Planning a Family by Choice, Not by Chance

By Dr. Leslie Mancuso, President and CEO, Jhpiego

Photo by MNCH Services Project Pakistan Initiation of family planning immediately after birth is both efficient for health systems and easier for women since few women in low-resource settings are able to return to a facility for further care.

Photo by MNCH Services Project Pakistan
Initiation of family planning immediately after birth is both efficient for health systems and easier for women since few women in low-resource settings are able to return to a facility for further care.

Every year, more than 180 million babies are born around the world. The birth of a child is a joyous occasion to be cherished and celebrated, but it is also a chance for new mothers to prioritize their health and plan for the future. As such, it represents a unique opportunity to reach the thousands of women who want to prevent an unintended pregnancy within the first 2 years after giving birth, but don’t have the time or ability to access family planning counseling or services. Proven to be one of the most effective tools available to reduce the deaths of women and children and improve health, postpartum family planning (PPFP) is also one of the most underutilized. The numbers speak for themselves:

  • 225 million women in developing countries lack access to family planning information and services.
  • Unmet need for family planning is highest for women in the postpartum period, during which 92% of new mothers want to space or limit future pregnancies but only 35% are using a method of family planning.
  • Addressing the unmet need for family planning can avert more than 30% of maternal deaths.

The good news is that support and demand for family planning, especially in the postpartum period, are once again becoming a global movement. Starting with the groundbreaking  London Summit on Family Planning in 2012 and Statement for Collective Action for Postpartum Family Planning, and continuing with the recent Accelerating Access to PPFP Global Meeting in Chiang Mai, Thailand  and upcoming International Family Planning Conference

From more than 40 years of experience working at the intersection of maternal and newborn health and family planning, Jhpiego understands the importance of integrating services for both. A no-missed-opportunities approach recognizes that every service contact—prenatal visits, childbirth, postnatal care, child immunization—presents an opportunity to counsel women on their family planning options. As technical leaders, we also know that comprehensive PPFP programming requires many types of frontline health workers being involved at each step along the prenatal-to-postpartum continuum of care. In low-resource settings, midwives and nurses are often the only point of care for women during pregnancy and childbirth. That’s why ensuring that they are properly trained, supported and empowered to provide PPFP counseling and services is so critically important.

In Pakistan, for example, women have an average of 3.8 children, and 37% of births occur within intervals of less than 24 months. Recognizing the impact PPFP can have on the health of a woman, Jhpiego, in collaboration with Pakistan provincial departments of health and with support from the David and Lucile Packard Foundation, is working to increase access to family planning counseling and services for women across Punjab Province. To date, 42,814 pregnant women and 24,552 postpartum women have been counselled on their family planning options and 13,209 accepted a method. In addition, the project has built the capacity of 52 Master Trainers, 550 Lady Health Visitors—a position similar to a skilled birth attendant—and 103 community health workers to provide PPFP counselling and services.

The lessons learned under the Pakistan program are currently being applied in other programs in the country, including a large Maternal and Child Integrated Program (MCHIP) associate award funded by the United States Agency for International Development that seeks to expand the range of methods offered to postpartum women and test the acceptability of male providers offering implants. This program offers an opportunity to learn about the challenges of delivering these services at a much larger scale.

We are seeing similar success with PPFP in India, which has made tremendous investments in improving nursing education and scaling up access to PPFP services through a number of partnerships with the Government at national and state levels and with support generous donors such as the Bill and Melinda Gates Foundation. These successes are not unique to Asia, as demonstrated in Burkina Faso, where a dynamic team of family planning trainers leveraged the support of the Ministry of Health and a modest commitment from Jhpiego at the 2012 London Summit to provide women in Burkina Faso with access to PPFP and exceeded all expectations.

Utilizing the skills of frontline health workers and building on the pillars of successful family planning programming, government support, collaboration, capacity building, technical continuity and integration, we can become the catalyst for bold action on behalf of millions of women. Now is the time to act, to strengthen the health workforce in this critical health care need, invest heavily in PPFP programs, ensure appropriate supplies of contraceptive methods and say a resounding yes to women who want to plan their family by choice, not by chance. Please join us and share your commitment to making sure a broad range of contraceptive options are available to women after giving birth no matter where she lives.Sign here!

BREAKING: Bipartisan Frontline Health Workers Resolution Introduced by Reps. Lowey, Crenshaw

By Scott Weathers, IntraHealth International and Frontline Health Workers Coalition

Reps. Nita Lowey (D-N.Y.) and Ander Crenshaw (R-Fla.) introduced H. Res. 419, “Recognizing the Importance of Frontline Health Workers” today in the U.S. House of Representatives. According to the WHO, as of 2015, at least 400 million people lack access to one of more essential health services provided by frontline health workers.

H.Res. 419 would:

* Reaffirm the “critical role of frontline health workers in achieving core global health goals, including ending preventable child and maternal deaths, ensuring global health security, and achieving an AIDS-free generation”

* Commend the “progress made by the United States in helping to build local capacity and to save lives in the world’s most vulnerable communities by training and supporting frontline health workers;”

* Acknowledge that “in the aftermath of natural disasters, disease outbreaks, and conflict, frontline health workers continue to perform critical services to save the lives of mothers and children without access to medicines, equipment, or running water in many cases;”

* Urge “greater global attention and support for local frontline health workers to ensure their ability to respond effectively during humanitarian crises and to safeguard the health of the world’s most vulnerable populations, including populations in conflict-affected states;”

* Call on “all relevant Federal agencies, including the United States Agency for International Development, the Department of State, and the Centers for Disease Control and Prevention, to develop a coordinated, comprehensive health workforce strengthening action plan that is data-driven with concrete targets for increasing equitable access to qualified health workers in developing countries, particularly in underserved areas, to support the Global Human Resources for Health Strategy.”

Full text of the resolution is available here.


Connecting Frontline Health Workers to Training and Information

By Carolyn Moore, mPowering Frontline Health Workers

For most people in developing countries, frontline health workers are the first and often only source of essential  health services.  Our partners and colleagues in the Frontline Health Workers Coalition support health workers through advocacy, programs, and policy. At mPowering Frontline Health Workers (mPowering), we focus on training.

With the right training and ready access to information they need, frontline health workers can provide critical and life-saving care to their communities. However,  research shows that training for frontline health workers is often inconsistent, insufficient, or simply not available.

With the rapid growth of mobile technology worldwide, mobile health (mHealth) offers an unprecedented opportunity to improve opportunities for training. With even a basic mobile phone, frontline health workers can listen, learn, and teach, using interactive health content.

With access to the right information and training, frontline health workers can use audio and video to support health education in communities; keep up to date with new learning or refresh their skills, and use diagnostic tools to guide them in their work.

This June, mPowering launched ORB, an online library of mobile-optimized training content. ORB aims to help frontline workers access the knowledge they need to transform health outcomes for millions of women and children.

ORB is freely available and accessible through Internet-enabled mobile devices; and content can be saved to share offline.  All of the content on ORB is published under an open license, meaning that anyone can use, distribute, and in some cases adapt, the content on ORB.

With over 300 resources, in 14 languages, ORB’s resources are being accessed in more than 100 countries. By combining easy-to-use, open source content that health workers can use online or offline, ORB has the potential to radically enhance the quality and reach of existing training efforts.

ORB by mPowering from Nathan Heidt on Vimeo.

We encourage users to view, share, and adapt the content on the site; and we welcome submissions of new content and interest in becoming a content partner. Visit ORB today to explore the content; and contact mPowering to learn more.

mPowering is a partnership working to support effective training, supervision and support for frontline health workers. We leverage the power of mobile technologies to connect health workers to the information and on-the-job resources they need.  Learn more at

A First Responder on the Frontlines of the Yemen Humanitarian Crisis

By Jenna Montgomery, International Medical Corps

Doa’a conducting a water, sanitation and hygiene distribution in Aden, Yemen.

Doa’a conducting a water, sanitation and hygiene distribution in Aden, Yemen.

Doa’a is a health program officer in Yemen working for International Medical Corps. Since

last spring her reports have appeared on our website providing a rare view from inside a country at war where 80% of the population is in need of humanitarian assistance. The violence is so pervasive that few outside organizations remain in the country.


Doa’a’s blog posts  portray a nation whose people hover on the edge of catastrophe –where stocks of fuel, food, water and medical supplies are severely depleted, where over half Yemen’s 25 million people are in danger of not having enough to eat  and war is never far away.  Doa’a is 30 years old and lives and works in the southern port city of Aden. She’s married and has a baby boy. In her blog last May she described chaotic scenes as fighting came to her once calm neighborhood. Despite bombings and constant shooting, Doa’a remained calms and tried to provide assistance wherever and whenever she can. In one entry, she wrote, “If I see injured people within half a mile from my home, I run out to try to save them. I have also been to the Touwahi Medical Center on several occasions to do minor medical procedures. There are no surgeons there who can perform the kind of operation needed to repair major war wounds. So far I have been involved in 17 first aid interventions and minor surgeries to assist injured men who arrived at the medical center.”

On Wednesday, May 5, Doa’a and her family were forced to flee their home when the fighting surrounded them. After a harrowing escape, Doa’a and her family found refuge with relatives in another part of the city. She then continued her work with International Medical Corps, helping establish a new health clinic in the city to serve the thousands of displaced people. She wrote, “I did an assessment last week of the health services in the area and found out there were no medical centers. I called our program manager, who immediately responded. We rented a warehouse and established an International Medical Corps clinic. We are now working 24/7 in the warehouse. Going back to work and feeling that I am helping my people helps relieve the stress.”

While taking a short break from her family and her work, Doa’a reflected on her situation, saying, “I always wondered how other people like the Palestinians or Syrians live in war situations. Now I am living it myself and can feel their fears and suffering more. We cannot stop the war on our own but I hope to be able at least to provide humanitarian support to those people in need.”

Crowded in a small apartment with 22 people, she described the conditions made more difficult due to the lack of electricity and the intense summer heat, with temperatures that reach 108 degrees. Despite her own struggle to survive, Doa’a keeps working to help others. She helps deliver hygiene kits to new internally displaced persons (IDPs) in the area and distributes food vouchers to every family in the neighborhood.

Following such days, she wrote that before going to sleep she cried. “I feel sad and angry for my country,” she wrote. “We used to live in harmony, regardless of religious affiliation. Now, we are frightened about the future. What do I wish for? I wish for the day I can tell you: ‘We are back home and the war is over’.”

Finally, at the beginning of August large scale fighting subsided in Aden and after three months of living as an IDP, Doa’a and her family were able to return home to her old neighborhood and her apartment. At the same time Doa’a and other members of the International Medical Corps team in Aden returned to their office, located in an area that witnessed some of the city’s heaviest fighting. Doa’a and other members of International Medical Corps’ Aden team are now busy conducting assessments of the most urgent needs. The task is a large one because they are helping support 38 medical centers, four mobile clinics and two hospitals in Aden and Lahij alone. In her most recent entry, Doa writes, “The sad reality is that bombing has ceased but the humanitarian crisis is unprecedented. We are especially worried about child malnutrition which has been on the rise since the war started.”

To continue to follow Doa’a’s story, visit her blog at:

Honor humanitarians like Doa’a on World Humanitarian Day, August 19, 2015. Follow #HealthWorkersCount and  visit and do your part to #ShareHumanity.

International Medical Corps has maintained a permanent presence in Yemen since 2012, with three offices and more than 175 local staff in the country. Our humanitarian assistance programs currently include: rapid emergency response, health systems strengthening and service provision, maternal and child health, protection, community development and water, sanitation and hygiene.

Since its inception 30 years ago, International Medical Corps’ mission has been consistent: relieve the suffering of those impacted by war, natural disaster and disease, by delivering vital health care services that focus on training. This approach of helping people help themselves is critical to returning devastated populations to self-reliance. Visit us on Facebook and follow us on Twitter.

Stronger Health Systems Could End Abuse during Childbirth

By Rebeccah Bartlett, UNC-IntraHealth Summer Fellow, IntraHealth International


When I volunteered in a maternity ward in the Philippines in September 2013, I had about 18 months’ experience under my belt as a midwife and a couple more as nurse. I had done similar work in Papua New Guinea and was eager to return to a low-resource setting to sharpen my skills and develop my clinical thinking.

I hoped I would be of some help to the local frontline health workers. Lighten their load slightly. Maybe give them a chance to breathe a little by providing an extra set of hands. Within a day I realized this was not going to be the experience I had hoped.

It wasn’t the unsanitary conditions or the lack of resources that surprised me, though I admit I wasn’t expecting to see a litter of kittens running around the infectious diseases ward.

What troubled me most was the way the women were treated.

My public health instincts had me imagining new patient services flow charts, moving the literal dumping ground of rubbish and broken hospital equipment away from the wind tunnel that blew directly into the TB ward as I watched family members operate breathing equipment they’d had to purchase themselves to keep loved ones alive.

These were simple problems, though, compared to what I saw from the corner of the labor room, where I was instructed to “just watch”—women verbally abused, humiliated, mocked, shamed, and abandoned.

Of course, the nurses and doctors I worked with in the Philippines did not wake up every day with the desire to mistreat the women in their care. Many of the types of problems I saw are the result of failures within the health system. Short staffing, for instance, can lead health workers to take dangerous shortcuts, become exhausted, and burn out, with terrible consequences. According to the World Health Organization, there’s a shortage of 7.2 million doctors, nurses, and midwives worldwide.

Women Abused, Humiliated, and Abandoned

I witnessed more than one woman give birth by herself while the nurses gossiped behind the desk. I assisted once or twice when I couldn’t help myself, but when I did this the woman whose hand I held or whose baby I placed on her chest was chided for embarrassing herself or given an “obstetric slap” for not “being strong like a good Filipina woman.”

And it wasn’t just the physical and verbal abuse. Even the care the women received reflected the staff’s contempt and disregard.

I saw a doctor use the same syringe and needle on five different women as she administered medication, storing the other sterile needle kits—which each woman is expected to bring at her own cost—“for later.”

I saw another doctor use the same instrument to break two women’s amniotic sacs, merely rinsing the tool under the tap in between.

I was left with one woman for nearly an hour as she lay, slowly bleeding from a deep tear during childbirth, whilst the doctor suturing her left to see another client and the other on-call doctor slept behind the nurses’ desk. The nurses didn’t want to wake him. I was not yet confident in my suturing skills. All I could do was attend to her observations, increase her IV fluids, and watch for possible hemorrhage or shock.

Respectful Maternity Care Is Everyone’s Responsibility

Mistreatment during childbirth is not unique to this facility in the Philippines. According to a new report published in PLOS Medicine, many women around the world experience these and other abuses when giving birth.

“They are slapped and pinched during labor, yelled at, denied pain medicine, neglected and forced to share beds with other women who just gave birth,” the New York Times reports. “And that is just a partial list of the abuses and humiliations inflicted on women around the world as their babies are born.”

If a woman can’t be protected and cared for at the exact moment she brings life into this world, when can she expect it?

In addition to greater support and investment in the health system and workforce, health workers need strong role models. They need colleagues who not only demonstrate compassionate care in their own work but who demand accountability when women are mistreated under their watch. Respectful maternity care is everyone’s responsibility.

In nursing school, I found my purpose in Millennium Development Goal 5: to improve maternal health. I learned that between 1990 and 2013, the maternal mortality rate dropped by almost half, but that 289,000 women still die every year in childbirth or due to related causes.  Twenty times that will experience an acute or chronic disability.

For some perspective, this is the equivalent of three out of every four people in my hometown of Canberra, Australia, dropping off the face of the planet in just one year.

I remember the looks the women gave me when they were mocked and shamed and abused, and I knew they knew they deserved better. I silently begged them to forgive me for not being able to help more, for doing little more than witnessing their trauma. Two years on, I am still trying to help. Now instead of acting as a witness, I act as an advocate.

What I saw in the Philippines occurs throughout the world. As the report in PLOS Medicine points out, women from lower- and middle-income countries, from stigmatized backgrounds, and those who live within health systems in crisis all face greater risk of disrespect and abuse in childbirth.

By building stronger health systems, helping countries better support their health workforces, and advocating for equality for women and girls, we can end their trauma. And we can give mothers and babies the chance they deserve to thrive.


Advocating for Change: Empowering the Maternal Health Workforce We Need to Save Lives

By Lilia Carasciuc, White Ribbon Alliance

In Western Tanzania, Elvina Makongolo is the only midwife on staff at the Mtowisa Health Centre’s maternity ward. She works around the clock to give pregnant women the care they need. She knows all too well the risks these women face in giving birth so far away from the lifesaving equipment required in emergencies.

“We are too few midwives…so being understaffed, this leaves me to do everything: cleaning, preparing the instruments, preparing delivery kits, and still when a pregnant woman comes, I deliver her, keep her safe, record her information. If we were many, we would help each other to relief the burden,” Elvina said.

White Ribbon Alliance (WRA) is making sure the world knows how crucial midwives like Elvina Makongolo are in saving the lives of mothers and newborns. Yet all too often, midwives work in substandard conditions, for small salaries, and are trapped in a vicious circle of low public regard and poor performance. We are supporting midwives around the world to advocate for their profession, changing the public’s perception of their work and pushing for improvements in midwives’ pay and working conditions so that their vital role is recognized and justly rewarded.

Sadly, chronic health workforce shortages in Tanzania pose enormous barriers to women’s access to safe and reliable maternal and child health services. Women the Rukwa region must walk all day to see a skilled midwife at Mtowisa Health Centre, and must walk an even further 200 km to the nearest hospital in the event of an obstetric complication or emergency.

Time and time again, we have seen how powerful health workforce advocates can be in urging governments to recognize the indispensable role of health workers in achieving national maternal and child health goals. As a result of our campaign in Malawi, the Minister of Health committed to develop a strategy for increasing the number of professional midwives; to work with Malawi’s directorate of human resources to develop a career path for midwives; and to include in the next national budget funding for research to determine the number of midwives in the country.

Following our campaign in Tanzania, Prime Minister Pinda directed all district councils to allocate an adequate budget for human resources to support comprehensive emergency obstetric and newborn care. Because of citizen advocacy in Uganda, the government provided an 18% salary increase for enrolled midwives and nurses, as well as a 13% salary increase for registered midwives.

In many other countries, midwives still face extraordinary staffing shortages, inadequate medical supplies, and public scrutiny. To address these challenges, we are sharing our lessons learned in citizen empowerment and advocacy, hoping to help others spark change. Only then can we recruit, train, employ and retain the skilled frontline maternal health workforce so urgently needed to prevent deaths in childbirth.

White Ribbon Alliance formed over a decade ago to give a voice to the women at risk of dying in childbirth. Our mission is to inspire and convene advocates who campaign to uphold the right of all women to be safe and healthy before, during and after childbirth. We help citizens recognize their rights and hold their governments to account for commitments made to maternal and newborn health. 

A Call to Scale-Up Community Health Workers

This post originally appeared on the Huffington Post Impact Blog. 

By Jeffrey Sachs, Earth Institute at Columbia University

This post is co-authored with Sonia Sachs on behalf of the 1 Million CHW Campaign.

Public health officials and practitioners from around Africa and from international public and private organizations, businesses, and universities, met in Accra, Ghana June 9-11 to consider ways to scale-up the coverage of high-quality community health worker (CHW) systems in our countries to achieve universal health coverage (UHC). In the meeting they pledged to work together to speed the scale-up of CHW systems in sub-Saharan Africa, and issued the following urgent appeal.

Joint Call to Action

We have reviewed the national experiences and the scholarly evidence demonstrating that CHW systems are a critical, integral, cost-effective, and long-term part of effective overall health systems. CHWs save lives, promote public health and wellbeing, bridge health system gaps, improve the quality of life, and help to prevent and end epidemics like Ebola. As members of the communities they serve, CHWs are the health workers closest to households. CHW systems offer high-quality, meaningful employment for young people.

We know that effective national-scale CHW systems start at home. We urge all African governments, including Ministers of Finance and Health, to recognize the indispensable role of CHWs in public health and epidemic control, by taking the following steps:

  1. Making and implementing plans for national-scale CHW systems;
  2. Expanding the domestic funding available for CHW systems;
  3. Ensuring that CHWs are properly trained, remunerated, supported by cutting-edge information systems, and empowered with the proper supplies, equipment, and training needed to provide both preventive and curative care with professional skills and to empower communities in their own health;
  4. Preparing CHW systems to address the non-communicable disease challenges that will be central to the new Sustainable Development Goals (SDGs);
  5. Supporting CHW systems with state-of-the-art information and communications systems made possible by breakthroughs in mobile broadband, telemedicine, remote monitoring, remote diagnostics, and other recent ICT innovations of great promise and significance;
  6. Empowering communities to work effectively with CHW systems;

On the international side, we underscore the urgent need to scale-up international support for CHW systems, and to convert the fragmented global CHW funding into pooled financing that supports national CHW systems. We are concerned about donors supporting parallel programs rather than national programs. Because of such parallel programs, CHW systems are scattered across many projects, each with its own protocols, ICT systems, if any, varied durations, and inconsistent approaches on training and the range of activities of the CHWs.

We strongly urge donors to pool their CHW resources into a few pooled global funds, including the Global Fund to Fight AIDS, TB, and Malaria, GAVI, the new Global Finance Facility, and possibly a new Global Fund for Health Systems. These pooled funds should provide additional financing for CHWs in a flexible and timely manner. We call on the donor partners to end the donor fragmentation and the long delays in disbursements. The time for scale-up has arrived.

We note that two countries in Africa, Guinea and Sierra Leone, are still battling Ebola, while Liberia has succeeded in ending their Ebola epidemic in part through the successful deployment of community health workers. Ebola is a scourge that takes hold in places with under-financed and fragmented health systems that lack effective CHW system support. We call on the international community to support the Ebola-affected countries to scale-up their national health systems, including high-quality CHW systems, with full urgency.

We note that the world is on the verge of adopting the new SDGs, calling among other things for UHC as part of SDG 3. We also note that world leaders will assemble in Addis Ababa, Ethiopia next month to take steps to finance the new SDGs. We firmly believe and declare that success in universal health coverage will require the proper funding and scale-up of CHW systems in our countries and throughout Africa. We call on world leaders to heed the exciting opportunities at hand to save lives by the millions in the coming years through professionalized, high-quality CHW systems linked to overall high-quality health care systems.

We address this appeal to the leaders of national governments and the international health organizations. We kindly request the One Million Community Health Workers Campaign report back to the participating governments in advance of the UN SDG Summit in September 2015, so that we can move forward effectively and confidently together in an urgent and timely manner.

June 11, 2015
Government representatives from:

Ministry of Health, Burkina Faso
Ministry of Finance, Burkina Faso
Ministry of Health, Congo-Brazzaville
Government of Ghana
Ministry of Health, Ghana
Ministry of Finance, Ghana
Ghana Health Services
Ministry of Local Government and Rural Development, Ghana
Ministry of Health and Public Hygiene, Guinea
Ministry of Health, Kenya
Ministry of Health and Social Welfare, Liberia
Ministry of Finance, Liberia
Ministry of Health, Malawi
Ministry of Finance, Malawi
Ministry of Health, Mozambique
National Primary Health Care Development Agency, Nigeria
Ministry of Health, Rwanda
Ministry of Health and Social Action, Senegal
Ministry of the Economy, Finance, and Planning, Senegal
Ministry of Health and Sanitation, Sierra Leone
Ministry of Finance, Sierra Leone
Ministry of Health, Uganda
Ministry of Finance, Uganda
Ministry of Health and Social Welfare, Tanzania
Ministry of Finance, Tanzania
Ministry of Community Development, Zambia
Ministry of Health, Zambia

Representatives from:

Brandeis University
Earth Institute at Columbia University
Moi University
Clinton Health Access Initiative, Zambia
Columbia Global Center East & Southern Africa
Columbia Global Center West & Central Africa
Global Health Workforce Alliance (GHWA)
Harvard University
Tanzanian Training Centre for International Health
Johns Hopkins University
Last Mile Health
Living Goods
Management Sciences for Health, USA
Management Sciences for Health, Ghana
Management Sciences for Health, Rwanda
Millennium Development Goals Health Alliance
Millennium Promise Inc.
Millennium Villages Project, Ghana
CORE Group
National Health Insurance Fund, Ghana
Sanford International Clinics, USA
Sanford International Clinics, Ghana
Save the Children, Sierra Leone
Sustainable Development Solutions Network
University of Ghana School of Public Health
University of Washington
WHO Ghana
World Vision International
World Vision, Ghana


Statement Submitted at World Health Assembly 2015 on Ebola

This statement was submitted by IntraHealth International on behalf of the Frontline Health Workers Coalition for World Health Assembly 2015 on Agenda Item 16.1: 2014 Ebola virus disease outbreak and follow-up to the Special Session of the Executive Board on Ebola. The statement can be found here:

I speak on behalf of IntraHealth International, a US-based NGO partnering with the World Health Organization and global health community to empower health workers and foster sustainable solutions to health care challenges, and the Frontline Health Workers Coalition, representing 41 member organizations, whose secretariat is housed at IntraHealth.

The Ebola epidemic in West Africa has highlighted an urgent need for increased support for frontline health workers and the systems that support them in this region and around the world. WHO reported that as of May 6, 2015, 868 health workers were infected with Ebola since the onset of the epidemic, and 507 of them died caring for the 26,593 people confirmed or suspected to have been infected with the virus. Nearly all of these lives have been lost in three countries–Guinea, Liberia and Sierra Leone–that all had less than 3 doctors, nurses or midwives per every 10,000 people before the Ebola epidemic even took hold, far less than the 22.8 per 10,000 ratio WHO has stated is the minimum needed to deliver basic health services. As we continue to battle and move forward from this epidemic, IntraHealth urges the WHO and member states to focus investments on building a resilient, sustainable health workforce in Guinea, Liberia, Sierra Leone and the other 80 countries around the world that do not meet the minimum WHO threshold. We must increase support for local health workers on the frontlines of care, build strong and sustainable supply-chain management system, address stigma, and invest in long-term training programs. IntraHealth also urges member states to support the development, financing, and implementation of a robust Global Human Resources for Health Strategy, as agreed upon during last year’s WHA, to ensure lessons from the Ebola epidemic do not go unlearned, and that global health security for all is no longer threatened by chronic under-investment in health workers and systems.

Midwives For a Better Tomorrow, For Every Woman and Every Child

By Toyin Ojora-Saraki, Founder/President, The Wellbeing Foundation Africa

[This blog originally appeared from the Huffington Post Global Motherhood Blog]

Celebrated on May 5th each year, the International Day of the Midwife recognises the invaluable role of midwives in health. As the Global Goodwill Ambassador for the International Confederation of Midwives (ICM), I would like to personally thank midwives for their inspiring work in delivering quality care to women and newborns.

Around the world, skilled midwives keep expectant mothers informed throughout their pregnancy and labour, empower all women of childbearing age to make healthy choices for their family and provide medical assistance for newborns in the fragile first days of their life. However, access to midwives varies considerably across sub-Saharan Africa, with rural communities bearing the brunt of the inequity of access. For example, in Nigeria, 14% of pregnant women give birth completely alone, and in 2013, only 40% of women gave birth with a skilled birth attendant present. And the shortage of midwives is not just a Nigerian problem. The ICM have found that if women are to receive the quality care that they need before, during, and after birth, the world needs 350 000 more midwives.

At the Wellbeing Foundation Africa (WBFA), we believe that an investment in the access to midwives and the training of midwives is crucial to the survival of mothers and babies around the world. This is why I am pleased to announce – on the International Day of the Midwife – that WBFA has forged a new partnership with Johnson & Johnson and the Liverpool School of Tropical Medicine (LSTM) to deliver an innovative global training package for local health workers in Kwara State, Nigeria, that has the potential to reduce maternal mortality by 15% and still birth rates by 20% in the state.

As First Lady of Kwara State for eight years, I have long worked to save Kwaran mothers and babies at the most vulnerable juncture of their life. To achieve this, we have instigated frontline programmes such as the Alaafia Universal Health Coverage Fund (AUHF), which draws on innovative financing mechanisms to enable Kwaran families to access affordable health insurance and supported the commissioning of the state-of-the-art Maternity Referral Centre in Eruku, Kwara. All of our frontline interventions have been designed to allow them to be scaled up and replicated in communities in Nigeria and across the African continent. Yet, progress cannot occur in silos, and we are glad to have partners to work with that can bring further global innovations back home to Kwara with us.

I am proud that this new project will bring a world-renowned ‘skills and drills’ training package for Emergency Obstetric Care and early Newborn Care (EmONC) from LSTM to Kwara. In 2013, a report by the African Journal of Reproductive Health found that 6 out of the 16 Local Government Areas in Kwara State did not meet UN standards for emergency obstetric and newborn care. To combat this service provision gap, LSTM’s Centre for Maternal and Newborn Health (CMNH) has designed, implemented, and evaluated an innovative EmONC package to improve the quality and availability of skilled birth attendants (SBA) and provide a measurable increase in the knowledge and skills of healthcare providers.

Midwives are central to the project in Kwara, as the training programme will include support to pre-service midwifery institutions to improve the competency based EmONC training components of their curriculum. The programme will include in-service training for 80-100% of midwives, doctors and community health extension workers who provide maternity services in the state’s public sector hospitals, setting up skills labs in three general hospitals, and upgrading the capacity of one skills lab in a pre-service midwifery institute. With the help of our team on the ground in Kwara, WBFA has been able to support the local operation of the project and ensure stakeholder engagement at every stage.

As we near the end of the Millennium Development Goals (MDGs) process, the International Day of the Midwife is more important than ever. Experience from the MDG process has made it abundantly clear that midwives should be placed at the very heart of the post-2015 development agenda, and access to midwives should be specifically indicated within the targets of the Sustainable Development Goals (SDGs) related to reproductive, maternal, newborn and child heath. Without this provision, the international community may fail to meet their promises to women and their families.

Therefore, we urge governments to invest in midwives now so that by 2030, birth can be safe for all, no matter where they live. Placing midwives at the heart of maternal, newborn and child health policies and programmes will ensure that there are more health professionals with midwifery skills, in the right place, at the right time, with the right education, the right support and the right pay. We know that more midwives and more access to midwives will ensure a better tomorrow, for every mother and every child. We must act now for a better tomorrow, for every mother and every child.

New ILO Report: The World Needs More Rural Health Workers, A Lot More

By Aanjalie Collure, IntraHealth International

Photo from ILO Report: Global Evidence on Inequalities in Rural Health Protection (2015)

On April 27, a new report released by the United Nations International Labor Organization (ILO) made a distressing finding: without adequate numbers of health workers, especially in rural areas, more than half of the world’s rural population – and more than three-quarters of the rural population in Africa – will go without access to effective health care in 2015.

The report, entitled Global Evidence on Inequities in Rural Health Protection, was the ILO’s response to observable trends in economic dis-investment and neglect in rural health systems around the world. Now, with this report indicating that nearly 56% of the world’s rural population – and 83% of Africa’s rural population – live without critical healthcare access, the ILO has provided powerful evidence to demonstrate why strengthening the rural health workforce is imperative to filling this gap.

According to the report, inadequate numbers of rural health workers is one of most crippling determinants of poor access to health services in rural areas across the globe. While approximately half of the world’s population resides in rural areas, only 23% of the health workforce is stationed here. This amounts to a deficit of approximately 7 million health workers in rural areas, comprising the vast majority of the ILO’s estimated 10.3 million global health worker deficit.[1]

“Health workers are a prerequisite for access to health care. Without skilled health workers, no quality health services can be delivered to those in need,” asserts this report.

So, what do the recorded health workforce shortages mean for people’s access to life-saving health services? ILO research provides a grim response to this question: precisely because of these health workforce deficits, 50% of rural areas and 24% of urban areas lack access to the essential health services they need.  In Africa, the impact of health workforce shortages is even more acute: half of urban residents lack access to health care due to health worker shortages, and a staggering 77% of rural residents lack essential health coverage, precisely because they are devoid of the health workers needed to serve their communities.

Even more striking is evidence that shows that these health worker shortages not only impede accessibility to health services, but have a direct and real impact on health outcomes as well. Data collected by the ILO demonstrates that the maternal mortality rate in rural areas is very strongly correlated with the degree of health workforce shortages in that area: “with decreasing levels of health workers, particularly midwives, the maternal mortality rate increases significantly,” warns the report.

In this context, the ILO makes a powerful assertion: national and global health policies must prioritize investments needed to “train, employ, renumerate and motivate” the rural health workforce we need to bridge inequalities in access to basic health services, and accelerate progress in meeting global health goals. In rural areas especially, improvements must be made in guaranteeing safe and decent working conditions in rural facilities, appropriate wages, and additional incentives to recruit and retain staff.

Improving the infrastructure of rural hospitals and guaranteeing the provision of much-needed equipment, supplies and transport services for rural health workers can also go a long way in building this rural health workforce. With the international community now coming together to strive for universal health coverage (UHC) as a major global health priority, we must acknowledge how these critical investments in frontline health workforce strengthening are central to achieving this goal.

[1] The ILO has calculated the 10.3 million global health workforce shortage based on a threshold of 41.1 health workers per 10,000 people.