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:

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 


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.


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.


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


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


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.

accenture photo 1

“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.

accenture photo 2

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.

Tracing the Money: A New Tool to Impact the Budget Process

This article originally appeared on the Family Care International Blog, available here:

By Kathleen Schaffer, Family Care International 

Kenya calendar 2A 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.


International Women’s Day: Women #MakeItHappen on the Frontlines of Global Health

By Aanjalie Collure, IntraHealth International

Photo by Jonathan Torgovnik/Reportage by Getty Images

Photo by Jonathan Torgovnik/Reportage by Getty Images

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.

Health Workforce Shortage Weakens AIDS Response

This article originally appeared in the Center for Global Health Policy’s Science Speaks blog, available here.


Photo from FHWC Congressional Briefing on “Building the Health Workforce We Need to Achieve an AIDS-Free Generation.” From left to right: Dr. Kate Tulenko (Vice President, Health Systems Innovation, IntraHealth International), Kelly Curran (Director, HIV and Infectious Diseases, Jhpiego), Dr. Address Malata (Principal, Kamuzu College of Nursing, University of Malawi), Lisa Carty (Director, US Liaison Office, UNAIDS), Ambassador Deborah Birx (US Global AIDS Cooridnator), Vince Blaser (Acting Director, Frontline Health Workers Coaliton).

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: 

debbirxAmbassador Deborah L. Birx, M.D., U.S Global AIDS Coordinator






Dr. Address Malata, Principal, Kamuzu College of Nursing, University of Malawi (Part of Nursing Education Partnership Initiative)






Lisa Carty, Director, US Liaison Office, UNAIDS

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: