Integration of Frontline Health Workforce Will Determine Success of SDGs, Universal Health Coverage in 2018 and Beyond

By Vince Blaser, Frontline Health Workers Coalition 

As 2018 begins with the clock already ticking on the 2030 Sustainable Development Goals targets – the heroic, sometimes harrowing, and heartwarming stories of six frontline health workers from four continents delivered on a crisp November evening in Dublin reflect both the promise and the tangled reality of the policy planning and program implementation needed to fulfill the promise of unprecedented global consensus on health and development.

What I hope stuck in the minds of thousands of the top global health experts that had gathered in Dublin for the Fourth Global Forum on Human Resources for Health was not the geographic diversity of these health workers’ stories, but rather their diversity of skills.

Maria Valenzuela, a community health worker for Esperança in Phoenix, Arizona, speaks at the “Lives in Their Hands” storytelling night Nov. 13, 2017, co-sponsored by the Frontline Health Workers Coalition, Global Health Workforce Network, Women in Global Health, and the World Health Organization. Photo courtesy Frontline Health Workers Coalition and IntraHealth International.

Intuitive though it may seem, ensuring access to a proper skill mix – represented in part by Mexican- American community health worker Maria Valenzuela, Liberian nurse Miatta Gbanya, Zambian nurse-midwife Marjorie Makukula, South African paramedic Rushaana Gallow, Burmese community doctor Hay Mar Khine, and Irish cardiac physiologist Paul Nolan at the “Lives in Their Hands” storytelling night in Dublin – is a complex yet fundamental equation for global health policy leaders to solve in 2018 and beyond. 

How do you move from policy to implementation to deliver “truly patient-centered” care?

How well this question – posed at a side session in Dublin led by Medtronic Foundation and IntraHealth International – is answered and acted upon will determine the success of SDG3 to “ensure healthy lives and promote well-being for all at all ages” and the success of all disease- and health issue-specific compacts and targets under SDG3’s umbrella.

As borne out in several sessions in Dublin, community health workers (CHWs) are a key part of the answer, as they are already helping to deliver tremendous progress in dozens of countries around the world. At the Medtronic Foundation and IntraHealth session – Hafeez Ladha of the Financing Alliance for Health detailed a new analysis finding that in sub-Saharan Africa, about $1.1 billion is spent annually on community health programs. This spending has helped lead to major improvements on health indicators from HIV/AIDS to maternal and child survival in countries like Ethiopia. And, as Mallika Raghavan of Last Mile Health presented at the same session, CHWs are a central pillar of Liberia and other countries’ plans to ensure their entire populations receive patient-centered care and are protected from threats like Ebola in the years to come.

However, CHWs’ potential is still largely underreported, untapped, disaggregated, and severely underfinanced. The Financing Alliance for Health estimates about $3.1 billion is needed annually to implement sustainable community health programs in sub-Saharan Africa, about $2 billion less than what is being spent now. New efforts – such as USAID and UNICEF’s partnership on community health program integration in 7 low- and middle-income countries and the Bill & Melinda Gates Foundation’s work to improve primary health care (PHC) performance – are aiming to address this gap.

Skill mix, teamwork key to successful community health

For a surge in community and primary health programs to be effective, we must learn from the past. As pointed out by IntraHealth’s Laura Hoemeke during the Medtronic Foundation-IntraHealth session in Dublin, CHW and PHC programs of all shapes and methods have been tried since the Alma Ata Declaration of universal primary health care in 1978 to widely different outcomes.

Critical components of success – as noted in first-ever Global Strategy on Human Resources for Health: Workforce 2030 – is a “collaborative primary care approach built on team-based care” that reflects “a more diverse skills mix …  to harness the potential contribution of all health workers for a more responsive and cost-effective composition of health-care teams.”

Less than 40% of current spending in sub-Saharan Africa is supporting integrated CHW programs, according to the Financing Alliance for Health – underscoring a need for disease-specific programs to more effectively integrate their health workforce strengthening efforts, as well as a need to better integrate CHW programs into national HRH plans. The Frontline Health Workers Coalition in 2013 worked with several donor agencies and partners on a CHW Harmonization Framework to improve integration of CHW programs – an essential ongoing effort our members continue, that must be firmly embedded in the World Health Organization’s (WHO) first-ever guidelines on CHW programs, expected to be finalized in 2018.

As recent reports like Midwives Realities, Midwives Voices and labor disputes such as the doctors’ strike in Kenya remind us – ensuring a resilient health workforce able to deliver universal health coverage (UHC) and meet global health targets requires that we listen and meaningfully include frontline health workers of every cadre in the policymaking and advocacy process. By doing so, we can chip away at any misperceptions and apprehensions between cadres and health workforce delivery models to better answer and act on the question of how to implement truly patient-centered care.

And as new and better health workforce data starts to be collected via the National Health Workforce Accounts, the WHO-ILO-OECD Working for Health data collaborative and other sources, we as advocates in 2018 and beyond must do all we can to ensure the interest, momentum, and enthusiasm to improve access to primary, essential services is harnessed to country-led, sustainably financed approaches that deliver a team of connected frontline health workers with the passion and skills shown on that stage in Dublin to enable their communities to thrive.

Restituta Achieved Her Dream Of Helping Other Women

By Bianka Patsalos-Fox, Touch Foundation

This blog was originally published by Touch Foundation on December 14th, 2017

Restituta Mabilla Limbe is a determined 34-year-old woman who always dreamed of helping women and young girls in her community. Growing up in Sengerema, a rural town in north-west Tanzania, Restituta noticed a pattern of inequality between the women and men in her community. In spite of having four siblings, she was the only child expected to work, because she was the only woman. Her younger brothers were free to do as they pleased, while she and her mother carried all of the family’s responsibilities. To Restituta, women unjustly had more difficult lives since traditional norms required them to work hard day and night.

Working as a dispatcher in Touch’s Mobilizing Maternal Health program, Restituta helps women in labor reach emergency care. Photo courtesy of Touch Foundation

Inspired by the inequality she witnessed as a child, she dreamed of a way to help other women in her community. Her dream had to be put on hold due to her family’s lack of finances at the time she was enrolling in University, a rare accomplishment for Tanzanian women. Restituta was obligated to study Information Technology because it was the only course she could receive funding to complete.

After several years of studying and then working as a graphic designer in another part of the country, Restituta moved back to Sengerema to be closer to her family. One day, she saw an advertisement for an open dispatcher position as part of Touch Foundation’s Mobilizing Maternal Health program. Holding the flier in her hand, Restituta felt certain this position would allow her to realize her dream of helping women.

Today, Restituta is the top dispatcher at Sengerema District Hospital. Her typical day at the referral center, which is open 24/7, involves taking calls and arranging emergency transport via a mobile application for pregnant women and newborns so women can safely deliver at health facilities in the care of skilled providers. She has even earned the position of Team Leader because of her hard work and commitment leading her peer dispatchers. However, this is not Restituta’s only role. She is also the mother of two young boys, a four year old and one year old. With the support of her mother, Restituta is able to leave her children at home and go into work every day to save mothers and newborns.

Restituta’s job is often challenging due to cultural barriers. Traditionally women in Tanzania are accustomed to delivering in their own homes. With nearly half of all Tanzanian women giving birth at home without the care of a skilled healthcare worker, there is a high risk of birth complications. One of Restituta’s greatest challenges is convincing family members that their loved one is in grave danger and needs to be transported to the hospital immediately. Through Touch’s Mobilizing Maternal Health program, Restituta has been a key player in reducing maternal mortality by 27% in her community.

Restituta has achieved her dream of helping women in her community, but her work is far from finished. Her interest in the health field has grown immensely and she hopes to return to school and earn her nursing degree in order to continue helping vulnerable women and young girls.

Optimizing the Role of Community-Based Workers in HIV Service Delivery

Three Questions Answered by René Berger, Director in the Global Health Division, Chemonics

This series was originally published on December 13th, 2017 by Chemonics

René Berger is a Director in the Global Health Division of Chemonics. He has more than 17 years of experience working with USAID and implementing partners as an HIV/AIDS expert. Mr. Berger has been involved with the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) since its inception and brings a strong understanding of the process and expectations of the initiative from both the Washington and field perspective.

 

 

What is the importance of the community-based workforce for delivery of HIV services, and how can this workforce be further leveraged to advance HIV goals?

R.B: Community-based workers play a number of key roles in supporting our effort to achieve epidemic control. Across the entire continuum — from identifying infected individuals, to linking them to treatment, and ensuring that they remain adherent to medications — community-based workers play an essential identification, linking, and motivating role. PEPFAR and USAID have seen the value of community-based workers. They assist in rolling out models of differentiated care. They also help to decongest health-care facilities of patients who do not need to see a clinician or other type of provider. Community-based workers may also lead or support community groups that facilitate the distribution of antiretrovirals. I strongly believe it will be the support that comes from the community that will help us reach the final milestone of viral suppression.

One of the many benefits of community-based workers is they are from the community and, therefore, know the community. They know who has been sick and when they’ve linked them with HIV care and treatment. They know who is receiving treatment for HIV and can help ensure that those individuals continue to take their medication and receive the follow-up care they may require. Ultimately, we may find that these community-based workers are also helping us defeat the stigma around HIV by showing the human side of HIV care.

What work is the Human Resources for Health in 2030 (HRH2030) Program currently doing to support the community-based workforce?

R.B: HRH2030 is supporting a number of activities to assess the community-based workforce for USAID. In Uganda, we are working to build a model to identify the human resource needs around providing differentiated care. Two of the four common models are community-based — these are community-led groups overseeing HIV treatment (mostly refills for medications) and individual pharmacy distribution points based in the community. These too may be overseen by a community-based worker.

In South Africa and Zambia we are also doing assessments of the community-based workforce to identify who they are working with, what services they are providing, where they are providing services, how long it takes to provide the services, and how much they are compensated. The goal of these assessments is to identify efficiencies — for both the services being provided and the compensation that the community-based workers receive.

How can community-based workers impact national efforts to control the HIV epidemic, especially long-term?

R.B: Community-based workers have an important role to play if we are going to achieve the UNAIDS 90-90-90 goals. Whether it’s identifying new patients who require treatment or ensuring that someone who has been receiving antiretrovirals for years continues to take their medication, these community-based personnel will be invaluable. They are really the eyes and ears on the ground and the ones who will be able to best say whether we are achieving the ambitious goals we’ve set out to achieve control of this epidemic.

Why UHC Day is a Call to Action for the World’s Youth

By Arush Lal, Global Health Corps Fellow, IntraHealth International 

It’s no accident that Universal Health Coverage Day — December 12 — falls on the heels of Human Rights Day. Universal health coverage (UHC), the goal of ensuring that all people can access essential health services without exposure to financial hardship, is a dignity and a right not afforded to many around the world.

Today, I remember Gabriel, a Panamanian boy half my age who first taught me how a fractured health system fails people. I met Gabriel in the waning hours of our fourth clinic day, where our team of passionate doctors and volunteers was visibly exhausted after treating hundreds of patients in the remote islands along Panama’s rugged coastline. I vividly recall watching him bear the sweltering heat as he waited to be examined, and felt proud when I saw him leave with a much-needed bottle of Albendazole and a bag of nutritional supplements for his sister back home.

As I instructed the team to wrap up for the day, I suddenly noticed Gabriel running the winding path back to the clinic, stopping in front of me wide-eyed and out of breath. He urgently explained that his disabled grandmother needed medications to control her diabetes, but no health workers reached their part of the island. I asked him if he could bring her to the clinic before we left, but he informed me she was too weak to make the hour-long journey to meet us.

I desperately wanted to help, but we were short-staffed, facing a surge of patients and a setting sun. As the leader of the group, I was faced with an impossible decision: provide the medication without an examination or send the boy home empty-handed. I was forced to choose the latter.

Gabriel is one of 400 million people who lack access to health workers, and that number grows every day. In fact, it’s estimated that the world will face a shortage of 18 million health workers by 2030, meaning a shameful rise in stories like Gabriel’s.

Where someone lives should never determine if they live, but although illness is universal, healthcare isn’t. As a vocal advocate for UHC, I now focus on health workers, because without them, health doesn’t happen.

Where someone lives should never determine if they live, but although illness is universal, healthcare isn’t. As a vocal advocate for UHC, I now focus on health workers, because without them, health doesn’t happen. Frontline health workers are the first and only point of contact for many marginalized populations, often facing unsafe conditions with limited training, equipment, and resources needed to perform their lifesaving duties.

Investing in health workers isn’t just a cost-effective solution (the UN Secretary-General’s Commission on Health Employment and Economic Growth estimates a 9 to 1 return on investment), it’s essential to achieving the Sustainable Development Goals (SDGs) — eliminating poverty, fueling economic growth, reducing gender inequalities, and saving millions from preventable diseases.

In many ways, Gabriel reminded me of myself. Just as I, one of the youngest team leads in VAW, was busy overseeing our clinic operations to ensure rural populations had access to lifesaving care, so was he, a compassionate nine-year-old, spending his day scouting medications for his family rather than, well, being a kid. But where healthcare is scarce, everyone, including our youngest, must step up to the plate.

Arush Lal asks a question during a plenary at the Fourth Global Forum on Human Resources for Health in Dublin, Ireland, Nov. 13–17, 2017.

 

With the support of Global Health Corps and IntraHealth International, I recently attended the Fourth Global Forum on Human Resources for Health, convened by the World Health Organization and several partners in Dublin, as a youth delegate and panelist. Along with 1,000 policymakers and advocates, we discussed possible solutions to the health workforce crisis and the pivotal role young people play.

Youth must be empowered to push for greater accountability, stronger policies, and sounder investments to improve access to frontline health workers and resilient health systems. Without over 3 billion of us at the table, world leaders will continue to struggle achieving their global health targets.

Over half the world’s population is under 30, and young people have woefully untapped potential as crucial advocates and partners in achieving UHC. Youth aren’t just the leaders of tomorrow; they’re leaders today, as young doctors, policymakers, and researchers. Bold, innovative, and visionary, my peers are making noteworthy advances in the way we pursue global public health. Youth must be empowered to push for greater accountability, stronger policies, and sounder investments to improve access to frontline health workers and resilient health systems. Without over three billion of us at the table, world leaders will continue to struggle achieving their global health targets.

Innovative Education

As the next health workforce, young people must be actively involved in planning their future, and we should push for academic programs that cultivate students who are well-versed in the SDGs and UHC. This includes expanding models like the UN Regional Centers of Expertise, one of which I recently helped create in Atlanta, to bring the global goals onto college campuses. Similarly, there is a need to create effective education programs, like an undergraduate degree in global health systems and technology I proposed at Georgia Tech, aligning interdisciplinary curriculum with the goal of achieving UHC.

Taking Action

Young people should work with local governments and NGOs as implementers in the fight for UHC, because youth are effective at reaching vulnerable populations. IntraHealth is a shining example of how to mobilize young people as frontline health workers. Through its CS4FP Plus program, IntraHealth has trained 92 youth ambassadors to lead family planning campaigns, featuring advocates like 16-year-old Nina Kone of Burkina Faso, who pushes for gender equality while de-stigmatizing sexual education, and Abou Diallo, who ensures that young people have access to contraceptives and reproductive health services in Guinea.

A Voice for Change

Few things are more effective than a passionate young person with a platform and a voice to cut through cynicism and question the status quo. Youth can and should advocate globally, ensuring governments commit to the policies they enact.

The Dublin Declaration and an accompanying Youth Call to Action are promising examples of youth engagement in UHC done right. For the first time, “youth” appears as a key stakeholder in the Dublin Declaration — and for good reason too. Youth perspectives are catalytic in achieving the SDGs, and our fluency in social media to push our messages far and wide make us an asset to governments trying to drive change. The first generation faced with climate change and an innately powerful imagination for new technology, we apply innovative solutions to health systems gaps, creating database and information systems, training health workers online, and improving telemedicine.

Young people: Be proactive and vocal advocates for change in achieving UHC, building relationships with diverse stakeholders and holding leaders accountable when they fail to deliver.

Established leaders: Engage youth more meaningfully, as key partners and not as an afterthought or disconnected silos. Mentor us, empower us, give us a platform.

For me, the story of Gabriel regularly reminds me of two truths we simply can’t ignore:

Emboldened youth today are our future — it’s time we start recognizing it.

Our world needs more health workers — it’s time we start showing it.

Champion Women to Address the Health Workforce’s Leaky Pipeline

By Vanessa Kerry, Seed Global Health

Humanitarian emergencies caused by infectious disease, conflict, and natural disasters have caused shock after shock to health systems worldwide. The headlines are still fresh in our minds. Ebola. Zika. The Syrian refugee crisis. The list is hundreds long, unfortunately. And each time a crisis hits, it underscores the same lesson: the only way health systems can effectively withstand shocks and deliver consistent, high-quality care to all members of the community during – and critically after crisis when deaths are actually highest – is to have a strong, highly trained global health workforce.

This week, the community of organizations and leaders focused on health systems came together in Dublin for the Fourth Forum on Human Resources for Health, to advance the landmark recommendations from the Global Strategy on Human Resources for Health: Workforce 2030 and the UN Secretary-General’s High-Level Commission on Health Employment and Economic Growth (ComHEEG). With a shared objective to further define the roadmap required to build the global health workforce, the plan for policy, financing, and action is on the agenda for the future of our health workforce.

Central to these discussions must be recognition of the power and impact of female health workers – and a meaningful effort to champion them. Currently, there is global shortage of at least 14 million health workers, a gap that without concerted action grow to more than 18 million by 2030 unless urgent action is taken. Women make up about 70% of our current global health workforce, and can help effectively and impactfully fill this gap if we make the right investments. We must confront the health workforce’s leaking pipeline and champion, train, and support all health workers, but especially the women.

Women health workers face unique challenges. Women are often disenfranchised during training. And even though the profession is majority female, women have a harder time establishing credibility with peers – especially male peers – and often with their own patients. Female-dominated professions such as nursing are also subordinate in the health hierarchy. But even in these scenarios, women health workers push past the credibility gap, working tirelessly to deliver the best possible care. And they persevere as, for example, is medical intern Lillian Alphonce Mbuni. In Tanzania, where she is based, only one-third of the physicians are reported to be women. Lillian is defying tradition to show that with the right training and support, anyone can be a doctor.     

At Seed Global Health, our vision is a future in which every country has a robust health workforce able to meet the health needs of its population. And that means recognizing the unique barriers women face, and prioritizing education, training and leadership development for all health workers, regardless of gender.

By providing women with opportunities for training, advancement, and leadership, we can transform the landscape of equity in global health. Together, we can ensure the female innovators and leaders who form the backbone of our global health workforce aren’t leaving the field. In fact, ComHEEG reports that investing 2% of GDP in education and health services could increase overall employment by 2.4-6.1%, with women projected to gain 59-70% of new jobs from this investment.

Since Seed Global Health launched, 186 volunteer clinical educators and faculty have been placed in 27 institutions across five countries, teaching more than 13,000 students through nearly 230,000 instruction and service hours. Teaching and training transforms critical thinking – which in turn saves lives. And with the right support, health workers are more likely to stay in the countries rather than leave after they have trained. Our goal is to change the way care is given so people know that they can survive, and thrive.

Capacity-building is not a quick fix, but we believe that the road to the health workforce of our future and to closing the gap in standards of care globally begins with meaningful, long-term investments in teaching, training, and retaining the health workers we have now. On the front lines of health in low-resource settings, these true health champions are essential to community wellness, security, and prosperity for generations to come.

The Humanity Behind Frontline Health Care

By Margarite Nathe, Senior Editor, IntraHealth International

This post originally appeared on Global Health Writes on November 14 2017.

Kicker: The job is difficult, frustrating, risky—and immensely rewarding. The Fourth Global Forum on Human Resources for Health began with six powerful accounts from the front lines of health care.

Please don’t rape me. Please don’t rape me. Please don’t rape me.

This is what was going through Rushaana Gallow’s mind in 2015 when one of the men who had climbed into her ambulance to rob it put his hand inside her shirt. She and another emergency medical technician had been prepping to take on a patient who was having chest pains in one of Cape Town, South Africa’s “red zones”—areas so dangerous that health workers aren’t permitted to enter without a police escort—when they were attacked.

“I’ve been shot at,” Gallow told the audience yesterday during the first day of the Fourth Global Forum on Human Resources for Health. “I’ve been assaulted by patients’ families and friends. I’ve ended up with multiple injuries.”

Sometimes her friends ask why she keeps going back to a job that’s so difficult and dangerous, but her response is unwavering.

“I have a passion for what I do,” she tells them. “I love it.”

Rushaana was one of six frontline health workers from around the world on stage last night during the forum’s storytelling session. Each one told us about the moments from their careers that most terrified, elated, or surprised them—and what keeps them going to work every day despite the challenges.

It was perhaps a surprisingly humanizing end to the first day of a conference that’s drawn over 1,000 health workforce experts and global health specialists from around the world to Dublin, Ireland. Other topics throughout the day included health policy, financing, and data meta-analysis—all important, but unlikely to leave a lump in your throat.

I realized as the frontline health workers were speaking that the acronym “HRH” doesn’t do them justice. They are the human resources for health, the living beings that make any level of expert care possible. But the terminology will never capture what it takes to help a mother deliver her baby on the Liberian roadside by the light of a cell phone. Or to watch helplessly as a cardiac patient dies, despite everything you’ve done to try to help him. Or to hear a client say, “You’ve given me hope.”

Not every day on the front lines of health care is an inspiration, of course. The job is grueling and risky and frustrating. During the best moments, health workers like Gallow take comfort in knowing that they help the people of their communities—whose smiles, tears, and thanks make any other job unimaginable. Other times, though, they feel like they’re struggling to keep the conveyor belt of endless patients moving along, with too few resources to do the job well.

The job is made even more difficult by the worldwide shortage of health workers, which, according the World Health Organization, could reach 18 million by 2030 unless we manage to create 40 million new health sector jobs before then. This is a major barrier to reaching universal health coverage or any of the other aspirations we’ve set for ourselves through the global Sustainable Development Goals.

The hope of solving this challenge is front of mind for many of us here in Dublin this week. In the days ahead, we’ll hear in-depth discussions on what it will take to not only fill the shortage of health workers, but to build the ideal workforce of the future. One that can care for our changing, growing global population. One that’s ready for a rising tide of noncommunicable diseases and unexpected pandemics. One that has the training and resources it needs to provide health care to all 7.6 billion of us.

Health Workers: the backbone of strong health systems

By Chunmei Li, Director, Johnson & Johnson

This story was originally published on the Healthy Newborns Network Blog.

Health workers are heroes.    

Let me tell you about a family I met on my travels. The baby’s name was Michael. His mother, Proshe, was one of the “lucky” ones able to get to a clinic to give birth to her child.

But at the moment of birth, at the split second when the room should have been filled with the sound of Michael’s first cry, the room was silent. After a few attempts, the doctor (who probably experienced this scenario hundreds of times before) issued an order to stop, and left the room.

But Michael was a fighter, and Eva, the midwife who attended his birth, had been trained to deal with birth asphyxia. The doctor left the room, and Eva sprung into action and put her newborn resuscitation skills to work.

The next day, the doctor came back to the hospital and saw Proshe, happy and breastfeeding her baby. Confused, he asked what happened. He was told that Eva had resuscitated the baby, and that both mother and child were healthy and well. A trained health worker had saved this child, sending a family home to celebrate their newest blessing. Without access to skilled care, this family would have otherwise gone home to mourn.

Health workers like Eva work long hours, often in difficult environments, to ensure people in their communities get the care they need. But there aren’t enough of them to meet demand. Globally, 30% of women give birth without a skilled birth attendant. In Africa, that number is higher – almost 50%. This shortfall in health workers, expected to be more than 18 million by 2030 if current trends continue means that universal health coverage in low and middle-income countries will not be reached unless concerted action is taken to strengthen the global health workforce.

The world is at a crossroads when it comes to the health work force – and we have a major opportunity to close the gap. The Global Strategy and Human Resources for Health: Workforce 2030 and the Five-Year Action Plan of the UN Secretary-General’s High-Level Commission on Health Employment and Economic Growth (HEEG Commission) – both unanimously approved since 2015 at the World Health Assembly – provide a path to build the health workforce of the future. Workforce 2030 and the HEEG Commission show the economic benefits of making investments in the health work force, recognizing that the health sector drives well-paying, long-term employment and sustainable development, and is the key driver in achieving health and well-being for all. 

Health workers are truly the backbone of any health system. Proshe experienced this first hand, when a trained frontline health worker made the difference and saved her baby’s life. By implementing the recommendations in Workforce 2030 and HEEG Commission, we can build the health work force of the future, creating jobs and lifelong learning opportunities so that more families can thrive.   

How one Burundian doctor became the only OB/GYN in Sengerema, Tanzania

By Bianka Patsalos-Fox, Touch Foundation

This story was originally published on the Touch Foundation blog on October 20 2017.

Dr. Harusha Simplice is the only obstetrician-gynecologist at Sengerema Designated District Hospital, serving over 700,000 people. After becoming a general practitioner Dr. Harusha secured his specialist training through Touch’s Treat & Train program, which improves medical education and patient care in the Lake Zone.

A Burundian refugee forced to flee to Tanzania as a teenager, Dr. Harusha Simplice always knew he wanted to be a physician. According to his mother, at the ripe age of two he used to comfort his friends and family by reassuring them that one day he would be a doctor. His father also wanted to be a doctor, but he was never able to practice as he died in an accident two months after graduating from medical school. When Dr. Harusha was in his final year of schooling his mother was diagnosed with cervical cancer and died just a year later. It was his mother’s death that cemented his desire to help women and strive to one day become an obstetrician-gynecologist.

After graduating, Dr. Harusha began practicing medicine at Sengerema Designated District Hospital. Five years later, Dr. Harusha, now a father of two boys with another one on the way, decided he needed to find a way to receive specialized training to become an obstetrician-gynecologist and pursue his aspiration of helping women. At this point Dr. Harusha encountered Touch Foundation, just as we were in the process of expanding our Treat & Train program to Sengerema Designated District Hospital. Through Dr. Harusha’s perseverance and partnership with Touch, he was able to receive the education required to specialize in Obstetrics and Gynecology.

Today, Dr. Harusha is the only trained OBGYN at Sengerema Designated District Hospital. This 300-bed hospital serves over 700,000 people and delivers about 25-30 babies per day. For Dr. Harusha, it is not uncommon to attend to multiple women giving birth in the same room with the help of just two nurses. In fact, in Tanzania the shortage of healthcare workers is a main contributor to the high maternal death rate.

In early October, Dr. Harusha completed a training held by our partner MeduProf-S on SonoSite ultrasound machines in order to perform heart disease and obstetric ultrasound screenings during maternity checkups. For all of the clinicians present at the training, this was their first experience with an ultrasound machine. In the United States, women usually receive an initial screening at the beginning of their pregnancies to confirm a viable pregnancy. Most women in the United States will receive numerous ultrasounds throughout a pregnancy, and at least 1 anatomy screening at 20 weeks to ensure healthy development. Most Tanzanian women have never received an ultrasound screening during their pregnancy, but this is changing as women are increasingly requesting them and the technology is becoming more widely available. Dr. Harusha’s training, and others like it, will not only give women access to ultrasounds to ensure the health of their developing babies, but will also screen them for any heart anomalies, which can go undiagnosed until delivery, putting the mother at risk during labor. Following the training, the SonoSite ultrasound machine installed at Sengerema hospital, and three additional machines were installed in other high-risk area health centers.

Dr. Harusha truly believes in the sustainability of the unique education model of Touch’s Treat & Train program. He continues to learn new skills which are valuable for him and also valuable to the medical students he is training and to the women he is attending to. For Dr. Harusha, continuing his education and partnership with Touch empowers him to achieve his goal of saving the lives of women and children.

Advocating for Health Workers: Interview with Vince Blaser

By Daisy Winner, Seed Global Health

This interview was originally published by Seed Global Health on October 18th 2017.

Health workers are the backbone of strong health systems and thriving communities. Yet by 2030, there will the world will face a shortage up 18 million providers – hurting primarily those in low- & middle-income countries. That means mothers will go without necessary care, newborns will go without the assistance often needed to take their first breath of life, and countless patients will forgo the quality nursing and medical care they need and deserve.

Vince Blaser is the Director of the Frontline Health Workers Coalition (FHWC), an alliance of 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. Seed Global Health is a proud member of FHWC, adding a point-of-view that investments in doctors, nurses, an midwives can create a positive ripple effect across entire health systems and nations.

Seed Global Health Director of Communications, Zack Langway, interviewed Mr. Blaser about the role of the FHWC and why it’s mission is more important today than ever before.

Zack Langway (ZL): Thanks for taking time to chat with us, Vince. The Frontline Health Workers Coalition represents a wealth of experience and expertise in improving health around the world. What is the role of the organization in strengthening the global health workforce, and how do you accomplish that?

Vince Blaser (VB): The Frontline Health Workers Coalition harnesses the collective expertise, experiences, and voice of public and private U.S.-based organizations, outside of government, to advocate for greater and more strategic US and global investment in frontline health workers in low- and middle-income countries.

We do this by hosting regular coalition meetings to brainstorm and execute joint advocacy activities, implementing education and advocacy outreach to U.S. and global policy makers and influencers, developing policy analyses and recommendations, and conducting communications activities to highlight the amazing impact of frontline health workers and the political imperative to support them.

ZL: Why is the need for health workers so urgent, and how does training and teaching play a role in meeting that urgent need?

VB: Throughout our lives, health workers are central to our health and prosperity. Yet more than 400 million people lack access to the essential services provided by health workers on the frontlines of care. This lack of access to frontline health workers is a central reason millions of children die before they reach age 5, that hundreds of thousands of women die in childbirth, and millions die of diseases and conditions that could have otherwise been prevented by the presence of a trained and supported health worker. Health workforce shortages not only affect the communities that lack access, it threatens the entire world – as we saw from the spread of Ebola in West Africa.

Central to increasing communities’ access to frontline health workers is ensuring health workers have the training and educational support needed to perform their jobs. This holds true both for the training and education aspiring health workers receive, as well as in-service training and education of existing health workers.

ZL: Where can advocacy make a difference, and how are health workers themselves engaging as advocates for a stronger workforce?

VB: Advocacy can make a difference in every single community, every single country, and in every single region. As a result of advocacy efforts, ensuring a robust, fit-for-purpose health workforce is enshrined as a target in the Sustainable Development Goals, the first-ever Global Strategy on Human Resources for Health: Workforce 2030, and the five-year action plan of the UN Secretary-General’s High-Level Commission on Health Employment and Economic Growth (HEEG Commission).

These advocacy wins will only result in sustainable change if advocates around the world push from the community to global levels of effective implementation of goals and strategies to achieve these ambitious yet achievable targets for the health workforce. Frontline health workers themselves are the most powerful advocates for effective implementation, as their direct experience sheds the greatest light on the need for greater and more effective investment in their work.

ZL: What are the major “moments” on your radar where you’re hoping to see progress — announcements, commitments, data indicating some success in closing the gap — in human resources for health?

VB: The forthcoming Fourth Global Forum on Human Resources for Health in Dublin, Ireland this November will be a seminal moment for health workforce experts around the world to come together to assess the state of the global health workforce and initial progress and planning on some of the goals and compacts I mentioned earlier. We are hoping the five-year action plan of the HEEG Commission I mentioned earlier will result in firm commitments by both government and non-government stakeholders for financing country-led plans to address the most acute issues facing their health workforce.

As FHWC has underscored in a policy analysis, we are also hoping that collection of data for all health worker cadres – including community health workers – is urgently prioritized, especially in forthcoming WHO guidelines on community health workers.

ZL: Where have efforts to bolster the health workforce failed so far, and what can we do differently in the SDGs framework than we did in the MDGs framework to improve outcomes in strengthening health workers?

VB: Ensuring a fit-for-purpose and sustainable health workforce is a complex issue involving education, poverty, labor, mobility, access to proper supplies etc. The financing and jurisdiction over health workers is equally, if not more, complex. This complexity has at times left health workers as somewhat of an afterthought even though policymakers and influencers have often agreed about the urgent need for action to strengthen the global health workforce.

The SDGs and compacts unanimously agreed to at the World Health Assembly provide a strong, country-led framework that put strengthening the health workforce as a central component of achieving progress across all health issues. This provides some momentum and optimism that health workers will no longer be seen as a global health policy afterthought but rather the center of sustainable progress on health in the coming decades.

Orthopedic surgeon recounts dangers, impact of working in war-zones and natural disasters

By Crystal Wells, Roving Communications Officer, International Medical Corps

photo courtesy of International Medical Corps

Dr. Santhosh Kumar was in the operating theater, a patient intubated on the table in front of him, when the earthquake hit. It rattled cupboards and shelves to the ground. People screamed and ran out of the building, but he and the anesthetist held their ground.

“All of a sudden the operating theater was empty,” Dr. Kumar said. “I had an intense urge to run. I looked up and saw my anesthetist standing there, holding the ambu-bag (manual ventilator) in his hand. Of course he had to stay—he was holding  a life on that bag. I was still holding the screw driver.”

Dr. Kumar and the anesthetist finished the surgery, which was for a fracture thigh-bone, as a two-person team as aftershocks jolted the room around them. “We thought of running,” Dr. Kumar said. “We talked about it, but we don’t have a habit of going away from a surgery before we finish it. All through my career I was taught you don’t take your gloves off until you finish the surgery.”

Dr. Kumar was in Nepal as part of International Medical Corps’ emergency response team to the devastating 7.8-magnitude earthquake that devastated the country on April 25. Based in Thiruvananthapuram, a city in southern India, Dr. Kumar deployed to Kathmandu the same day the earthquake hit and was on the ground the very next day, working around the clock to establish International Medical Corps’ search-and-rescue and emergency medical teams in some of the hardest hit areas.

Hundreds of aftershocks followed the main earthquake—including one clocking 7.3 in magnitude. Dr. Kumar was in a Kathmandu hotel with other International Medical Corps colleagues when it hit. This time, he ran outside. “I called the anesthetist to see if he was OK, and he was with his family in an open area outside his house,” Dr. Kumar said. “The fact that we both did not run out of the operating theater is not a heroic act, but rather the product of years of practice to finish the surgeries you start.”

An orthopedic surgeon, Dr. Kumar has responded to conflicts and natural disasters the world over, from Nepal to Haiti, Nigeria, Somalia, and Syria. Dr. Kumar was first introduced to humanitarian work as a medical student in 1993 when he volunteered in the aftermath of an earthquake in Latur district in central India. “I became fascinated with disaster medicine,” he said. “I thought, ‘I would like to do this work if I become a doctor.’”

He first started working with International Medical Corps in 2011 at the height of the civil war in Libya. Over the next six months, he worked in field hospitals, caring for trauma injuries, from Benghazi to Misrata, Tripoli, and Sirte as the frontlines of the conflict moved, work that was made possible with support from the U.S. Agency for International Development’s Office of U.S. Foreign Disaster Assistance.

As he operated on people injured in the war, he trained field hospital staff in orthopedic surgery techniques. He was also part of the first emergency response team to reach Tripoli when the city was under siege. Dr. Kumar and the International Medical Corps team worked around-the-clock to reopen a hospital that had been shuttered by the conflict, restoring care to thousands of Libyans.

“Bullet injuries to the bones are totally different than other orthopedic injuries,” he said. “When a bullet hits a bone, it shatters it into a lot of pieces, which will be really inside the flesh. The bone can’t be reconstructed [from these pieces], so we have to take bones from other places to reconstruct it.”

Other deployments, like to remote corners of South Sudan in 2013, required Dr. Kumar to use old orthopedic surgery techniques because even basic instruments and equipment were not available. Following cyclones, like the ones that hit the Pacific island country of Vanuatu and Orissa, India, in 2013, most of the medical needs are not orthopedic, demanding Dr. Kumar to focus on delivering primary health care services to survivors, rather than providing surgery.  

“In disasters, you need to be extremely flexible and open-minded,” Dr. Kumar said. “You might be an expert in a certain discipline, but survivors should be our primary objective. We need to improvise and mold our knowledge and skills to suit their priorities.”

When at home in Kerala, Dr. Kumar works as assistant professor in orthopedics and deputy superintendent of a 3,000-bed government medical college teaches at a university, a position that he hopes will help inspire the next generation of medical first responders. “Despite what people think, this work is not as dangerous as it sounds. I might be more likely to die in a road traffic accident at home than in a war or disaster—and the impact I can have far outweighs the risks I face in the field.”