What Does Health System Integration Really Mean to Frontline Health Workers and Those They Serve?

By Allison Annette Foster, University Research Co.

As the Frontline Health Workers Coalition and other advocacy movements push for increased number and integration of frontline health workers into the health systems of developing countries, we need to pause to consider the implications of this integration for the health workers themselves, and for the people they serve. This point was brought home to me on a recent visit to Buikwe, Uganda, where USAID is supporting our efforts to understand what variables influence the performance of community health workers and Uganda’s village health teams.

Take the case of one woman how has been on a village health team for two years and is not trained to support home-based and self-managed care of people living with HIV/AIDS. She described to me how moved she was to develop deep relationship with people living with HIV/AIDS. She felt such empathy for one man under her care who was terribly thin and who suffered from a lot of pain. She told me how she felt so well when she could soothe him with those under her care. She had never imagined how hard their life was and she wished she could only help them more. She also shared how seeing their life had motivated her to make significant changes in her own behavior so she would not put herself at risk of HIV infection.

Another village health team member who has similar responsibilities shared that he is considered by others as the “village doctor” because he is the only health worker many families see. He was troubled that he did not know yet all that he needed to learn to be sure and help everyone with all their medical concerns.

Learning about how these two colleagues on the frontlines experience their roles, and with so many men and women who have embraced their leadership in the community as a calling and as an enormous responsibility, we ask ourselves what kind of responsibility do we have to them? From my desk in Bethesda, Maryland, after a meeting with international development partners, I write a blog, and I research a paper. How will my work change the lives of village volunteers?

For example, we are part of a global team at the global that is developing a framework through which countries will integrate the community health workers cadre into the formal health system.

Of course, it would be good for the countries to increase their workforce through low-wage earners who are able to maneuver through the rural areas. More families will be encouraged to come to the health center for the real care they need if they know a frontline health worker is there. But once these health workers are part of the health system, will they be overcome with empathy for the home-bound AIDS sufferer? Will they swell with the same pride as the “village doctor”? Or will their entry into the mechanics of a system put them to work in difficult environments, to struggle with shortages and burnout, maybe to suffer from harassment from higher-skilled professionals. Will they be expected to pursue a career path, become a nurse auxiliary, and then a nurse? Maybe they will decide to take advantage of their qualifications and move out of the village to the urban areas – perhaps join their professional association, perhaps they will have to strike for equitable pay and benefits. Maybe they will be recruited to work in a high-income country and leave their communities and families behind.

We should be striving to strengthen the careers of existing frontline health workers. But as we do, we must also ensure sure there is a community volunteer to sit with an undernourished man and soothe his bed-soars or sit at the table with friends and colleagues to promote healthy lifestyles as the “village doctor” does.

As frontline health workers become integrated formal health, we need to consider the impact it has on communities as we integrate. As a member of the Frontline Health Workers Coalition, I am committed to continue advocating for our frontline heroes at all levels, and for the people they serve. Moreover, I will be sure to take seriously the responsibility I have in representing them.