Building the frontline surgical workforce needed to deliver global health progress, drive economic growth

By Sara Anderson, ReSurge International

Photo courtesy of ReSurge International.

In May 2017, two important anniversaries will be noted: the earthquakes in Nepal and the passage of World Health Assembly (WHA) Resolution 68.15, acknowledging the critical role of strengthening emergency and essential surgical care and anesthesia as part of universal health coverage (UHC). While these events may seem unrelated, one illustrates the importance of the other.

The photo above was taken soon after the Nepal earthquakes. It is of the ReSurge Nepal surgical team, the largest reconstructive plastic surgical team in Nepal, with nine of the country’s 16 reconstructive plastic surgeons. With our local partner NGO, they treated more than 800 earthquake victims in the recovery.

ReSurge Nepal was able to immediately care for the injured after the earthquakes because of the investments we made in surgical capacity and health workforce. ReSurge’s investment in training began in the early 1990s, with Dr. Shankar Man Rai, who was a young resident then. With our training and support and Dr. Rai’s leadership, ReSurge Nepal now restores the lives of thousands by providing the reconstructive surgical care needed year-round.

Yet, further investments and health workforce training must be made to counter the extreme shortfall of surgical access in low-income countries, including Nepal. Although thousands are now receiving care in the country, millions are still without access.

According to the Lancet Commission for Global Surgery, as many as 5 billion people do not have access to safe, affordable surgical and anesthesia care, with only 6% of all surgical procedures benefiting the world’s poorest third. Surgical conditions – from trauma, obstetric conditions, and infectious and non-communicable diseases – represent approximately 30% of the global burden of disease.

Contrary to popular belief, surgical care is as cost effective as many other public health initiatives — $82 per disability-adjusted life years (DALY) for general surgery vs. $52 per DALY for BCG vaccine for tuberculosis prevention and $454 per DALY for antiretroviral drugs to treat HIV/AIDS. The World Bank’s Disease Control Priorities (DCP3) states that “essential surgical procedures rank among the most cost-effective of all health interventions.” For every $1 spent on strengthening local surgical capacity, $10 is generated through enhanced health and increased productivity, according to a United Nations’ report.

Access to surgical care is also a critical component of health systems strengthening, UHC and fulfilling the Sustainable Development Goals. Inherent in the framework of a sustainable health system is access to safe surgical care. Non-communicable diseases kill 38 million people around the world every year, and surgical conditions make up a significant proportion of this burden. For example, 60% of all cancers require a surgical intervention.

Moreover, there is a shortage of 1 million surgical, anesthesia and obstetrical specialists in low- and middle- income countries. By 2030, the Lancet Commission estimates that this workforce must double to sustain the maintain status-quo, let alone account for increases needed to address the unmet burden of surgical disease.

This critical shortage of surgical health workforce, coupled with the unmet need of 5 billion people, motivated the world’s health ministers in May 2015 to recognize that strengthening surgical and anesthesia care is essential to universal health coverage; their resolution was unanimously adopted, with strong support of the United States. And just as the WHA recognized that surgical care is essential to a complete health system, the WHA also recognized that such a robust health system depends on a comprehensive global health workforce on the frontlines of care, from community health workers to nurses to surgeons. The UN Secretary General’s High-Level Commission on Health Employment and Economic Growth recently called for investment in a “fit-for-purpose health workforce” to stimulate economic growth, promote gender equality and the strong global workforce necessary to achieve the SDGs.

A relatively small investment in building surgical capacity in Nepal has already made a significant impact. The impact of surgical training is long-term and exponential..

Imagine if the US and countries around the world also invested in a robust global health workforce, as recommended. Could there be a better investment? As Dr. Richard Horton, editor of the Lancet, explained,

“Contrary to a half-century of consensus among economists, investing in health—and specifically health employment—is good, not only for health but also for the economy…. Investing in the health workforce is not a ‘cost disease’ at all. On the contrary, investing in health workers improves the growth rate of economies.”

Note: The G4 Alliance’s Mira Mehes and Lauren Baumann, as well as the research of the Lancet Commission on Global Surgery, contributed to this article.

Every Woman Everywhere Deserves Cervical Health Screening

By Rosinah Dialwa and Bakgaki Ratshaa, Jhpiego

It is long before 8am and nearly 80 women are waiting outside of Donga Health Clinic in Francistown, Botswana, for free, same-day cervical cancer screening and treatment. Nurse Portia Maphalala and her colleagues stand by the door, eager to begin screening women.

“I want to screen as many people as possible and spread the message about cervical cancer prevention,” says Maphalala. “I will encourage women that prevention is so much better than treatment. The earlier they screen, the better.”

Cervical cancer is a disease that while slow-growing, preventable and treatable, kills nearly 750 women across the globe every day. That’s over 260,000 mothers, daughters, sisters and friends who lose their lives each year because of a lack of access to prevention and treatment services.

Eighty-five percent of these deaths happen to women of reproductive age living in low-and middle-income countries. Women who are contributing to their communities and caring for their families.

With a rate of 30.3 new cases per 100,000 women, Botswana’s rate of cervical cancer is nearly twice the worldwide average. This high rate is due in part to the extremely limited availability of screening and treatment programs caused by a shortage of health workers, and in part to the country’s high HIV incidence, which increases the risk of cervical cancer.

Ndiaye, 34, a “see and treat” client at the Donga Health Clinic in Francistown, Botswana. Photo courtesy of Jhpiego/Botswana.

The promising news is that we know what works:

  • Reaching girls with a vaccine to protect them from the human papillomavirus (HPV), the cause of almost all cervical cancer cases;
  • For older women, providing HPV testing and increasing access to same-day screening and treatment; and
  • Developing innovations to improve upon current treatment methods and reduce their cost.

Still, as Jhpiego has learned over 20 years of experience in cervical cancer prevention and control programming in 23 countries, all of the evidence-based interventions and innovations we have at our disposal are useless without frontline health workers to support national programs to reach all eligible women and girls.

This includes health workers like Maphalala and her fellow nurses who, over six days, screened 321 women around Francistown. Of those, 60 women were found to have precancerous lesions, and every one of those women who was eligible for same-day treatment received the necessary cryotherapy, effectively halting the progression of cervical cancer.

Jhpiego and Botswana’s Ministry of Health, with support from the President’s Emergency Program for AIDS Relief, the U.S. Centers for Disease Control and Prevention, Pink Ribbon Red Ribbon, and the tireless efforts of frontline health workers, are working to ensure that women in Botswana receive high-quality cervical cancer prevention and treatment services, all in the same visit.

As we mark Cervical Health Awareness Month this January, we must remember the millions of women in underserved communities who do not have access to well-trained frontline health workers to provide lifesaving care, as well as the impact these shortages have on families. Through partnership and a comprehensive approach that increases the number of frontline health workers in remote, vulnerable areas, we can reach all eligible women and girls and put an end to this silent killer once and for all.

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.