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.

Frontline Health Workers Return on Investment for Newborns

By James Litch, Global Alliance to Prevent Prematurity and Stillbirth (GAPPS)

Every year, 15 million babies are born preterm, and of those, more than 1 million don’t survive their first month of life. Additionally, nearly 3 million babies are stillborn every year. While we hope that increased pregnancy research will allow for preterm birth and stillbirth to one day be prevented entirely, we know that the surest way to increase healthy births in the here and now is through the increased training and deployment of frontline health workers.

A shining example of the tremendous impact for newborns of investments in skilled birth attendants on the frontlines has been Indonesia. With more than 4.4 million births annually, the Indonesian government has a policy to provide at least one midwife in every village to decrease the maternal and infant mortality rate. By 1997, over 96% of the population of Indonesia had access to 54,000 village-based midwives.

In 2003, competency-based training in basic neonatal resuscitation, combined with supportive supervision and a low-cost resuscitation device was provided to village midwives. One year after the training, 65% of the trained village midwives had resuscitated at least one baby who did not breathe at birth, and in 85% of these cases the baby survived. More than two-thirds of the babies (70%) needed only tactile stimulation and/or appropriate positioning of the head and maintenance of warmth. From 2003-2005, the newborn mortality rate decreased by 40% from 15 per 1000 to 9 per 1000. [VB1] The training and equipment cost per baby delivered was US $0.25.

Frontline health workers care for a baby in Bangladesh. Courtesy ©Paul Joseph Brown/ GAPPS

Frontline health workers care for a baby in Bangladesh. Courtesy ©Paul Joseph Brown/ GAPPS

Today, hundreds of thousands of frontline health workers in areas of high newborn mortality around the world have received training in basic newborn resuscitation and are available when and where babies are born to provide life-saving care. There is even more we can accomplish with what we already know, and a new report is laying the groundwork for us to get there.

GAPPS contributed to the Every Newborn Action Plan (ENAP), which was recently launched at the Partners’ Forum in Johannesburg and outlines a plan for investments in quality care at birth that can save the lives of 3 million mothers and babies who die needlessly around the world every year. The ENAP points out that most newborn deaths are from preventable and treatable conditions and that frontline health workers are the best kind of investment: Low cost and high reward.

According to ENAP, an “additional investment of only $1.15 per person per year in 75 high burden countries would prevent 3 million deaths of women and babies. This care requires skilled health workers, especially midwives, and essential commodities, such as steroid injections costing less than a dollar per treatment, or resuscitation devices costing under $5.1

Through my more than 20 year career in global health, including many years living and working in developing countries, I have become acutely aware of the importance of skilled health workers before, during, and after birth. The program I direct at GAPPS, the Perinatal Interventions Program (PIP), is developing and promoting step-by-step guides to help frontline health workers use low-cost, evidence-based solutions to quickly diagnose and appropriately treat women at risk for preterm birth, stillbirth, and other serious birth complications. The guides are designed for use in homes, clinics, birthing centers, and hospitals in low-resource communities around the world.

The PIP materials aim to increase awareness and understanding of existing effective solutions and healthcare practices, as well as inform providers and mothers about harmful interventions in an effort to improve maternal and newborn health. Examples of practical guidelines that are in development include: recognizing and managing women in preterm labor; decision trees for managing delivery of a preterm infant; and caring for preterm newborns through their first week.

The PIP is just one example of how the global maternal and child health community is prioritizing frontline health workers, and the investments put forth in the Every Newborn Action Plan will pay dividends for millions of women and children around the world for years to come.

Health Workers Step Up to Save Lives

By Kait Atkins, Jhpiego

This week, thousands of health workers, researchers and advocates gather in Melbourne, Australia, for the 20th International AIDS Conference. Tragically, we lost several of these dedicated professionals aboard Malaysian Airlines Flight 17. Their loss is felt and mourned deeply among all those fighting AIDS, and further inspires our commitment toward the conference’s theme: “stepping up the pace” to change the course of the epidemic.

As we at Jhpiego think about stepping up the pace of the fight against HIV and AIDS, we know that frontline health workers play a critical role—armies of tireless, committed men and women serving to step up the pace in global HIV prevention, treatment and care services. Health workers are integral to our mission of improving the health of women and their families.

“The leading cause of death for women of reproductive age worldwide is HIV and AIDS, and in sub-Saharan Africa, 60 percent of people living with the disease are women,” says Jhpiego’s President and CEO Leslie Mancuso. Jhpiego has had the great privilege of working alongside countless frontline health workers in the fight against HIV and AIDS. They inspire us with their leadership and compassion, and the unique ways that they impact the communities in which they work.

Here are just a few examples of why we believe increasing investment and support for frontline health workers is vital to ushering in an AIDS-free generation.

Midwives Bring Hope

In Ethiopia, midwife Yesuf Adem is bringing hope to HIV-positive mothers in their communities. Adem’s work in Leguama Health Center has allowed him to help mothers like Yeworkwuha, who learned early in her sixth pregnancy that she was HIV-positive. Adem was trained in the prevention of mother-to-child transmission of HIV (PMTCT) by the Jhpiego-led Maternal and Child Health Integrated Program (MCHIP), a project supported by USAID. He carefully counseled Yeworkwuha on the prospects of living positively with her diagnosis, explaining to her the high chance of having an HIV-free baby with proper medication and even how to breastfeed properly.

Now, after having given birth to a baby boy, Yeworkwuha says that “without [Adem’s] support, I could have been severely ill or could have even ended up dead. Instead, I was given the chance to see my children grow.”

Jhpiego HIV Counseling

An HIV/AIDS Counselor at a women and children’s hospital in Nigeria counsels a client who has come in to get her results.

Community Health Workers Go Door to Door

In Mozambique, through funding by the Centers for Disease Control and Prevention (CDC), Leta Ernesto Majonise is one of a team of community health counselors who go door to door. They test residents for HIV, check for symptoms of tuberculosis (TB), provide wellness information and connect people with services through Jhpiego’s integrated HIV and TB community counseling and testing approach. Majonise joined the ranks of Mozambique’s community health counselors because she knows many people in her community suffer from preventable diseases. She has counseled and tested nearly 600 people and referred 70, including patients who are HIV-positive or suspected to have TB, for services.

“I enjoy my work,” Majonise says, “because I am convinced that this program is helping people change their minds [about accessing health services] and their lives.”

Nurses Break Stereotypes

In Tanzania’s efforts to prevent the spread of HIV, Illuminata Sanga is breaking ground and stereotypes. She is among the 200 nurses who are performing voluntary medical male circumcisions (VMMCs) proficiently and safely in an area of Tanzania that has been hit especially hard by the HIV/AIDS epidemic. Sanga received her training in VMMC as part of the Jhpiego-supported MCHIP program, supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through USAID.

“Over 60 percent of the providers in Iringa are nurses, taking the lead in all steps of the VMMC procedure. This is a strong example of task shifting, a key component of efficiency principles recommended by WHO [the World Health Organization] in scaling up VMMC services in the target countries,” says Augustino Hellar, VMMC Program Advisor at Jhpiego’s Tanzania office.

The stories and achievements of these men and women provide only a glimpse of the incredible efforts of frontline health workers responding to the HIV epidemic in sub-Saharan Africa.

As this response continues to evolve—with new strategies such as the use of microbicides for HIV prevention and pre-exposure prophylaxis for the most at-risk populations—it is imperative to ensure that frontline health workers continue to receive the skills and support they need to bring care to their communities, and to increase equitable access to health workers to ensure that all those who are in need of HIV treatment and care receive it.

With frontline health workers’ continued contributions, we are truly stepping up the pace in the global fight against HIV.

What Motivates Our Best Health Workers? Investing in Patients and Communities

By Susan W. Hayes, ReSurge International 

The following is a Q&A between Susan W. Hayes of ReSurge International and Drs. Shafquat Khundkar and Nancy Chee, recipients of 2014 The REAL Awards, a set of awards designed to celebrate and accelerate the lifesaving work of frontline health workers everywhere. 

Every day, health workers save lives and renew health in all countries around the world. Properly trained and supported frontline health workers deliver critical services to their local communities and save millions of lives each year. Often working in difficult circumstances with few resources, what drives these health workers to continue striving day in and day out to reach those who are most in need of quality medical care?

As a member of the Frontline Health Workers Coalition, I was thrilled to nominate Drs. Shafquat Khundkar and Nancy Chee for The REAL Awards and was not a bit surprised when they were selected for the honor. They are two of the most exemplary health workers I have known in my years with ReSurge International. After the awards presentation this spring I had a chance to interview Nancy and Shafquat on their experiences – on what motivates them and their views on what is needed to improve health care worldwide:

 What motivates you to do the work you do every day?

Shafquat: When you look at the smile of a mother who had a cleft lip or a burned child who has had a surgery and their limbs can now move easily – that smile, that pleasure, is unsurpassed by any pleasure money can buy. I have had grandmothers come over hundreds of miles just to say, “Who is the person who changed my grandchild? I want to see that person.” This is a feeling that no one else gets. I can’t explain it in words, but it is a real driving force. It just keeps you going. I know that for many people money is very important, but this is something different. This is something great.

Nancy: My lifelong work began as a child, knowing I wanted to help people. Growing up in an immigrant family, I learned about core values and that you love and care for one another through all things, good or bad. While attending college, I fell into a career through which I could live out these values, as an occupational therapist. I have learned so much from other amazing health care providers who have taught me not just professional skills, but also how to show compassion for your clients. Having been at this for more than 30 years, I still love my work and have the same desire to help others that I had as a child. It is also refreshing to be able to share my experiences and teaching with students in a graduate school program. I hope they may be inspired to share their work and help others as frontline health workers here and abroad.

Drs. Shafquat Khundkar and Nancy Chee in Washington DC for the 2014 REAL Awards ceremony. Photo courtesy ReSurge International.

Drs. Shafquat Khundkar and Nancy Chee in Washington DC for the 2014 REAL Awards ceremony. Photo courtesy ReSurge International.

In Bangladesh or the countries you’ve visited, have you seen a shortage of health workers? If so, what do you believe is the cause of that shortage?

Nancy: In every single country I have visited and worked in, there have been shortages of health care providers. Causes for this include access to the education needed to train qualified workers, and opportunities and resources for individuals to become health care workers. Many people in underserved countries are poor and can manage only to survive day to day in making ends meet. Being able to get an education beyond the basics would allow people to seek careers as doctors, nurses or therapists. But once educated, the challenge is to retain these workers to stay and care for their own people.

 Shafquat: Yes, certainly. There are a lot of factors. One is a short scope for training. There is also a shortage of people who instill a feeling of doing this for people and inspire people to continue to do reconstructive surgery. It’s the attitude, the inspiration – there is a shortage of that. There must be something that attracts people.

What kind of need have you seen for reconstructive surgery and rehabilitation in these countries?  

Shafquat: There’s such a huge need for reconstructive surgery in Bangladesh. With various incidences of burns, trauma and other conditions that require reconstructive surgery, and with longevity increasing, we are bound to see the need for it on the rise. For years to come, Bangladesh will require reconstructive plastic surgery. Even if we try to do cosmetic surgery, that will not compose more than 10% of the work.

 Nancy: I work in the area of hand reconstruction and follow-up care, and not being able to use one’s hand, great or small, can affect the life and function of individuals. This can be physical, psychological and emotional. On the outside, one can be seen as disabled and deformed, especially with burn injuries, but this also affects one’s psychological and emotional being. Also, in many cultures, people with injuries or deformities can be shunned or be used for money – begging to make a living. There is such a shortage of services and care for these patients. Going abroad is one small way I feel that I can contribute directly to patients, but more importantly, to the knowledge of local staff, which will continue the care after volunteers leave.

 Why is it important for the international community to put more funding toward frontline health workers?

 Nancy: Because that is the only way health care can best be provided and sustained in each community. It is honorable for people travel to volunteer in underserved communities, but after we leave, the work and care can only continue through the frontline health workers in these communities. Countries need to invest more funding within their own borders if they want to ensure that their people can receive long-term care. This can be direct financial support to hospital, clinics and workers, but there also has to be an investment in education and opportunities to train future health care workers.

 Shafquat: We in developing countries can’t do it alone. We need support. There are NGOs that are supporting us, but they also need support. It is the responsibility of the U.S. government to make sure that these NGOs can do that. NGOs know which people in the field are the right persons to work with, and through them, they can work to improve health in local communities.

 To read more about these health workers, view The REAL Awards’ honoree pages for Nancy and for Shafquat. And to view photos of Shafquat in action in Bangladesh, check out this photo narrative.

 Dr. Shafquat Khundkar is professor of plastic surgery at Popular Medical College Hospital in Dhaka and founded Bangladesh’s first plastic surgery residency program. He has worked with ReSurge surgical teams in Bangladesh since 1990, and in 2000, ReSurge established a Surgical Outreach Program in Dhaka so Shafquat and his team could provide care to patients year-round.

 Dr. Nancy Chee is a senior hand therapist at California Pacific Medical Center in San Francisco. She has worked as a therapist for nearly 25 years and has volunteered with multiple NGOs for many years. Since 2003, she has treated patients and taught therapists with ReSurge in many locations, including Nepal, Sri Lanka, Bolivia and Vietnam.

 Susan W. Hayes is president and CEO of ReSurge International (formerly Interplast), a Frontline Health Workers Coalition member which has provided more than 100,000 reconstructive surgeries and built medical capacity in developing countries since its founding at Stanford University in 1969.