Health worker heroes at the frontline of the Ebola crisis

By Philip Carroll, Save the Children

The Ebola outbreak which started in south eastern Guinea in early 2014, has now spread to Liberia, Sierra Leone, Nigeria and Senegal. Ebola has highlighted the devastating impact that a crisis can have on an already fragile health system and has also highlighted the life-saving and heroic work of frontline health workers, who are risking their own lives to protect and save the lives of vulnerable children in remote communities.

Francis Vandy Rogers. Courtesy Save the Children.

CHW Francis Vandy Rogers. Photo courtesy Save the Children.

Francis Vandy Rogers is a trained community health worker and a carpenter. Francis, his wife and four children are temporarily displaced as a result of a fire outbreak that burnt down their thatch roofed house and 14 other houses in the town in April 2013. They are currently residing at the community training center – temporarily given to him as a result of his active role in the community – while reconstructing their house. Their main sources of water for drinking and other domestic uses are boreholes with hand pump and streams.

Every morning Francis carries his tools box and First Aid box to his workshop where the community people meet him for primary health service while doing his carpentry work. “Usually when they come for treatment I’d leave the wood work, get my hands washed and attend to them then I get back to work,” says Francis.

Francis explains the importance of the training and how he is helping the community. He says, “This training is useful because our people say ‘Korglor yia laygor eh kpokowa’ (translation: Information about an impending war can save the aged from being killed). If God has made it possible to get information about this killer disease they call Ebola, we should do everything within our power to put a bearer before it, especially when they have told us that it is not far from us. I learnt a lot about the prevention of this disease, which I’m going to sensitize my community members seriously about it.”

Francis continued, “First, we are going to ask the town chief to call all the people through the town crier to a meeting so that we can have the opportunity to sensitize everybody. Then we will continue with one on one sensitization and in the event of suspected case, we will immediately report to the health center. From what I learnt in the training, Ebola is a very serious disease that can kill very fast so even the sensitization method and message will be serious so that the people themselves should know that this a serious and must take it seriously.”

CHW Lansana Fofanah. Photo courtesy Save the Children.

CHW Lansana Fofanah. Photo courtesy Save the Children.

Another inspiring example of a heroic health worker is Lansana Fofanah, who is a farmer and a trained community health worker. Lansana and his wife have five children, two of which are living in kinship care. On a typical farming day, Lansana leaves his house very early in the morning and spends rest of the day and returns late in the evening to catch up with the Muslim congregational prayer. Lansana usually reserves a day or two in a week to do his community health services.

Talking about the training and how he plans to sensitize the community, Lansana says, “This training is very good and I consider it as an empowerment to save lives in our communities. Because prevention is the best solution to this Ebola disease. I have also learnt about the causes its signs and symptoms when someone is infected. We should always refer the Ebola patient immediately to the [primary health unit] to avoid its transfer to another person in the community.”

He adds, “I am going to call my community people to a meeting and I will explain to them the dangers of this disease. Because this Ebola does not have medicine and the only solution is prevention so we must abide by all the preventive rules such as stop eating dead animals, monkeys, baboons and bats and even fruits that have been eaten by these animals. Through this we can prevent the Ebola in our communities.”

This is the first time Francis and Lansana have been trained to carryout sensitization on Ebola virus prevention awareness and emergency preparedness.

 

What Lizzie Longshaw – and Her Daughters – Teach us about Health Promotion

By Julia Nakad, Hesperian Health Guides

A horrific car accident when she was only 2 caused Lizzie Longshaw of Zimbabwe to have her left arm amputated. As she grew up she realized that she and other women with disabilities in her community were further disadvantaged – they didn’t receive health exams since disability-friendly and accessible clinics were too far away and too expensive for them to visit, and the stigma against women with disabilities was too great at “normal” clinics. Lizzie and a group of women with disabilities began meeting regularly to discuss their health challenges, using a copy of Where Women Have No Doctor to learn more about the issues that most concerned them, including family planning and cancer. After months of working together, they persuaded a Ministry of Health official to open a government-funded mobile clinic to provide free cancer screening and family planning services for women with disabilities.

Lizzie’s group began organizing 20 years ago, before mobile phones, tablets and Internet cafes were available. For Lizzie and her colleagues, access to accurate health information led to dramatic improvements in health outcomes for women with disabilities. The incredible work carried out by Lizzie and the National Council of Disabled Persons of Zimbabwe inspire us to ask how we can increase well-being for all by increasing access to accurate, easy-to-use health information through today’s technology.

In some ways, books and print materials are the still the best: They have no batteries to run out, the only bandwidth they depend on is the reader’s concentration, and they’re easy to pick up and put down as life interrupts. But new technologies offer advantages, too.

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On Hesperian’s HealthWiki, a searchable online platform that functions well on slow internet connections, we make freely available the accurate, easy-to-understand health information found in our books. With Hesperian titles available in the HealthWiki in English, Spanish, and an increasing number of other languages such as Arabic, Chinese, Filipino, French, Haitian Kreyol, Khmer, Lao, Portuguese, Vietnamese, and Urdu (and more coming!),this resource helps equip health workers as they build health training and education programs in their communities. And as Lizzie’s experience shows, it also helps them to organize around unmet health needs and advocate for change.

In the past year, the HealthWiki received 2.5 million page views. While information about sanitation and hygiene, healthy food, and “pain in the belly and gut” are popular topics, a striking trend in HealthWiki engagement relates to women’s health information, especially in Spanish. Five of the 10 most viewed pages address pregnancy and reproductive health. Top sending countries to the HealthWiki include Mexico, Colombia, Argentina, Peru, Venezuela and Chile.

Latin America activist-researchers know that adolescents as young as 12 are increasingly engaging in sexual activity, that very high numbers of young women in Latin America report their first sexual experiences as forced or unwanted, and that it is often difficult to access contraceptives and dangerous or impossible to access safe and legal abortions. It stands to reason that the critical need for information about sexual and reproductive health in this region is reflected in HealthWiki use. Among the most-accessed pages in the HealthWiki are “Métodos seguros para realizer un aborto” (Safe abortion methods), “Riesgos y señas de peligro durante un embarazo” (Risks and danger signs during pregnancy), “Violación sexual” (Rape), and “Complicaciones del aborto” (Complications of abortion). Being able to find safe, trustworthy and comprehensive information in an online form responds to the needs of a new generation of tech-savvy yet still marginalized young women. The sheer number of visitors to the HealthWiki’s sexual and reproductive health materials demonstrates that this resource is meeting an urgent need by providing access to information that is otherwise difficult, or dangerous, to obtain.

The HealthWiki also supports the work of frontline health workers. Amelia Brandt, Associate Program Director at Medicines for Humanity, has experience taking the information in the HealthWiki from the computer to the field. In her role overseeing projects in Latin America, she covers 10 projects in 4 countries: Guatemala, Guyana, Haiti and the Dominican Republic. She works with local, faith-based organizations and non-governmental organizations to build the capacity of community and frontline health workers, with the goal of reducing child mortality.

The “LaLoma” project serves the communities of Consuelo and Quisqueya in the Dominican Republic, with the support of Medicines for Humanity. Photo courtesy of Medicines for Humanity.

The “LaLoma” project serves the communities of Consuelo and Quisqueya in the Dominican Republic, with the support of Medicines for Humanity. Photo courtesy of Medicines for Humanity.

Consulting with her partners on clinical evidence they collect in their communities, Amelia leads a process to determine which areas need training. She then searches for useful materials: “The first place that I go is the HealthWiki,” Amelia said, adding, “I pull out everything relevant that I find (for example, materials about women’s health- adolescent pregnancy is major concern, especially in the Dominican Republic) and send it to our partners in the field for us to discuss and determine what will be most appropriate for use in trainings with our [community health workers]. The material is accessible – it includes health information, different ways to present that information, and activities to accompany it. It’s easy for people with different levels of training experience to use.”

Where Lizzie Longshaw had to labor over a book, a photocopier, and paper, scissors, and tape, new technologies like the HealthWiki make Amelia’s job easier and more conducive to localization.

From promoting contraception options to preventing the spread of Ebola, frontline health workers are the lifeblood of health systems, especially in remote and resource-poor areas. Providing health information to support their programs and facilitate the long-term improvements only they are capable of carrying out is crucial. Health information in all formats – books, flip charts and posters, radio and video, online and via cell phone  – in as many languages as possible will make all the difference in the world.

 

Saving Lives Starts with Frontline Health Workers, Congressional Roundtable Told

By Zoe Matza, Frontline Health Workers Coalition

Strengthening the health workforce on the frontlines of care is a must for United States’ global health priorities to be achieved, leadership of the World Health Organization, U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and USAID told a congressional roundtable on Wednesday.

Across all U.S. global health priorities, including “ending preventable child and maternal deaths, achieving an AIDS-free generation, ensuring global health security, and future agendas like non-communicable diseases, health systems and human resources are the backbone of the response,” Dr.  Ariel Pablos-Mendez, assistant administrator for global health at USAID, told a standing-room only audience.

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Congressional staff members, Obama Administration officials and global health leaders gathered to hear Dr. Pablos-Mendez, U.S. Global AIDS Coordinator Amb. Deborah Birx, WHO and the Global Health Workforce Alliance’s Dr. James Campbell, and International Medical Corps’ Ann Canavan discuss the state of the frontline health workforce and their importance in furthering progress in global health. The Frontline Health Workers Coalition, International Medical Corps, IntraHealth International, Elisabeth Glaser Pediatric AIDS Foundation, Management Sciences for Health and Save the Children co-hosted the roundtable in cooperation with Reps.  Betty McCollum (D-Minn.) and David Reichert (R-Wash.), co-chairs of the Congressional Global Health Caucus.

It is “startling to see that many of the US [government] priority, focus countries are continuously reporting that the biggest bottleneck to accessing care is the health workforce – this frontline health worker,” Dr. Campbell, who directs the WHO health workforce department as well as the Global Health Workforce Alliance in Geneva, said during his overview of the current global health workforce landscape. He added several countries have made substantial progress by focusing investment on scaling up community-based practitioners to deliver a package of essential health services and strengthening the referral system to other health workers.

Recent reports that peg the global health workforce shortage to be at least 7.2 million, possibly more than 10 million, are helpful to make the case to raise the level of focus on the workforce issue, but Dr. Campbell said that a new global strategy on health workforce that WHO is mandated by member states to produce by 2016 must go beyond looking at the shortage to highlight the high return on investment for countries to invest in improving their health workforce.

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The need to make the case to focus on health workers more in terms of economics and finance was echoed by Amb. Birx and Dr. Pablos-Mendez. Amb. Birx said that PEPFAR since its inception has helped to train and retain at least 140,000 health workers but added that “better numbers” are needed on health workforce gaps, successful health worker training and deployment, and the economic and social impacts that inadequate access to a quality health workforce has on populations. She added that PEPFAR is working with USAID and other agencies on a strategy to ensure health workforce and health systems issues are being adequately and sustainably addressed not only in U.S. “priority” countries but in all low-income countries.

Dr. Pablos-Mendez said that while the United States’ long history of helping countries strengthen their health workforces has been integral in progress that has allowed 100 million children’s lives to be saved in the last 20 years, there remains much to be done to ensure the health workforce needed to achieve long-term targets. He said better evidence and data is needed to support and drive U.S. government leadership and investment in health workers, but added that the current Ebola outbreak in West Africa has tragically highlighted how weaknesses in frontline health workforces and systems can make responses to global health emergencies far more difficult.

The importance of focusing on workforce deficiencies during public health emergencies like the Ebola outbreak, as well as in conflict and post-conflict settings, was picked up by Ann Canavan, Director of Health Policy and Practice for International Medical Corps (IMC). Through highlighting responses to workforce situations from South Sudan, to Afghanistan to the Ebola-affected countries in West Africa, Canavan said there is an urgent need for better financing, investing, and accountability on addressing workforce issues in emergency settings.

Amb. Birx and Dr. Pablos-Mendez responded to questions about the challenges of funding a cross-cutting intervention like health workforce in an environment of disease-specific funding by noting that a coordinated approach across U.S. global health and development investments is important.

It was heartening to feel the enthusiasm in the room as panelists spoke optimistically and emphatically about the role of USG investment in health workforce development, recognizing the successes and continued need for strong US support and focus on frontline health workers.

 

Learning to Pay the Price: The Need for Remuneration of Frontline Health Workers

 

This post originally appeared on the Maternal Health Task Force blog page.

By Cindil Redick, One Million Community Health Workers (1mCHW) Campaign

In many parts of rural sub-Saharan Africa, clinics and hospitals are few and far between. A recent report by Save the Children estimates that every day approximately 22,000 children die before they reach their fifth birthday. This fact is augmented by the World Health Organization’s (WHO) estimation that at least 1 billion people have little to no access to health workers. The worst part is that this results in death. Quality care provided by a health worker can prevent most of the causes of maternal and child mortality.

CHW checking children for malnutrition in Kenya. Courtesy MDG Center, Kenya.

CHW checking children for malnutrition in Kenya. Courtesy MDG Center, Kenya.

This health worker shortage is a critical issue in over 80 countries. The WHO and Global Health Workforce Alliance estimate that there is a global shortage of at least 7.2 million doctors, nurses and midwives. In an attempt to address these serious healthcare gaps, many organizations, communities, and countries train and deploy community health workers (CHWs). CHWs are community members, often female, who volunteer to provide essential health services to their communities. From prenatal and postnatal care, to malaria diagnosis and nutrition assistance, CHWs provide lifesaving treatment often at little or no cost to the community. They are vital in the fight to improve maternal and child health.

On average, CHWs are responsible for visiting about 100 households and are usually expected to provide follow-up treatment as well as health promotion services to the greater community. However, far too often, CHWs do all of this—enough work for a full-time job—for little or no pay. That’s right, this cadre of health workers is largely unpaid. This lack of remuneration only exacerbates the already stressful job of CHWs, which can have a devastating impact on maternal and child health.

So, what’s the rationale for not paying CHWs? The most widely cited reasons include:

  • Compensating CHWs will detract from their sense of community
  • Compensating CHWs will reduce their value or legitimacy within the community
  • Compensating CHWs is difficult due to lack of domestic resources

Although this list is not extensive, it is telling. There appears to be a general absence of “willingness to pay” for CHWs within the international community. However, research has shown that CHWs who are compensated, either financially or non-financially, perform better than those who volunteer. This is indicative of a growing trend in both programmatic and academic literature that demonstrates not only the need for, but also the value of remunerating CHWs. Some of the most recent evidence can be found in USAID’s 2011 CHW Assessment and Improvement Matrix Toolkit, which suggests financial and non-financial incentives as one of 15 recommendations for CHW improvement.

CHW performing routine check-up on an infant in Senegal. Courtesy, 1mCHW Campaign.

CHW performing routine check-up on an infant in Senegal. Courtesy, 1mCHW Campaign.

Across the world CHWs are making healthcare accessible. They are an integral part of a country’s health system because they are members of the same communities as the people they serve. As such, they too face the same barriers to health and livelihood as their community. By not compensating CHWs, the international community is not only failing to recognize them professionally, but is also perpetuating poverty and reducing the capabilities of an effective cadre of health workers. All of which adds up to this: we are stalling progress in maternal and child health.

CHWs improve health and communities by bringing care to those who need it. It’s time to reciprocate and show CHWs the care and dignity they deserve through health workforce formalization and proper remuneration.

On the Frontlines of Armed Conflict: A First Responder’s Story

By Jenna Montgomery, International Medical Corps

Emergency room nurse Nora Hellman is a frontline health worker who has responded following natural disasters and during armed conflicts around the world to provide lifesaving medical care. With a background in wilderness medicine, Nora has deployed to extremely difficult working conditions with International Medical Corps but is quick to point out the courageousness and hard work of the local staff she worked alongside throughout numerous disasters. She reminds us that after her assignments, she was able to go home but the nationals she worked with and helped train to become First Responders are still there continuing to work on critical humanitarian programs.

Nora first deployed to Haiti following the devastating earthquake in 2010 and then again to respond to the cholera outbreak the following year. After Typhoon Haiyan ravaged the Philippines in late 2013, Nora again used her emergency medicine training to provide relief after a natural disaster. However, the following assignment during armed conflict in South Sudan proved to be extremely challenging for the now seasoned First Responder.

“Providing health care in a conflict area is very different than doing so in one affected by a natural disaster,” Nora said. “It is dangerous; I did not always feel safe. No one did. It is emotion – you see firsthand men, women and children hurting each other. Probably the most stressful thing about working in a conflict area – you never know what is going to happen on a given day – the situation is dynamic, change is the only constant and reliable information is hard to come by.”

Nora Hellman training a South Sudanese nurse. Courtesy International Medical Corps

Nora Hellman training a South Sudanese nurse. Courtesy International Medical Corps

The conflict in South Sudan has now uprooted 1.1 million people and men, women and children who continue to flee their homes in search of safety from violence but they still face dangers such as hunger, disease and other medical concerns. Nora worked for almost two months at the United Nations base in Malakal, a remote oil town in the northern part of the country that experienced many episodes of violence.

Nora doesn’t like to dwell on the horrible things she saw. Instead she takes a more hopeful approach, focusing on the ‘smart, competent and dedicated’ South Sudanese she worked alongside. “These people are students, trained by International Medical Corps. We believe that community members are their own best First Responders, given the proper tools and educational opportunities. They are always there first and they always stay after everyone else leaves.”

Nora worked side-by-side in Malakal with a group of six student nurses who fled their school in Juba when the fighting became too intense. “Our team of doctors, nurses, and midwives worked with them and trained them – we educated them on how to assess and treat children with diarrhea and dehydration, recognition of severe malaria cases, how to screen for and treat malnutrition—things they should have been learning in school.”

Nora marveled at these young men’s tireless work ethic. They saw hundreds of patients every day who needed everything from basic medication to treatment for stab wounds. Once, during a particularly dangerous day of fighting near the compound, Nora and other staffers were forced to take shelter in a bunker. However, these young men braved the violence and opened the clinic themselves to treat over one hundred fellow South Sudanese wounded from the fighting that day.

Today these young nurses continue to use their training to provide medical care to vulnerable community members in South Sudan.

Nora said, “It was the greatest privilege of my life to teach, support and be with these young men as they learned the skills they will need to survive in South Sudan and usher the next generation into a more stable, peaceful, productive time.”

500 Days to MDGs’ Target Date: New Video of Why #HealthWorkersCount for #MDGMomentum 

By Aanjalie Collure, IntraHealth International

Today – August 18, 2014 – the global community comes together to recognize the 500-day mark until the target date for the United Nations Millennium Development Goals (MDGs). On this day, we take the time to honor the contributions of frontline health workers around the world in advancing the three health MDGs: reducing child mortality (MDG4), improving maternal health (MDG5), and combating HIV/AIDS, malaria and other diseases (MDG6).

To demonstrate how integral frontline health workers have been to these global health goals, we have created an animated video highlighting why #healthworkerscount for #MDGMomentum.

Although frontline health workers have provided many communities with the services they need to lead healthier and more prosperous livelihoods, huge gaps remain in the service and accessibility of health workers. The World Health Organization (WHO) estimates that 1 billion people around the world have little to no access to frontline health workers. In addition, Save the Children estimates that there would be a 43% reduction of newborn deaths if more people had access to skilled care during labor. These statistics remind us how prioritizing health workforce strengthening is essential to accelerating progress during these last 500 days until the target date of the MDGs, and beyond.

As the global community begins to discuss the post-2015 Sustainable Development Goals, health workforce strengthening and addressing the enormous health workforce shortage must be at the forefront of discussions if we are to enable further progress on global health goals. Help us show the world that #healthworkerscount for #MDGmomentum by using these hashtags and sharing this video on Twitter and in your social media circles!

Prenatal Education in Indonesia

By Tiffany Montgomery, Kaiser West Los Angeles Medical Center and member of Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN)

In December 2013, along with other maternal health advocates, I visited Bandung, Indonesia to observe the progress being made by frontline maternal-child health workers.

Among children under age 5, Indonesia’s child mortality rate is 31 deaths per 1,000 live births. This number is down from 35 deaths per 1,000 live births in 2009, 34 deaths per 1,000 live births in 2010, and 32 deaths per 1,000 live births in 2011. Frontline health workers are helping to decrease the rates of infant morbidity and mortality through effective parent education and exceptional health services.

A woman, pregnant with her second child, demonstrates proper handwashing.

A woman, pregnant with her second child, demonstrates proper handwashing. Courtesy Tiffany Montgomery

On the first day of our trip we visited a free prenatal education class sponsored by the Sederhana Berdampak Luar Biasa (SELARAS) program. It was the first of four monthly sessions in which the women would participate. Two midwives led the one-hour-long class, referred to by participants as the mothers’ group. Through song, the mostly first-time mothers bonded. They sang, “In one hour we’re having our mothers’ class. In one hour we’re going to be smarter. In one hour we’re going to have fun. In one hour, we’re going to have a healthy pregnancy.” During this particular session, the mothers learned about the spread the bacteria and the importance of proper hand washing.

 

As the curriculum for the mothers’ group is still fairly new, there have not been any women to enroll in the group during more than one pregnancy. However, not all of the group participants were pregnant for the first time. One mother, currently pregnant with her second child, said other women encouraged her to join the group. She spoke of how a midwife taught her about exclusive breastfeeding during her first pregnancy. The information she received motivated her to breastfeed that child for two years. She thought the information on breastfeeding was beneficial and decided to come to the mothers’ group to gain more beneficial information.

Since its inception, 14 mothers’ groups have occurred. About 80% of pregnant women in the community come to the group. According to the midwives, one of the greatest successes of the group is the development of community engagement. For instance, a “community car” has been established as a volunteer transport service. At any hour, there is a designated car and driver for women without access to cars.

On their designated day, men in the community drive laboring women to the local puskesmas, or clinic. While the men enjoy this aspect of community engagement, one of the challenges faced by the group is the lack of attendance by fathers. One midwife stated that while it is difficult to get fathers to attend the group, they support the women’s attendance. An additional challenge is getting the women to move from the idea of a traditional home delivery to acceptance of delivery in the puskesmas, using a skilled birth attendant.

Group photo with mothers' group supporters, midwives, mothers, and the First Lady of the community. Courtesy Tiffany Montgomery

Group photo with mothers’ group supporters, midwives, mothers, and the First Lady of the community. Courtesy Tiffany Montgomery

Currently, there are only seven skilled birth attendants in the community. These health workers are responsible for the care of 4,000 people, including 800 children under 5. Two traditional birth attendants remain in the community and are working to increase comfort with receiving care from skilled birth attendants. In order to do this, they refer pregnant women to midwives and resist caring for the women themselves. In this sense, traditional and skilled birth attendants are working together to ensure the best outcomes of the mothers and babies in their community.

 

 

These frontline health workers are engaged in life-saving work, but they can not do this work alone. When asked what could help her to better do her job, one midwife replied, “Capacity building from the government, … more support from the government to encourage women to deliver at skilled health facilities.” Continued United States government-support of frontline health workers will help to ensure that these health advocates are prepared to provide optimal care to the pregnant women in their communities. I look forward to learning more about the practices of frontline health workers. Visiting Indonesia made it clear to me that, in every part of the world, mothers want the best health outcomes for themselves and their children. A mother’s love is universal.

Health Workers on the Frontlines of Ebola Outbreak in West Africa

 

“Most of the dedicated health workers are really doing a commendable job, dedicating their lives to working in very difficult conditions and caring for persons that have come down with Ebola. What we need to do is commend them for their bravery and their commitment for caring for the patients.” – Francis Kasalo, Coordinator of the WHO’s regional coordination center for Ebola in Conakry, Guinea. Source: Devex, July 30, 2014

FHWC logo no taglineThe Frontline Health Workers Coalition commends the ongoing efforts of thousands of health workers on the frontlines of the Ebola outbreak in Guinea, Liberia and Sierra Leone for their remarkable courage and resilience. Despite working in conditions of severe workforce shortages, inadequate facilities and major personal risk, these health workers are providing the necessary care that will save lives and help to end the outbreak.

The Coalition calls for the safety and support of frontline health workers to be of paramount importance during the response to the outbreak.

According to the Global health Workforce Alliance, World Health Organization International Health Regulations (IHR) emphasize the need for in-country “specialized staff” to provide consistent monitoring and prompt responses for health epidemics. Several recent actions, including the 2014 release of the United States government-led Global Health Security agenda, are focused on improving disease surveillance and responses.

However, Guinea, Liberia and Sierra Leone are among 83 countries worldwide that the WHO in 2013 reported to have below the minimum ratio of doctors, nurses and midwives (22.8 per 10,000 population) needed to provide basic health services to a population, and severe inequities in workforce distribution also exist within these countries. As James Campbell, Director of Health Workforce at WHO and Executive Director of the Global Health Workforce Alliance recently stated, the Ebola outbreak in West Africa highlights the “critical need for investment in health workers and health systems” worldwide.

Far greater global focus and investment on health workforce strengthening, especially on the frontlines of care, is crucial to responding to disease epidemics and to providing the essential care that can save millions of lives every year. Developing country governments and donors must work together to ensure that frontline health workers in West Africa and around the world have the support, tools and knowledge necessary to do their work.

Mali Ramps Up Training Auxiliary Midwives in Key Intervention to Combat Maternal Death

By Kate Greene, Abt Associates

In rural Mali, auxiliary midwives—called matrones–are often the frontline of care for pregnant women, but until recently they have not had the authority and training to perform critical maternal care services. Through the USAID-supported Improving National Capacity to Implement High Impact Health Services and Promote Healthy Behaviors in Mali project (ATN Plus), Abt Associates and its technical partners supported the government of Mali in policy reforms to allow task-shifting of active management of third stage of labor to matrones and brought the initiative to scale country wide.

A matrone learns proper techniques during active management of third stage of labor training. Courtesy Abt Associates

A matrone learns proper techniques during active management of third stage of labor training. Courtesy Abt Associates

This practice – which involves several procedures for safe labor and delivery, including the use of oxytocin to induce and support labor – is a critical component in the fight to end preventable maternal deaths. The World Health Organization (WHO) has a set of guidelines for this type of care in part to reduce postpartum hemorrhage, the leading cause of maternal mortality. It also helps decrease other major complications that can occur during delivery, including retained placenta. Given that a recent report found that Mali only has 30% of the estimated health workforce needed for maternal and newborn care, allowing this management to be conducted by matrones has played a key role towards achieving universal access for safe labor and delivery.

To test the practice, the program and the Prevention of Post-partum Hemorrhage Initiative (POPPHI) partners first trained a pilot group of these frontline health workers between 2006 and 2008. The initial results were promising enough to convince the Malian government to change its policies to allow matrones to practice active management of third stage of labor and implement the initiative countrywide. Matrones participating in the pilot group were assessed on the skills and techniques involved in the management practice and scored 96%, essentially the same as other skilled birth attendants’ score of 97%. Furthermore, matrones’ scores in recognizing and handling delivery complications were virtually identical to those of other skilled birth attendants.

Impressed with the results, Mali’s Minister of Health called for a swift establishment of a commission to develop an action plan for training all matrones throughout the country on the practice. Dr.  Konaté Lasséni, Secretary General of the Ministry of Health added, “The life of a woman does not have a price. The department will do all that’s possible to protect against postpartum hemorrhage.”

After the formal dissemination of the findings from the pilot test on the feasibility of matrones’ use of active management of third stage of labor and the authorization by the health ministry of matrones to apply the practice in 2009, the project team ensured that stakeholders in all regions received copies of the study results, trainers were trained, and qualified providers and nursing and midwifery educators were also trained.

In total, 113 trainers were trained and 755 qualified providers (including educators) and 938 matrones were trained in the application of the practice. At the end of the project, 97.2% of facilities in the project districts had a staff member trained in the application of active management of third stage of labor and the ability to offer this life saving intervention on the frontlines of care to more women and their infants.

Health Workers Pay the Ultimate Price in the Fight Against Ebola

This post originally appeared on the Vital Blog

By Mohamed Jallow, IntraHealth International

“I am afraid for my life, I must say, because I cherish my life,” said Dr. Sheik Umar Khan, one of the leading doctors fighting the spread of the Ebola virus in eastern Sierra Leone.

Last week, Dr. Khan’s fears came true when he was diagnosed with Ebola virus disease. He succumbed to the deadly disease yesterday and died at the very same hospital in Kenema where, just a few weeks ago, he was treating patients from the nearby district of Kailahun.

Dr. Khan is only one among a growing list of medical workers who have been infected while battling the spread of Ebola across West Africa.

In Sierra Leone, 40 nurses and other frontline health workers have died in the line of duty.

In neighboring Liberia, two prominent doctors—Dr Samuel Brisbane, a Liberian doctor, and Dr. Kent Brantley, an American doctor from North Carolina working for Samaritan’s Purse—have been infected with the disease while treating patients.

Losing Dr. Kahn is an immeasurable loss to Sierra Leone. According to the Ministry of Health, he has treated more than 100 victims since the first reports of the Ebola outbreak back in February.

The disease has a fatality rate of up to 90% and has claimed the lives of more than 600 people in Guinea, Liberia, and Sierra Leone.

Sierra Leone’s health care system is already underfunded and understaffed, and now the Ebola outbreak is putting a strain on the country’s limited resources.

In Liberia and Guinea, the response to Ebola has inundated their respective health systems and disrupted cross-border commercial activities—the main lifeline of border communities.

Liberia has announced the closure of its land borders with Guinea and Sierra Leone and has stepped up surveillance at all airports.

According to the World Health Organization, Sierra Leone is among 83 countries facing a health worker crisis. The mounting death toll of health workers is only going to exacerbate the already perilous situation. The outbreak’s effects will linger long after the epidemic is brought under control.

Moreover, the reputation of health workers is taking a hit. Sierra Leone is rife with rumors of health workers infecting patients, and families have at times violently attacked hospital staff and removed family members from hospitals. This has, of course, contributed to the spread of the disease in other parts of the country.

The long-term consequence of all this is that Sierra Leone’s health system will be weakened even further, reversing gains in providing essential life-saving interventions, especially for pregnancy and newborn services, and  access to the care, treatment, and prevention of highly prevalent diseases such as malaria, tuberculosis, and HIV/AIDS.