Celebrating Community-level Pharmacy Technicians

By Kathryn Utan, American International Health Alliance

Imagine living in rural South Africa, where there is just one practicing doctor for every 4,219 people in many places. Now imagine you’re also living with a chronic condition, such as diabetes, hypertension, asthma, or even HIV.

According to the World Health Organization (WHO), adherence to treatment regimens for these and other long-term conditions averages just 50%in high-income countries, with even lower rates in low- and middle-income countries. For untold millions of people around the world, lack of access to critical care and advice from a qualified health worker is a dangerous fact of life.

Mid-level health workers are in high demand, yet short supply as South Africa works to meet its rapidly increasing needs for health and allied care professionals. Pharmacy services are no exception, which makes pharmacists — and pharmacy technicians — integral members of multidisciplinary health teams. They play a critical role not only in the procurement and supply of medications, but also in developing evidence-based care plans; establishing ongoing and supportive relationships with patients; and providing follow-up care, advice, and support to improve health outcomes.

Nelson Mandela Metropolitan University is piloting the training of pharmacy technicians, a new cadre of pharmacy support personnel designed to improve equitable access to healthcare for all in the wake of South Africa’s introduction of national health insurance. Photo courtesy American International Health Alliance.

Teri-Lynne Fogarty, a lecturer and the coordinator of Nelson Mandela Metropolitan University’s (NMMU) Pharmacy Technician Program, explains that given South Africa’s shift toward service delivery at the primary level — including treatment and care for people living with HIV – pharmacy technicians are vital.

Jane Malaka is a recent graduate of NMMU andhas been working as a Pharmacy Technician at Rethabile Community Health Centre in the town of Polokwane in South Africa’s Limpopo Province for about six months.

“After they are diagnosed with HIV, every patient must go through a baseline evaluation to determine which antiretroviral medicines (ARVs) are best suited for them,” Jane says, explaining that while patients are on ARVs, continuous monitoring of blood levels are crucial to determine if the virus is being effectively suppressed.

“The goal for dispensing ARVs is to preserve life. It’s my job to help advise patients on the safe and correct use of these medicines, to answer any questions, and to highlight important information that doctors might have overlooked in a professional manner,” she continues.

Jane Malaka works with patients at Rethabile Community Health Centre in Polokwane, Limpopo Province. Her courses and job experience over the past six months, has given her the skills to dispense ARVs and other medications to patients at the primary care level under indirect supervision. Photo courtesy of American International Health Alliance.

Learning from other, more experienced members of the health team at the Centre, Jane says she has already gained valuable skills that help her to identify some side effects of certain ARVs.

“One day, a patient on a fixed-dose combination regimen [a single tablet that combines three separate ARV drugs: tenofovir, emtricitabine, and efavirenz] came to the pharmacy. Her patient history indicated that she had swollen feet and she had a prescription for antibiotics, prednisone, and hydrocortisone to apply to her feet,” Jane recalls, adding, “The doctor had already left when I tried to enquire. I suspected she was experiencing side effects from tenofovir, so I advised her to come back the following day to be seen by him.”

Pharmacy technicians and other mid-level medical support personnel like Jane are frontline health workers who are working with patients every day in South Africa and other low-resource settings around the globe.

Due to severe shortages of trained frontline health workers, pharmacy technicians are playing a critical role in South Africa’s response to HIV/AIDS and efforts to achieve the UNAIDS 90-90-90 targets of ensuring that 90% of all of people living with HIV know their status, 90% of those diagnosed receive sustained ARV treatment, and 90%of those on treatment maintain durable viral suppression by 2020. This new cadre also supports the goals of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to achieve an AIDS-free generation.

The South African faculty and staff who implement Nelson Mandela Metropolitan University’s Pharmacy Technician Program have been supported in their efforts through a twinning partnership with the St. Louis College of Pharmacy (STLCOP) that was launched in May 2013 by the American International Health Alliance (AIHA) with funding from PEPFAR and CDC in South Africa. This capacity-building partnership is managed through AIHA’s HIV/AIDS Twinning Center Program, which is supported by the U.S. Health Resources and Services Administration (HRSA).

This work to expand access to frontline health workers supported by the US government has been critical beyond the pharmacy technicians directly trained by the program. In July 2016, the partners released The Southern African Pharmacy Technician Training Manual, the first textbook designed specifically for pharmacy technicians in the southern African region. The jointly developed text is the first of its kind and can be used as a learning tool for pharmacy technicians in English-speaking countries throughout southern Africa as part of a university-level course or as part of an on-the-job training program for mid-level pharmacy workers.

Transforming Education through Student Retention and Recruitment

By Julia Bluestone, Jhpiego and Frontline Health Workers Coalition

This blog was originally posted on the Transformative Education for Health Professionals blog From Dialogue to Action.

Now is the time to push even harder for better and more strategic investment in health workforce education. In September, the UN Secretary General’s High-Level Commission on Health Employment and Economic Growth (HEEG Commission) released its report – “Working for Health and Growth: Investing in the Health Workforce” –  which lays out a compelling investment case for the health workforce, including investing in transformative education.

Community health nursing students conduct community outreach visits (Kate Holt/Maternal Child Survival Project, MCSF)

Evidence from the report reveals the economic return on investment in health is 9 to 1. The HEEG Commission was led by French President François Hollande and South African President Jacob Zuma. The Commission was co-convened by the World Health Organization, the International Labour Organization, and the OECD to examine the economic case for investing in the health workforce. One of the 10 recommendations from the report speaks specifically to our aim, “Scale up transformative, high-quality education and lifelong learning so that all health workers have skills that match the health needs of populations and can work to their full potential.”  In light of the staggering estimate that if current trends continue, the world will be short 18 million health workers by 2030 needed to deliver essential health services, now is the time for advocacy for transformative education, and momentum is on our side.

As Chair of the Frontline Health Workers Coalition – an alliance of 36 United States-based public and private organizations working together to urge greater and more strategic U.S. investment in frontline health workers in developing countries as a cost-effective way to save lives and foster a healthier, safer and more prosperous world – this report provides us with valuable advocacy messages. In my work at Jhpiego supporting transformative education approaches in the countries where we work, this report provides evidence that investing in transformative education is a best buy.

Transformative education is often referenced in relation to increased use of technology to reach greater numbers, or new models of health workforce education. I would like to focus on a more subtle but important transformation—rational student selection and recruitment.

In my work at Jhpiego supporting health worker pre-service education programs, we often see student selection and recruitment policies that need transformation. These include student selection criteria that is irrational or unhelpful, such as: assigning students to cadres based not on interest or passion, but only on test scores; limiting students to younger ages, effectively ruling out women who are looking to re-enter or enter the workforce later in life.

Midwifery Students accessing eLearning modules on a tablet (Kate Holt/Maternal Child Survival Project, MCSF)

This HEEG Commission report directly contradicts such criteria, reminding us that “women drive wealth creation through their employment in the health economy. In a sample of 123 countries, women make up 67% of employment in the health and social sectors compared with 41% of total employment.” The HEEG Commission report urges us to “maximize women’s economic participation and foster their empowerment through institutionalizing their leadership, addressing gender biases and inequities in education and the health labour market”. Ensuring rational student selection that reinforces social accountability to communities, is inclusive of age and gender and builds on interest and passion for a chosen profession is a low-tech solution we should embrace.

When it comes to student recruitment, we continue to see opportunities to transform to better include gender and improve retention.  Included in the WHO transformative education guidelines knowledge gaps and research agenda, this question is posed, “Do changes in recruitment practices have an impact on the retention of health workers in underserved poor, isolated or rural zones?”

 In 2011-2012 Jhpiego performed an integrative review of the literature to analyze factors contributing to quality pre-service education and created a conceptual model that shows the links between essential elements of quality pre-service education and desired outcomes. Our literature review found that targeted recruitment of qualified students from rural and low-resource settings appears to be a particularly effective strategy for retaining students in vulnerable communities after graduation.

Misoprostol for postpartum hemorrhage: Empowering health workers to save lives

by Shafia Rashid, Management Sciences for Health.

This blog was originally posted on Rights and Realities, the FCI Program of MSH.

In Senegal, approximately 1,800 women lose their lives every year while giving birth. The major cause of these deaths is uncontrolled bleeding after childbirth, or postpartum hemorrhage (PPH). More than half of Senegalese women live in rural areas and have limited access to well-equipped health facilities that can prevent or treat many of these deaths. Many women give birth, attended by matrones or volunteer birth attendants, in maternity huts. Recognized as essential health care providers by their communities, matrones have some formal training and are now registered with the Ministry of Health (MoH).

To effectively prevent or treat PPH, women need access to uterus-contracting drugs, or uterotonics, such as oxytocin or misoprostol. The recommended uterotonic, injectable oxytocin, requires cold storage and technical skill to administer. Misoprostol is a safe and effective alternative where oxytocin isn’t available or feasible; it doesn’t need refrigeration and is easy to use—particularly important features for use in remote, rural areas.

From 2013 to 2014, the Government of Senegal’s Direction of Reproductive Health and Child Survival, in partnership with USAID and Gynuity Health Projects, examined the use of misoprostol (600 mcg oral) or oxytocin (10 UI) via Uniject® for prevention of PPH at the community level. Matrones were trained to assist with deliveries and administer the designated intervention. According to the study, both misoprostol and oxytocin in Uniject® were equally effective and safe in preventing PPH, and matrones  posted at the health huts were capable of administering the medicine they were assigned.

As a result of the study’s findings, the National Health Commission approved the use of misoprostol for PPH in health huts across the country and granted matrones the authority to dispense medication and attend deliveries. Prior to the release of the study findings, the Ministry of Health did not consider matrones sufficiently qualified to administer life-saving interventions. They were only authorized to intervene in cases of imminent birth; otherwise, they referred women in labor to higher levels of care.

Senegal’s recent commitment to empowering matrones and supporting community-based distribution of misoprostol for PPH prevention was codified in the National Strategic Community Health Plan (Plan National Stratégique de Santé Communautaire, 2014-2018). The government registered misoprostol for PPH prevention and treatment, making misoprostol commercially available in 2013, and included it in the update of the National Essential Medicines List in 2013.

Senegal’s National Health Plan now officially recognizes matrones as a cadre of health provider in the country’s health system and the critical role they play in providing care at the community level. Matrones and other primary level staff from all 14 regions of Senegal participated in a national training so that they can effectively contribute to the roll-out and expansion of the national program for PPH prevention. Ongoing supportive supervision and close monitoring of the program is essential to ensure that matrones have the support they need to provide essential, life-saving care to women in their communities.

Do We Really Need 39 Million More Health Professionals?

By Bruno Benavides, Chemonics

Originally posted on Chemonics’ blog Connections.

Photo courtesy of Chemonics.

During the internship year of my medical training, Peru was affected by a severe El Niño. At that time, millions of people living in the poor peri-urban belt of Lima lacked access to clean water and sanitation services. These factors were a recipe for a massive outbreak of diarrheal diseases in children. The pediatric services in the hospital emergency room where I worked received one child affected by mild to moderate dehydration every three minutes. That year, the Ministry of Health introduced oral rehydration therapy (ORT) in the country, and we learned to use it during the outbreak. Hospital doctors, however, feared that ORT could damage the children’s kidneys, so we had to use it with extreme caution. We measured electrolytes in children’s blood, and used a mathematical formula to determine the maximum amount of ORT we could give them every hour.

Twenty years later, I was working in Dhaka, Bangladesh. One day I was affected by diarrhea and had to go home early. Altaf, the driver, asked me if I was feeling well and I shared with him my condition. He stopped by a pharmacy and purchase a handful of oral rehydration solution (ORS) sachets and meticulously explained to me how to prepare and drink the solution. The explanation was clear, to the point, and technically impeccable. “Altaf, where did you learned this?” I asked. “At home, boss,” he told me. “My mother taught it to me when I was a kid.”

Curious about what Altaf told me, I researched who taught mothers about ORT. I found that it was an effort led in the ‘80s by the International Centre for Diarrheal Disease Research, Bangladesh (ICDDR,B) in collaboration with the Bangladesh Rural Advancement Committee (BRAC), which taught 12 million mothers to prepare and administer ORS at home.

I also remember my first visit to the Mulago Hospital in Kampala. I walked through a valley of death — a dark corridor where people infected with HIV and AIDS were waiting to see a doctor but were actually dying in front of me. That image still haunts me, and I feel tears in my eyes when I remember it. Yet, a couple of days later I was in the field, learning from a new type of health worker that was combating the AIDS epidemic. College graduates without a background in healthcare, who were trained, supervised, and supported by The AIDS Support Organisation (TASO), were in charge of following up with HIV patients at home. They developed the skills to assess the household environment, identify risk factors that could prevent clients from adhering to antiretroviral therapy, provide counseling to strengthen healthy behaviors, and also identify signs and symptoms of complications. Those tasks were previously in the realm of the very few doctors available at TASO. When the number of clients living with HIV increased significantly, TASO was forced to change the model of care and incorporate lay health workers.

From a complicated formula administered by hospital ER staff to a remedy administered by mothers at home, ORT is a dramatic example of the devolution of healthcare to non-professionals. It is likely that a significant factor in BRAC’s decision was the shortage of healthcare workers. In their absence, BRAC had no option but to assign that health care task directly to caregivers at home. Similarly, given the shortage of professional health workers, TASO opted for a similar strategy: re-assigning HIV treatment follow-up tasks to laypeople available in the community.

The point of sharing these anecdotes is that empowering mothers to provide ORS at home allowed Bangladesh to reduce under-five child mortality by 70 percent over a 30-year period without the recommended number of professional health workers. In a sense, BRAC added 12 million people to the health workforce, even if that was only for administering ORS.

I wonder whether we can do even better. So far, we have reacted to the lack of professional human resources for health to implement what is called “task shifting.” We have been forced to do it, and in those instances, we have succeeded. But, how long are we going to continue reacting?

The World Health Organization estimates that we need to add 39 million healthcare workers by the year 2030 in order to achieve the health-related sustainable development goals. But, if we switch to a people-centered health system approach, do we really need that number of health professionals?

Today, UNAIDS recognizes that about 70 percent of tasks for HIV prevention, care, and treatment can be delivered at the household and community levels by non-professional cadres. The evidence suggests that we can develop a proactive approach to redistribute healthcare tasks beyond professional health workers, not because we do not have enough health professionals, but because it is the right way of organizing the health system. The health system should not be limited to the provision of health services provided by professionals. If we continue thinking from a facility-based perspective, it is likely that we will have a hard time obtaining the resources to employ, train, and support all the health professionals we need according to estimates. Yet, through redistributing tasks among professionals, laypeople, and caregivers, we can achieve outstanding health outcomes without necessarily increasing the professional health workforce by 39 million.

At their finger-tips: how mobile technology is motivating Frontline Health Workers in Bihar, India

By: Carolyn Grant and Mariela Rodriguez, CARE

Frontline health workers (FHWs) are often the first and sometimes only link to health services and information for communities and individuals. Many are overworked, unmotivated and lack the essential tools, training and support they need to do their jobs effectively.

This is the case in Bihar, one of India’s poorest and most populous states, where nearly one-third of rural households do not have access to any government-provided health services. What places like Bihar need are innovative solutions for bringing quality health care services to the doorsteps of families. And that is what they are getting.

To address the challenges FHWs face in delivering services in Bihar, CARE India introduced a mobile application to aid them in registering and tracking patients, managing care, and counseling pregnant women and mothers with newborns: the Continuum of Care Service (CCS), a simple and easy to use mobile intervention. FHWs can now input client information into their phone, enabling real-time data collection.  It also includes several modules related to decision support tools, such as counseling aids, clinical protocols, and checklists that help FHWs personalize counseling sessions and positively influence the mothers and children they are reaching. As one FHW from Agwanpur said, “I don’t need to remember everything. It (the mobile) guides me on what to discuss.”

Photo courtesy of CARE.

With mobile phones in hand, FHWs are equipped and empowered to serve their communities as a critical link to health services and information. In addition to enabling efficient, quality service delivery, the FHWs find the mobile phones motivating. Many FHWs see the mobile phone as a status symbol and it has elevated their value and credibility in the communities in which they work. Mothers in the community were also more likely to listen to counsel given by the FHW. One FHW from Nado states, “I feel proud using this with women in my village. It increases my value in their eyes.”

As a result of the intervention, home visits increased from 37% to 88% after just one year. Home visits during critical times of care also improved—at least two visits during the antenatal period increased by 10% and visits within a week of delivery by 13%.

In Bihar, a mobile phone is helping FHWs do their jobs better. Having information at their ‘finger-tips’ is dramatically improving FHW confidence and decision-making abilities.


Health Employment Ministerial Meeting Holds Promise To Advancing on Universal Access to Health Services

By Cecilia Amaral, Frontline Health Workers Coalition secretariat and IntraHealth International

Yesterday was Universal Health Coverage (UHC) Day – the anniversary of the United Nations’ endorsement of UHC – and organizations and advocates around the world made a collective call for a commitment to equitable health systems to ensure that essential health services are accessible and affordable to all.

Investing in health benefits economies – in fact, evidence reveals the economic return on investment in health is 9 to 1. UHC aims to ensure all people have access to quality, essential health services without imposing financial hardship, which hinder the economic benefits of a healthy population. To get there, progress needs to be made in addressing gaps in access to trained and supported health workers, projected to reach a shortage of 18 million by 2030, mostly in low- and lower-middle-income countries, if no action is taken. Addressing this issue means breaking down one of the most acute barriers to achieving UHC and holds the potential to save millions of lives.

Courtesy of IntraHealth International.

A key step in addressing the health workforce barriers to achieving UHC begins tomorrow and Thursday in Geneva (Dec. 14-15). Government and UN officials, health worker associations and unions, civil society, agencies and multilateral organizations, and private sector and other stakeholders will convene at the High-Level Ministerial Meeting on Health Employment and Economic Growth: From Recommendations to Action to agree on a five-year action plan to secure commitments and accountability for accelerated health workforce investments.

The Frontline Health Workers Coalition (FHWC) Director Vince Blaser will be there delivering a statement pledging support to the action plan and committing to continue FHWC’s work advocating for the health workforce agenda within the context of U.S. foreign assistance and with other advocates around the world to push for greater and more strategic investments in the global frontline health workforce.

The meeting will be webcast live. Please join us in watching and tweeting using the hashtags #HealthWorkers, #HealthWorkersCount and #InvestInHealthWorkers.

The Meeting is the latest in a series of steps taken in the last two years to address the global health workforce shortage. Following the unanimous approval of the first ever Global Strategy on Human Resources for Health: Workforce 2030 by WHO member states, the UN Secretary-General’s High-Level Commission on Health Employment and Economic Growth (ComHEEG) launched a report presenting the case for urgent investments in the health workforce that resulted in ten recommendations to attain the direct benefits of these investments in health and inclusive economic growth, paving the way to UHC.

With this solid evidence and the resulting five-year action plan, the FHWC will continue to support the backbone of UHC: the men and women on the frontlines of health that provide the affordable and direct services, especially for underserved populations in hard-to-reach areas, with the ultimate goal to save lives and foster a healthier, safer and more prosperous world.

To Achieve #HealthForAll We Need Health Workers for All

By The Editorial Team, IntraHealth International

This blog was originally posted on Vital, IntraHealth International’s Blog.

Patient at a clinic in Uganda. Photo by Trevor Snapp. Courtesy of IntraHealth International.

Universal health coverage is about the money—the cost of reaching people with health care and the human and economic costs of not reaching them.

But it’s really about people—those who need care and those who provide it.

It’s about the people stuck in the vicious cycle of poverty caused by medical bankruptcy when they can’t afford health care but often are too ill to work. And it’s about the health workers and the support they need to reach everyone with essential health care.

Health care is an investment, one that pays off not only in saving lives and improving the quality of life, but also in building stronger economies. We need strong investments by governments and donors to bring health care to those who continue to be left behind, often the poorest of the poor. And we need to focus on health workers and work with their communities to ensure those investments are specific and effective.

There is no one-size-fits-all solution. At IntraHealth International, we start by working with our private and public health sector partners to engage communities, strengthen primary health care systems, and identify and support health workers to deliver high-quality, essential services.

Sometimes this means expanding the definition or job description of a health worker.  Private sector logisticians are erasing contraceptive stockouts across Senegal. A data guru in South Sudan is revealing where HIV services are most needed. Nurses are stepping up to the plate to manage health teams in rural Zambia. Health workers like these are the heart of health care and a prerequisite for universal health coverage.

Today as we commemorate Universal Health Coverage Day, take a moment to consider the diverse skills and roles required to deliver health care and to encourage those pursuing these essential careers. (Take a moment, too, to sign this petition to make Universal Health Coverage Day an official awareness day on the global calendar every year.)

Then check out these five vital perspectives on what it will take to reach #HealthForAll by 2020.

  1. The Future of Health Financing
    We’re working toward a day when health coverage is universal and our global population has unprecedented options for health care. But how will we afford it?
  2. To Tackle Noncommunicable Diseases, We Must Invest in Frontline Health Workers
    A new policy report explores the challenges we face in addressing NCDs, and offers recommendations to overcome them.
  3. A Safe Bet: Investing in Resilient Health Systems for Everyone 
    Health systems are only as strong as the people who work within them.
  4. Africa Will Be Short 6 Million Health Workers by 2030
    But its countries could still achieve universal health coverage if they take action now.
  5. Nurses Will Take Zambia to Universal Health Coverage 
    Meet the country’s secret weapons.

Female Health Workers for the Prevention of Malaria

By Hawa Camara, Abt Associates

Courtesy of Abt  Associates.

Courtesy of Abt Associates.

Since 2011, the United States President’s Malaria Initiative’s (PMI)  Africa Indoor Residual Spray (AIRS)  Project has protected millions of men, women, and children in Sub-Saharan Africa against malaria by spraying insecticide indoors on walls, ceilings, and other resting places of vector mosquitoes.  The project  ensures safe and hospitable working environments for their employees, who are on the frontline of the fight against the deadly infectious disease. 

The PMI AIRS Project saw an opportunity to promote gender equality and women’s empowerment among its frontline health workforce by employing more women and providing them with an environment that would ensure their safety and availability to needed resources.

The project aimed to protect the safety of workers, especially women, by posting sexual harassment guidelines at each operational site, and providing gender and sexual harassment trainings to key stakeholders. Furthermore, female privacy has been a priority of this initiative: the project provides changing areas, separate washrooms and showers, to name a few, to ensure female health workers’ safety. Spray campaigns do not begin unless operational sites are verified as meeting these and other environmental compliance standards.

Additionally, to accommodate traditional norms that might prevent women from working all day alone with men to whom they are not related, the project instituted a buddy system for female spray operators. If there are female spray operators, there must be at least two women on the team.

The PMI AIRS Project also provided professional growth opportunities to their qualified returning workers. To date, the project has trained more than 21,000 women to support indoor residual spraying (IRS). The project is working with the National Malaria Control Program (NMCP) in each country to recruit and hire more women, ensuring a sustainable approach to gender-integrated IRS after the project ends. The project trained 7% more women to deliver IRS in 2015 compared to 2014.

Focusing on identifying women with potential for supervisory positions, these women receive mentorship and training and many return to work as team leaders or supervisors in the following year. While 25% of supervisors in 2013 were women, 2015 figures show an increase to 46%.

The PMI AIRS Project’s gender-focused initiatives have led to increased hiring of female frontline health workers and a dramatic increase in the number of women in supervisory roles, all while meeting or exceeding the project’s IRS targets.

Loan Program Brings Peace of Mind to Kenya’s Aspiring Frontline Health Workers

By Peter Abwao, IntraHealth International

Asthma remains the most common chronic disease among children and affects 235 million people worldwide. In Africa, myths associated with the condition mean children and adults struggle not only with the health challenges associated with asthma but also from societal stigma. Bringing up an asthmatic child is a challenge for the parents, and very humbling for the child.

It is from her experience growing up as an asthmatic child that Mercy Wangui Kariuki draws her passion for becoming a nurse.

“The tender care and support that I received from nurses and other health workers during those critical moments of my illness made me develop the desire to care,” she said at the launch event for the Afya Elimu Fund, a low-interest student loan program that helps aspiring frontline health workers afford the schooling they need and address Kenya’s health workforce shortage.

“As I grew up, all I wanted was to be a nurse,” Mercy said. “I knew this would give me an opportunity to know how to care for myself and also other patients with similar and other health needs.”

Mercy told this to a crowd of over 300 delegates in Nairobi last month, including United States Ambassador to Kenya Robert Godec, Health Cabinet Secretary Dr. Cleopa Mailu, other government officials, corporate executives, trainers, and fellow students. Kenya’s Cabinet Secretary for Education Dr. Fred Matiangi, representing Deputy President H.E William Ruto, presided over the event.

Mercy Wangui Kariuki speaks at the launch event for the Afya Elimu Fund in Nairobi, Kenya. Courtesy of IntraHealth International.

Mercy Wangui Kariuki speaks at the launch event for the Afya Elimu Fund in Nairobi, Kenya. Courtesy of IntraHealth International.

When Mercy took the stage on behalf of over 9,000 students who have been funded through the Afya Elimu Fund, her mission was to tell the senior government bureaucrats and private-sector functionaries—as clearly and simply as possible—that there is enough passion for health care work among Kenya’s youth to eliminate the country’s shortage of health workers, but that the fees associated with schooling are a major obstacle.

Mercy’s father died when she was only three years old, leaving her and her elder brother under the care of her mother. Her mother brought the two up living off peasant farming on less than one acre of land.

Growing up in the volatile Kuresoi Constituency in the Rift Valley meant that her family was not spared the instability caused by the ethnic clashes of the 1990s and early 2000s. More tragedy came for Mercy’s family when her elder brother died in a freak accident in Kenya’s Indian Ocean just after he had gotten a job with the Kenya Airports Authority.

“I was very depressed because my brother had brought so much hope to me,” Mercy said. “He had assured me that if I got admission to a nursing school, he would pay my fees. At this point I saw my dream literally go up in smoke.” 

But Mercy enrolled at the AIC Kijabe Hospital School of Nursing in February 2014. And like many students from underprivileged backgrounds, she soon discovered that enrolling in college was the easy part.

“The challenge of school fees became a major cause of anxiety, since my mother could only raise a small amount—barely enough to feed the family from farming,” she said. “It reached a point where I felt like hiding every time I saw the principal.

“Then when I was informed of the Afya Elimu Fund, I saw hope. AEF came to my rescue.”

Mercy appealed to those gathered at the event to increase funding for the program, so more students like her could have peace of mind as they prepare to work on the front lines of health care in Kenya.

“This launch gives a lot of hope to thousands of students out there,” she said.

Mercy is enrolled at the AIC Kijabe Hospital School of Nursing in Kenya. Courtesy of IntraeHealth

Mercy is enrolled at the AIC Kijabe Hospital School of Nursing in Kenya. Courtesy of IntraeHealth


The fund plans to raise 1.5 billion Kenyan shillings (KES) by 2018 to train 20,000 health workers and help bridge Kenya’s health workforce shortage, which currently stands at a ratio of 15 health workers per 10,000 people. (The World Health Organization recommends a minimum of 23 doctors, nurses, and midwives per 10,000 people.)

The Afya Elimu Fund has received more than KES 522 million (US$5 million) from various organizations, including the US Agency for International Development, the Ministry of Education through the Higher Education Loans Board, the Ministry of Health, IntraHealth International, the Standard Chartered Bank, the Family Group Foundation, I&M Bank, and the Ratansi Educational Trust.

Students repay the low-interest loans to the Higher Education Loans Board after graduation, which creates a revolving fund to support more students.

“Ladies and gentlemen, this is not just about getting my family out of poverty,” Mercy said. “Saving the lives of the vulnerable in society the way other health workers did for me is a better way to get out of poverty.” 

The Afya Elimu Fund was established by IntraHealth International’s FUNZOKenya project, which is funded by the US Agency for International Development, in partnership with the Higher Education Loans Board and the Kenya Healthcare Federation.

Inclusive data collection on CHWs, all health workers required to meet new global compacts, new analysis finds

By Vince Blaser and Michelle Korte, Frontline Health Workers Coalition secretariat and IntraHealth International

As researchers, practitioners and policymakers gather this week in Vancouver, Canada, for the Fourth Global Symposium on Health Systems Research in Vancouver , momentum for action has never been greater to address the gaps in the global health workforce that prevent universal access to essential health services and stymy inclusive economic growth. In the last 14 months alone, targets on strengthening the health workforce were prioritized in the Sustainable Development Goals, the first ever Global Strategy on Human Resources for Health: Workforce 2030 was unanimously approved by World Health Organization member states, and the report of the UN Secretary-General’s High-Level Commission on Health Employment and Economic Growth presented a robust multisectoral case for urgent investment in the health workforce.

chws_report_2016 To turn the momentum into results, several steps from all levels of policymaking are urgently required –one of the first is a firm commitment to better data on the current state of health workforce, data that is most severely lacking among community health workers.

Today, the Frontline Health Workers Coalition (FHWC) has released a new policy analysis, Prioritizing Community Health Worker Data for Informed Decision-Making, aimed at highlighting this acute need for data on health workers on the frontlines of care. This is not a new topic of analysis for FHWC – in fact this report is a direct follow up to our September 2014 report A Commitment to Community Health Workers: Improving Data for Decision-Making.

The new report aims to capture the urgent need to address prioritization of data for CHWs and all health workers in light of the new compacts reached since our last report was published in 2014. Among our recommendations, are for:

  • Countries to recognize CHWs as a formal cadre in their national health strategies and to clearly define their roles and responsibilities.
  • Countries to adopt the minimum data set for health workers recommended by the WHO to integrate into their health workforce registries, including National Health Workforce Accounts.
  • Countries to increase investments in mHealth technologies.
  • The International Labour Organization to update its 2008 definition of health workers, including CHWs, to include an updated set of core tasks and competencies.
  • Donors and partners to make coordinated investments in strengthening the capacity of countries to collect and analyze standardized and consistent health workforce data.

Discussion of these recommendations will be a crucial piece of a satellite session in Vancouver on Tuesday about the role of non-governmental organizations in ensuring harmonizing CHW programs – an ongoing conversation stemming from the commitment by several NGOs, donor agencies and other stakeholders at the Third Global Forum on Human Resources for Health in Recife, Brazil. We hope you will join us for that discussion and ones to follow.

Put simply, ensuring adequate access to essential health services, ensures global health security, empowers women and youth, and promotes worldwide inclusive economic growth. Investing in health workers, including in workforce data collection and analysis needed to address the most acute gaps in access to trained and supported health workers, is a crucial step along the way to ensuring such access.

You can read the new FHWC policy analysis at Frontlinehealthworkers.org/CHWReport.