Health Workers: On the Front Lines of Global Health Security Duty

By Dr. Mariam Reda, Chemonics

Last month, the first Global Health Security Conference 2019 (GHS2019) took place in Sydney, Australia, gathering more than 800 participants from 65 countries to discuss strategies to advance global health security through partnerships, research, academia, inclusive policies, and programs. 

Delegates at the conference pledged to honor the “Sydney Statement on Global Health Security,” which states as a first principle that global health security interventions “must strive to be inclusive, equitable, and data driven.” The goal of “inclusivity” has been a cornerstone of global health security efforts since the inception of the Global Health Security Agenda (GHSA) in 2014. Despite their extreme convergence and interrelatedness, discussions about strengthening the global health workforce are generally disjointed from conversations about health security. Inclusively linking global health security and health workforce strengthening approaches and programming is vital to achieving a world safe and secure from global health threats. But how can we do that?

Learn from the past. As we move forward to build on the Sydney discussions with new inclusive strategies and approaches, we can learn from our past experiences. Tuberculosis, a disease infecting one third of the world’s population, remains a major global health security concern especially with the rise in antimicrobial resistant strains. For years, interventions addressing this often-curable disease have proven the importance of: 1) engaging health workers early, frequently, and consistently to ensure timely case detection, retention on treatment, comprehensive contact tracing, and behavior changes to mitigate risks of transmission; and 2) aligning TB strategies with non-TB public health programming in areas such as HIV, maternal and child health, and others, through an integrated approach. The global health security community can learn from these experiences to ensure prevention, preparedness, and response to global health security threats are an integrated part of health programs with competent, trained, and skilled frontline workers being the backbone of these programs. 

Build community trust. The Ebola virus disease outbreak currently ravaging the Democratic Republic of Congo underscores the importance of frontline health workers working within their own communities. With the international development and humanitarian communities rushing funds and resources to contain the outbreak, the communities actually affected are asking: “Are you here because of Ebola? Where were you prior to Ebola?” 

To adequately, efficiently, and effectively respond to disease outbreaks, community trust and engagement is a must, and this requires the strong involvement of community health workers, who are often the bridge between health systems and communities, even before outbreaks appear. Recently, the critical role that community health workers play in health systems—often overlooked—gained a boost with a resolution at the 72^nd World Health Assembly. Community trust in the health system is earned and takes time to be established; local health workers can facilitate this, demonstrating another area where health workforce and global health security are closely linked and inter-reliant. 

As Lucica Ditiu of Stop TB partnership said in Sydney, "The moment we give wings to the local governments and organizations to implement according to their local context is when things will work."

Include everyone! Although global health security messaging and advocacy rely on the One Health inclusive approach for the creation of a safe and secure global environment, engaging all stakeholders has been challenging. Non-health sectors must be involved in all phases of global health security programming to prevent the exclusion of key stakeholders. For example, UNICEF is working with schools and teachers in Butembo and Katwa in the DRC to brief them on their role in fighting Ebola. These teachers serve as ambassadors in the fight against the disease and, more importantly, are an example of harnessing relationships within the community to further increase community trust and strengthen response efforts. In global health security, frontline workers include health workers, veterinarians, teachers, environmental health specialists, security officers, military personnel, and others working directly with communities. Everyone should be involved… Everyone is at risk! 

Tremendous advances have been made in strengthening surveillance systems, biosafety, and biosecurity measures, laboratory diagnostic capacities and increased political will to address global health security. However, if we do not capacitate, protect, and value the frontline workers—who are the first line of defense against health security threats—we will not achieve the inclusivity needed to achieve global health security targets. 

In the opening remarks at the GHS2019 conference, WHO Director General Dr. Tedros Adhanom stated, “Health security is a shared responsibility: we are only as strong as our weakest link.” By building on examples of inclusivity from the health workforce, the health security community can strengthen any weak links, and be better positioned to strengthen both the global capacity and countries’ capacities to prevent, detect, and respond to infectious disease threats.