Health workforce report feels like Groundhog Day for global health

By Mary Beth Powers, Frontline Health Workers Coalition and Save the Children

Groundhog Day is the day in February where in the United States, people wait for a groundhog to emerge from his underground winter home to see if he sees his shadow. If he does, it means we will have 6 more weeks of winter – an outcome that is typically met with dread. I have been feeling a bit like that as the global health community has been waiting for the release of the World Health Organization and the Global Health Workforce Alliance´s “A Universal Truth: No Health Without a Worker” report released here today at the Third Global Forum on Human Resources for Health to update the global state of the health workforce critical to maintaining and furthering progress in global health. Sadly, I think the world has seen its shadow.

Community Health Worker (CHW) - L - Ozara Husseini talks to Najiba, who has five children,  about the advantages of family planning and Najiba's decisions to start taking the pill at their home in Katasank near Bamyan, Afghanistan on the 8th June, 2010. Courtesy Kate Holt/Jhpiego.

Community Health Worker (CHW) – L – Ozara Husseini talks to Najiba, who has five children, about the advantages of family planning and Najiba’s decisions to start taking the pill at their home in Katasank near Bamyan, Afghanistan on the 8th June, 2010. Courtesy Kate Holt/Jhpiego.

The report suggests that fully 83 countries are estimated to be below the threshold of 23 skilled workers (doctors, nurses and midwives) for 10,000 people. This is quite alarming but worse still is the estimate that the global health workforce shortage for 2035 is nearly 13 million skilled workers. This is due in part to population growth and the aging of the current health workforce. Although the report notes net gains in health workers in many of the countries where reliable data was obtained, clearly we need new strategies to produce, support and retain health workers to fill the gap, as the Frontline Health Workers Coalition have stated in response.

Sadly, the report, like its predecessor, has limited ability to assess the situation on the ground with regard to many other types of health workers who are both filling gaps and providing much needed services quite ably around the world. Community health workers and other skilled health worker cadres like medical assistants and clinical officers are not typically counted by governments and not consistently reported to WHO, and thus are not well covered in the report. We know the world is short on these kinds of workers but without consistent definitions of these workers’ areas of practice and without reporting on them, we have at best an incomplete picture of the desperate situation the world is facing.

Community and other frontline health worker team members serve closest to communities in need and have greatly contributed to the progress being made on reducing child mortality, communicable disease spread and malnutrition. They, along with skilled birth attendants – many of whom serve on the frontlines – also contribute to the reduction in maternal mortality. But they are not always recognized for their contributions, compensated and, at the most basic level of recognition, they are not counted.

A frontline health worker in rural South Omo, Ethiopia, examines a pregnant woman. Photo Credit: AMREF

A frontline health worker in rural South Omo, Ethiopia, examines a pregnant woman. Photo Credit: AMREF

All health workers need to be recognized and valued for their important contributions to society.   At a meeting organized by Ray Chambers, the UN Secretary General’s Special Envoy on Financing the Health MDGs, a colleague from Zambia asked the group, “What if we, in Africa, respected our health workers like we respect and treat our armies?” His question stuck with me as we created the Frontline Health Workers Coalition in an effort to highlight the amazing work of frontline health workers and to support the global health funding which in part goes to training, equipping and encouraging the development of an army of life saving heroes around the world.

That’s one reason that we created the REAL Awards ( to celebrate the dedication, caring and impact of health workers around the world. We need more health workers and we need to respect and care for those that we’ve got. Many young health workers leave their posts in search of better opportunities or because the working conditions are just so tough due to the lack of investment in health systems. But if we can’t climb out of the hole that we’ve dug for ourselves and take a look at this situation, the future is a lot darker than just six more weeks of winter.

The Third Global Forum on Human Resources for Health, which started yesterday and closes Wednesday, is giving us a chance to open our eyes and the eyes of world leaders to the critical role of frontline health workers around the world and the need for more consistent counting and reporting of what they do so that we can effectively deal with global health workforce issues. We really have got to change our game in terms of valuing and supporting existing health workers and recruiting and training the next generation, or we will surely continue to see our shadow again and again in the future.

Placing their lives on the line to quell an Ebola outbreak

By Kelly Willis, Accordia Global Health Foundation

Outbreaks of the dreaded Ebola virus in the Africa’s Great Lakes region have claimed hundreds of lives in the last 20 years, but thanks to the courageous efforts of United States government-supported frontline health workers like Brenda Picho, an outbreak in Uganda’s Kibaale District in July was quickly contained.

Ebola hemorrhagic fever is a highly contagious disease that causes severe fever, muscle pain, vomiting, diarrhea and bleeding; the disease kills more than half of those infected. There is no vaccine and no known treatment. A rapid and coordinated response is essential in containing these outbreaks – and the outcome is largely determined by actions of the “first responders.”

Among the first responders in Uganda were the frontline health workers of Accordia’s flagship institution based in Kampala—the Infectious Diseases Institute (IDI), Makerere University. IDI staff has been working hand in hand with rural health professionals in Kibaale for years, building their confidence through training and mentorship opportunities, as well as strengthening existing clinical and laboratory systems.

Field staff at the Infectious Diseases Institute (IDI), Makerere University, hand out protective clothing to frontline health workers in Uganda’s Kibaale District during an Ebola outbreak in the area in July 2012. Courtesy: IDI

Upon discovering the outbreak, IDI staff immediately began working with local health leaders to organize efforts to contain the disease and protect those most vulnerable to exposure. In no time, emergency supplies had been procured, including protective clothing for frontline health workers most at risk. Prevention measures were demonstrated and isolation facilities were established. IDI staff led efforts to maintain safety standards, provided meals to the hospitalized and quarantined, maintained morale among other health workers, and minimized panic in the community.

At the center of IDI’s efforts was Brenda Picho. A pharmacist by training, Brenda works in Kibaale as part of the U.S. Centers for Disease Control and Prevention (CDC)-supported Saving Mothers, Giving Life project. Her efforts in the community had been focused on reducing maternal mortality by helping mothers during labor, delivery and responding to postpartum complications.

Brenda had heard of a pregnant woman in the community who had died in one of the health facilities and whose family kept getting sick and not responding to treatment. When the clinical officer who provided the family’s care fell ill, Brenda said she became “very alert and concerned.” When the cases were confirmed as Ebola, Brenda said she was “speechless,” adding, “I did not want to believe what I was hearing.”

Her natural fear of this dangerous disease did not stop her and other health workers from putting their own lives on the line to protect the health and wellbeing of others. Brenda’s actions and those of her colleagues are a telling example of how frontline health workers benefit the communities in which they live and work, and ultimately play one of the most essential roles in emergency response.

The U.S. government has a tremendous opportunity to highlight its support of inspiring health workers like Brenda, as well as strategically invest in supporting frontline health workers in the countries with the greatest need.

To read more about Brenda’s personal account of the Ebola outbreak Kibaale and to learn more about how IDI combines expertise in training, clinical care, prevention services, and research to provide fast, effective and comprehensive responses to health emergencies like this, please visit Accordia Global Health Foundation’s website

On the Frontline of Achieving an AIDS-free Generation

By: Lisa Bos, World Vision 

Photo Credit: Abby Metty/World Vision

Just a few months after starting to work for World Vision, I was able to make my first trip to see our programs in action. My country of choice was Zambia, for several reasons: it’s an English-speaking country (important when the purpose of your trip is to learn from your international colleagues), it was not too far to travel (only 22 hours!), and it was the home of some of the most exciting work World Vision is doing on HIV/AIDS.

During my time in Zambia, I spent two days visiting with volunteer caregivers working in a rural community near Mazabuka, southwest of the capitol of Lusaka. These volunteers take their own time, without compensation, to care for their communities. They clean sores of those suffering from AIDS, they educate and facilitate support groups for community members who are HIV positive, they ensure that pregnant mothers are taking their medication so they don’t pass on HIV to their babies, and they visit with children orphaned by AIDS and provide counseling. The program in Zambia is part of a partnership between World Vision and USAID, through the PEPFAR program, called Sustainability Through Economic Strengthening, Prevention, and Support for Orphans and Vulnerable Children (STEPS OVC).

Community caregivers are a part of a much larger cadre worldwide of frontline health workers who are the first person (and sometimes only person) an individual will see for their health care needs. These health workers are vital in the fight against HIV and AIDS not only for the diagnosis, treatment and support they can provide in a direct way, but also because they can help diagnose tuberculosis, which kills one in five HIV-positive individuals. They can ensure that a family has a mosquito net to sleep under because the viral load of a HIV-infected person increases ten-fold during an attack of malaria.

Last year on World AIDS Day, the Obama Administration announced a bold vision for an AIDS-free generation. The blueprint for how this can be achieved was just released on November 29th. While the blueprint includes many of the necessary steps needed to achieve an AIDS-free generation, including strengthening country health systems and the health workforce, this goal will not be met without people on the frontline like Nomsa Mdluli.

Nomsa Mdluli, 46, is a caregiver for 124 ill people in her community. Most are HIV positive, some have tuberculosis, and some are suffering from mental illness. World Vision has provided Nomsa with training and supplies, and her initiative has launched her to the head of the caregiver program in her area. Now she oversees many other caregivers, which often includes taking care of their patients when they are unable to do so.

Part of Nomsa’s great skill as a caregiver is gently persuading her patients to find out their HIV status so they can treat the disease in its early stages, avoid infecting others, and prevent more severe symptoms or even death.

“I’ve had a number of patients who have gotten well, who have gotten out of bed, regained their standard of life,” Nomsa says. “I get very motivated and encouraged when someone that I’ve taken care of regains their standard of life.”

I believe that an AIDS free generation is possible, but it will take funding, dedication and a lot of hard work. It will also take Nomsa and thousands more like her.

Supporting Sons and Daughters in Mozambique: Revitalizing a Community Health Worker Program

By: Carol Bales and Rachel Deussom, IntraHealth International

The “son of the community” takes part in a community meeting.

The local people call him “the son of the community.” On the verge of tears, he listens as they proudly say, “The dust will fly even if it’s raining, because we will be dancing.”

The young man is a newly trained agente polivalente elementar, a type of community health worker in Mozambique. At a community meeting in Tete Province, his neighbors are describing how they will celebrate when he receives his health worker kit and begins serving his community.

In Mozambique, the Ministry of Health is counting on these workers to provide basic health services to people in the most remote communities. Due to the country’s severe shortage of physicians, nurses, and midwives, many people don’t have regular access to basic care, and their health has suffered.

Expanding access to health services
In the 1970s, soon after independence, the Ministry implemented a national community health

Community leaders pose for a photo.

program that introduced the agentes polivalentes elementares. The program was interrupted in the 1980s during the armed conflict. Acknowledging international evidence on the vital role community health workers can play in expanding basic health services and meeting health goals, the Ministry and its partners decided to revitalize the program in early 2010.

Community health workers usually act as a point of referral that supports both the community and the formal health system. In Mozambique, they also educate communities on family planning and HIV prevention, counsel pregnant women, identify and manage childhood pneumonia and diarrhea, test for and treat malaria, and provide grassroots support to HIV/AIDS and tuberculosis treatment programs.

A new community health worker rides off to serve her community.

Providing in-country support

The USAID-funded CapacityPlus project, led by IntraHealth International, provided support to roll out the program to the provinces and districts. Key to this was hiring in-country staff to establish operational procedures and policies and coordinate working groups tasked with developing training materials, creating monitoring and supervision tools, and standardizing Medicine and Work Kits that include a bicycle and essential supplies.

CapacityPlus also worked with USAID’s Health Systems 20/20 project to design a performance-based incentives plan for program coordinators who are working to expand the program. In addition, CapacityPlus worked with the Ministry to design and implement a baseline survey to measure program impact.
Building local skills
Scaling up community health worker programs requires strong leadership, political backing, and resources. These workers need to receive adequate management and professional support from the formal health system and be appropriately compensated for their work.

Sandra McGunegill lives in Mozambique and served as CapacityPlus’s senior technical advisor to strengthen coordination of the program. She worked daily with Teresa Mapasse, the national coordinator, increasing her capacity to effectively plan and communicate about the program and supervise provincial coordinators. 

As a result, Mapasse now regularly gives presentations to the minister of health and others to engage partners and build political support. She coordinates community health worker training and subsidies, Medicine and Work Kit distribution, program monitoring and evaluation, and the development of Community Health Committees to drive local ownership and involvement.

An insider’s view
McGunegill relays what she heard a community leader say during the meeting in Tete: “Too often, pregnant women infected with malaria were seen riding on the back of a bike, vomiting as they are rushed to the health center.” She glances at her photograph of the new community health worker and adds, “It made it all worthwhile to hear the leader go on to say that now community health workers like this man can test for malaria in the community and distribute medication—and lives will be saved by receiving earlier treatment.”

More than 1,200 agentes polivalentes elementares have been trained to work in 50 districts. There are plans to train another 1,500 in the coming year. This means that many more sons and daughters of Mozambique will be working on the frontlines to offer health services to their communities.

Photos by Sandra McGunegill, courtesy of CapacityPlus/IntraHealth International.  

Uganda Increases Number of Health Workers

By: Meredith L. Ritchie, White Ribbon Alliance

Photo courtesy of the White Ribbon Alliance Uganda

Uganda deserves praise! The government recently committed to recruiting more than 1,014 midwives; 1,436 nurses; 758 nursing officers; 223 medical doctors; 283 anesthetists; 1,101 clinical officers; and 1,360 laboratory technicians for the fiscal year of 2012-13, according to the White Ribbon Alliance of Uganda.

The lifetime risk of death for a pregnant woman in Uganda is 1 in 35, according to the 2011 UDHS report. Additionally, Uganda’s 2012 Human Resources for Health Bi-Annual Report found that the proportion of approved positions filled by health workers at all levels nationally was only 58%, with some district hospitals having as low as only 16% filled posts. The report also found that health workers were poorly motivated and faced unsatisfactory working conditions. The Ugandan government also committed to raising health workers’ salaries from approximately $480 a month to $1,000 month in January 2013, in order to attract more workers to the rural, hard-to-serve areas of the country. This will hopefully relieve the alarming statistic found by a 2008 World Bank study: 80% of public sector medical workers in Uganda work in urban areas, where only 20% of the population lives.

Frontline health workers are often the first point of maternal services for Ugandan women, and they are essential for the management of safe pregnancies. Midwives, nurses and doctors are vital for progress on maternal and child survival. Ensuring that a health worker is within reach, and is trained, equipped and supported, is crucial to the achievement of Millennium Development Goals 4 and 5. During labor, complications cannot always be predicted and may rapidly become life-threatening. Countries where most births are attended by a health professional with the skills to spot and manage complications generally have lower death rates for mothers.

If this commitment from Uganda is fully met, the country’s health sector budget will increase from 7% to about 8% of the national budget. This map and graphic illustrates the critical need for skilled birth attendants across the world, and emphasizes the importance of frontline health workers in saving lives.  

Moving forward, the White Ribbon Alliance of Uganda and Coalition to End Maternal Mortality members will convene a reflection meeting to focus on monitoring and accountability mechanisms for these new health funds.

Combining Research and Implementation to Make Every Birth a Healthy Birth

By: Mike Gravett, Scientific Director, GAPPS 

Photo credit: Paul Joseph Brown / GAPPS

As a frontline health worker here in the U.S., far too often I see babies born prematurely and the long-term and sometimes life-threatening effects of an early birth. It’s difficult to fathom that around the world, 15 million babies are born prematurely every year, with more than 1 million of those babies dying in infancy.

World Prematurity Day is this Saturday, November 17, and gives us all an opportunity to honor the babies born too soon around the world, as well as reflect on the work being done by frontline health workers and researchers investigating what causes pregnancy complications.

The role of frontline health workers is critical to mitigating prematurity, particularly in low-resource settings with limited access to skilled physicians and high-tech hospitals. Often in these circumstances, frontline health workers are the first and only line of defense.

While GAPPS is researching ways to prevent preterm birth, we are also focusing on scaling up known interventions that can have an immediate impact. One model is the Perinatal Interventions Program, which comprises step-by-step guidelines to help health workers in low-resource areas know how to identify and treat women with high-risk pregnancies, as well as care for preterm infants.

However, even if all current interventions were universally applied, the preterm birth rate would drop by less than 20 percent. GAPPS has recently announced five new grants as part of the Preventing Preterm Birth initiative, which is funding innovative research projects to discover the causes of preterm births and develop new ways to prevent them. For example, 125 million pregnant women get malaria every year, and one project is investigating how malaria infections of the placenta affect the immune response which leads to preterm birth and stillbirth.

To help make every birth a healthy birth, it is vital that efforts are well coordinated and that funders understand research priorities. In the new issue of the American Journal of Obstetrics and Gynecology, GAPPS Executive Director Craig Rubens and I authored an article called A framework for strategic investments in research to reduce the global burden of preterm birth, in which we present critical actions that can be taken by both researchers and funders to help advance our shared understanding of adverse pregnancy outcomes.

We hope that this new article will serve as a blueprint for the years ahead. Together, frontline health workers scaling up known interventions, buoyed by innovative research around the world, will lead to preventing prematurity and ensuring safer pregnancies for all mothers and babies.

Frontline Health Workers Care for Hope

  By:  Catherine D’Souza, Pallliative Care Coordinator,
Integrated Hospice Unit Cameroon Baptist Convention 

Photo By: C. D’Souza

This is the story of Hope, a cancer patient cared for by the palliative care team of Integrated Hospice Program Cameroon Baptist Convention in Bui Division, Cameroon. Through FHSSA’s Partnership Program, which connects hospice programs in the U.S. with hospice and palliative care programs in Africa to offer financial, educational and clinical support, this program is partnered with Vitas Innovative Hospice Care of Milwaukee. Catherine D’Souza, a frontline health worker shared her experience caring for Hope.

Hope was in a darkened room in the house when I first met her. We knew she was there as we could hear her groaning. Her husband led us carefully through the shadowy house and we stumbled on the uneven mud floor. He removed a single light bulb from the living area and fixed it into the bedroom socket as we went through.

The light flickered and swung as our eyes slowly became accustomed to the gloom and we finally saw what I thought was a pile of blankets. There was Hope. She was sweating and crying as she tried to turn in bed to see us, her face twisted with pain. When she saw our small group standing there she smiled, and lit up the room. ‘Praise God’ she exclaimed.

Hope had been bed bound for one year before we met, and for three years before that she had been seriously ill. She had been to hospital when a small ulcer got bigger and had not gone away. After she was told she had cancer her husband sold all his livestock and possessions for radiotherapy and surgery but she had not improved.

The family had given their goats and chickens as she was promised by one traditional healer after another that they could heal her. Eventually the family couldn’t support her anymore and her husband didn’t have anything left to sell. The local nuns tried their best with soothing poultices as her pain worsened. Although she loved their kind words and prayers, they couldn’t relieve the agony.

Hope was true to her name and didn’t give up her spirit as the months of pain dragged by. I remember the first time I examined her wound. She was really scared, our driver soothed her with calm words and she was amazed that the medicine we had given her had taken the pain away so much that I could examine her without hurting. Hope can now walk around her compound, prepare vegetables, mend clothes and laugh with her neighbours. Her children have their mother back and her husbands’ face does not hold the lines of worry as it did before.

Hope calls her time before she met the palliative care team her ‘dark time.’ We cannot cure Hope’s cancer but we can let her live her life to the full for whatever time she has left.

Foreign Aid Cuts Affect Us All

By: Lisa Meadowcroft, AMREF

Photo Credit: AMREF

The final segment of the presidential debates is over.  Unfortunately, not much was said about the importance and impact of US aid to developing countries.  We all know that the global economic climate is tough and it’s unreasonable to expect any increases in foreign aid.  But what we can expect and hope will come to pass no matter who is in elected President next month, is that foreign assistance for global health and humanitarian aid will not be cut disproportionately.

Such drastic cuts would be ruinous.  In fact, they would cost lives.

In their July 2012 issue brief on the human impact of potential, substantial budget cuts on global health, The Foundation for AIDS Research (amfAR) found that, “applying sequestration cuts to US government global health programming would have minimal impact on deficit reduction, but would be devastating to the lives of many thousands of people globally.”

In the key areas of HIV/AIDS, TB and malaria alone, which are not only high priority for AMREF but sectors where frontline health workers have critical impact on the millions of people who depend on them the world over, the amfAR brief notes that cutting by US government support of 8.2 percent :

  • HIV/AIDS treatment for 276,500 people will not be available, potentially leading to 63,000 more AIDS-related deaths and 124,000 more children becoming orphans
  • An additional 100,000 people will not be treated for HIV/AIDS
  • 2.2 million fewer insecticide-treated nets will be procured, leading to nearly 6,000 deaths due to malaria; 3.6 million fewer people will receive treatment
  • 88,000 fewer TB patients will receive treatment, leading to 11,000 more TB deaths.

And the list goes on.

Compare this though to the great strides AMREF, along with other NGOs operating in the global health arena in the developing world, have made over the last 10 years.   Strides in both improving health outcomes and creating sustainable change by partnering with frontline health workers and their communities to give them the skills, knowledge and means to improve their own health.

As a result of the U.S. commitment to health in Africa alone, according to USAID’s Africa Bureau, “more children are living to see their first birthday, fewer people are dying from curable diseases like malaria and tuberculosis, and more communities have access to safe drinking water.  Two million Africans now benefit from life-saving HIV treatment and another 10 million people living with AIDS are receiving care through PEPFAR.”

Health improvement in developing countries is not only critical to the populations of African countries, it’s also key to US interests abroad.  Improved health results in larger labor forces and greater educational opportunities, leading to more stable economies and the potential for growth.   Stronger economies usually promote more stable political systems.  Stable political systems and strong economies in Africa are in the strategic interests of the US to promote peace overall and increase our trade opportunities around the globe.

What’s more, Americans are genuinely moved to help ameliorate human suffering – and according to a recent poll by the Better World Campaign, three out of four say that international issues influence their vote.  We Americans want and expect the US to do its fare share around the world.  In the next Presidential administration, we can’t cut foreign aid.  We will all feel the consequences.

AMREF, along with our colleagues in the Frontline Health Workers Coalition, see the impact of US aid in our work in Africa on a daily basis.

Because of the support of the US government, frontline health workers like Esther Madudu, a Ugandan midwife, receives advanced training to upgrade her skills, enabling her provide the emergency obstetric care needed to reduce preventable maternal deaths.

We see education programs in Tanzania that teach adolescent girls about their sexual and reproductive rights – helping create more gender parity and reduce unwanted teenage pregnancies.

Young Maasai women in northern Kenya learn that there are alternative rites of passage to female genital cutting, which in the past has led to so much trauma and even death for those women when they reach child bearing age.

And we see senior health care professionals from all over sub-Saharan Africa participate in advanced management training provided by AMREF and partners so they can master the skills needed to run hospitals and busy health care facilities.

And the list goes on.  In fact, this is the list that we should all want to go on and on and on.

Sustaining the Impact of Community Health Workers: Evidence from Health System Assessments

By: By Avril Ogrodnick, Abt Associates

Photo Credit: John Palen

Countries seeking to expand health services to the community-level to ensure equity of access to care frequently turn to community health workers (CHW) as an essential expansion of the health team.  A variety of approaches to training, hiring and supporting community health workers have been implemented by countries, and there are many important lessons learned to be shared across countries.

Through the Health Systems 20/20 project, Abt Associates examined the approaches that countries are taking to expand services through training and deploying CHWs. Health Systems 20/20 completed 25 Health System Assessments, a rapid indicator-based methodology that determines the key strengths and weaknesses of a health system using a set of internationally recognized qualitative and quantitative indicators.  The assessments found that a variety of approaches to utilizing CHWs are implemented by countries, from fully public and salaried employees to volunteers, and to autonomous, private providers who sell health and other products to generate income.

For example, in Angola, the government has recently reintroduced the CHW cadre, which existed until the civil war disrupted the health system. An estimated 6,000 CHWs have been trained in several separate initiatives by different organizations. CHW are responsible for home visits and community education and have strengthened the link between communities and health facilities.

In Uganda, the Living Goods model, launched in 2007, combines microfinance with the CHW concept. Village women are selected and trained to educate their communities on health promotion, sell health protection products door-to-door for a profit, and refer people to health facilities. Their first basket of products is obtained on credit, and the NGO provides close monitoring and supervision.

CHWs have been providing health services at the household/community level in Lesotho since 1975. The CHW program was adopted as a national strategy for PHC in 1979 following Lesotho’s participation at the 1978 Alma Ata Conference. Until 2008, CHWs received no remuneration, and their only benefit was free medical care for themselves and their immediate family. In 2008, the government took a step towards institutionalizing the community-based health service by paying CHWs a small monthly salary.

Perhaps the strongest example of CHWs is in Ethiopia, with the introduction of Community Health Extension Workers (CHEWs) at the local level in Kebeles under the Health Extension Program. CHEWs operate at the community level and are fully paid by the government. There are now four CHEWs per 10,000 people and their impact is witnessed throughout the health system.  According to Mr. Bizayene, CEO of the referral Mekelle Hospital, maternal mortality is decreasing because of the CHEWs’ efforts; he has personally only seen one maternal mortality case the year the HSA was done.

Findings from the HSAs also informed the steps countries can take to ensure that CHW models are sustainable in the long term.  Countries should first develop clear policies that define the specific roles and responsibilities of CHWs within the health system.  CHWs also require sufficient funding, appropriate training to address the community’s burden of diseases, supervision from health professionals, and appropriate incentives.

The contribution CHWs make to the health system can be substantial.  Further analysis of the lessons learned by countries implementing a CHW model is important to increasing the impact of these vital frontline health workers.

Supporting the World’s Frontline Health Workers


By: Congressman Robert Dold
Representing Illinois’ 10th Congressional District.


In the United States, polio was successfully eradicated in 1977. For years, this disease plagued the world and took the lives of countless children, and left many others disabled. Today, because of increased government support, scientific advances in immunization, and humanitarian groups like Rotary International that deploy dedicated health workers for vaccination campaigns, polio is now endemic in only 3 countries. Soon, many experts believe, polio can be completely eradicated from the world through access to life-saving vaccines.

This is terrific news and it demonstrates the impact of U.S. leadership on the lives of children around the world.

Today, the leading killers of children in the developing world are completely preventable and treatable diseases, pneumonia and diarrhea. Combined, they claim the lives of more than 2 million children under the age of five die every year. Ten countries in the developing world account for 60% of these child deaths. However, with greater access to health education and resources, these countries could save the lives of children.

Earlier this year, I co-sponsored the Frontline Health Workers Resolution (H.Res. 734). This is a bipartisan resolution that is aimed at recognizing the importance of community health workers throughout the world who are providing health care to the poorest of the poor areas. These individuals often have to travel days by foot and rely on a backpack of supplies to deliver life-saving health care to rural communities. In short, without them, millions of families throughout the world would never receive health care because they live too far away to access hospitals, clinics, doctors and nurses.

By providing vaccinations, basic antibiotics to treat pneumonia, oral rehydration therapy and zinc to treat diarrhea, and other health services, frontline health workers are often the difference between life and death. According to RESULTS, the Ethiopian government trained 40,000 community health workers and sent them out into the rural regions across that country. Five years later, there was a 50% reduction in malaria related deaths. This is impressive and speaks volume to the effectiveness of frontline health workers.

This month, UNICEF reported under-five child deaths dropped from 12 million a year in 1990 to 6.9 million a year in 2010 thanks to many of the services provided by frontline health workers. This is an incredible accomplishment, but more must be done.

In order to continue to lower child mortality rates and to prevent further deaths from pneumonia and diarrhea, I will continue to support efforts by our nation and others to support frontline health workers. By aiding those most in need, health workers throughout the world are saving children and teaching them important health skills that they can carry with them for the rest of their lives. I applaud those working on the frontlines and know that you are helping to end preventable childhood deaths.

(Note: This blog first appeared at: )