CES staff realized they could use these tablets for more than just data collection and efficient record keeping; they could also use them as tools to educate health workers and their patients. Mobile apps could also be used to train health workers and help them to build new skills such as identifying symptoms and responding to emergencies. Frontline health workers could also use educational images and messages with patients to help explain a condition or help a patient to describe their symptoms.

To explore this idea, CES performed a field-test using the Safe Pregnancy and Birth App, a mobile application developed by Hesperian Health Guides in 2011 to provide life-saving information about pre- and post-natal care. The field test was conducted by community health workers, midwives, and clinic staff, who used the app during checkups with patients. Health workers then provided feedback and recommendations about the app.

The field-test in Chiapas provided a great deal of useful and constructive feedback for Hesperian for future updates and development of additional apps. CES partners commented that they “plan on continuing to use the app in pre-natal monitoring, especially with health workers and prospective parents. In particular, field testers most appreciated the helpful sections about “Staying Healthy During Pregnancy,” a “How-To” section for health workers, and information about “Signs of Shock,” as well as the clear illustrations.

A screenshot from the “How-To” section of the app. Courtesy Hesparian Health Guides.

A screenshot from the “How-To” section of the app. Courtesy Hesparian Health Guides.

They also included helpful suggestions for making the content even more accessible to those with fewer literacy skills, and advice on how to improve the app so that it helps health workers and patients to develop an emergency plan. This feedback will help us refine the design and content of this and future apps. In general, CES field testers found that “it is anexcellent teaching and learning tool that will undoubtedly be a benefit to many people around the world by empowering them with useful and practical information for caring for a pregnant woman and her baby before, during, and after delivery.”

The app may serve an especially important role in Chiapas, where women die in childbirth 70% more often than the national average, with survival rates that are three times lower for indigenous women. According to CES, the leading causes of maternal death include postpartum hemorrhage, preeclampsia, and puerperal infections.

The app is downloadable from iTunes or Google Play, and functions offline once downloaded. Courtesy Hesparian Health Guides.

The app is downloadable from iTunes or Google Play, and functions offline once downloaded. Courtesy Hesparian Health Guides.

The app, which has been downloaded more than 193,000 times since its launch in September 2011, was recently selected by the mHIFA working group as one of the top seven mHealth pregnancy apps from a pool of nearly 1,600 apps reviewed. The mHIFA Working Group is part of Healthcare Information for All by 2015 (HIFA2015) , an online community committed to a world “where people are no longer dying for lack of healthcare knowledge.” They sought to identify the mHealth projects that empowered people with actionable lifesaving information on the topics of child health, maternal health, and first aid. Additionally, they were looking for projects that easily could be used in resource-poor areas, and found that the Safe Pregnancy and Birth app fit this criteria as most capable of providing “actionable health information directly to parents, families, and children.”

Counting Community Health Workers “Counts”

By Cindil Redick, One Million Community Health Workers Campaign

CONARKY, Guinea – How many community health workers (CHWs) are there? What are community health workers’ tasks? How can we more efficiently integrate CHWs into national health systems?

Global public health leaders widely acknowledge that there are not enough health workers in the world. Tragically, this fact has been further highlighted by current state of the Ebola epidemic in West Africa. With over 9,000 Ebola cases (confirmed, suspected and probable) spread throughout Liberia, Sierra Leone, and Guinea, we are seeing a devastatingly high need for frontline health workers.

The health workers that are on the frontlines where I am currently in Guinea and throughout in West Africa are doing admirably hard work to end this Ebola epidemic. But how many frontline health workers are fighting Ebola and addressing myriad health issues around the world? Unfortunately, due to a lack of data we do not have a clear picture of the number of frontline health workers, particularly CHWs, who are assisting in the efforts.

These were just some of the questions the One Million Community Health Workers (1mCHW) Campaign with the Frontline Health Workers Coalition, Johnson & Johnson and others explored in their side session at the Third Global Forum on Health Systems Research in Cape Town, South Africa a few weeks ago.

The basis for this panel discussion was a newly published policy report released by the Frontline Health Workers Coalition endorsed by 17 organizations including the 1MCHW  Campaign about the difficulty in assessing the state of CHWs within the global community. Panel speakers from Jhpiego, IntraHealth International, the University of Washington’s Institue for Health Metrics and Evaluation and the 1mCHW Campaign provided the context necessary for a dynamic discussion.

Sept. 29, 2014: Panelists from at the Frontline Health Workers Coalition satellite session during the Third Global Symposium on Health Systems Research in Cape Town discuss the need for improving community health worker data for decision making. Credit: Frontline Health Workers Coalition.

Sept. 29, 2014: Panelists from at the Frontline Health Workers Coalition satellite session during the Third Global Symposium on Health Systems Research in Cape Town discuss the need for improving community health worker data for decision making. Credit: Frontline Health Workers Coalition.

During the session, it was widely recognized that despite being invaluable to improving health outcomes in many countries, CHWs are still an “invisible cadre” due to a lack of uniform and organized data. More importantly, the fact that there are many different types of CHWs adds to the difficulty in tracking them—sometimes, the variation in types of CHWs confuses members of the communities they serve.

Defining CHWs is only the first part of the solution. After CHWs are defined and professionalized, how do we count them? This question led to an interesting conversation about the need for CHW registries. There was support for the creation of CHW registries. However, it was suggested during the discussion that data should be collected at the local, district and central levels, and it must feed up to the national level. It was also made clear that CHW registries need to be cohesive so that the proper cadre of health workers is counted and tracked. To do this, the development process must involve CHW supervisors and implementers to help plan for data collection; otherwise, the data flow will fall apart at local levels. It was also recommended that data be collected via mHealth systems, which offer promising options to make it easier for governments to collect data and support CHW level supervision.

Our panelists and audience largely recognized the value in establishing a universal definition for CHWs and widely supported the creation of national registries of CHWs. A solid definition of a CHW leads to better data, and better data not only enables governments to integrate and support CHWs as key components in their community health systems but also track CHWs’ efficacy over time. In turn, CHWs will be able to serve their communities at their maximum potential.

The clearest take-aways from this session and others in Cape Town is that harnessing the power of data is key to both strengthening the CHW workforce, professionalizing the CHW workforce and better understanding CHWs’ impact on health outcomes to inform policy decisions. Knowing this, it is imperative for us in the advocacy community to continue all efforts for CHWs and CHW data collection to finally make these frontline health workers count.