World Health Worker Week 2017

World Health Worker Week is an opportunity to mobilize communities, partners, and policy makers in support of health workers in your community and around the world. It is a time to celebrate the amazing work that they do and it is a time to raise awareness to the challenges they face every day. Perhaps most importantly, it is an opportunity to fill in the gaps in the health workforce by calling those in power to ensure that health workers have the training, supplies and support they need to do their jobs effectively.

They are caretakers. They are educators. They are your neighbors, friends, and family. Without them, there would be no health care for millions of families in the developing world.

Frontline health workers are midwives, community health workers, pharmacists, peer counselors, nurses and doctors working at community level as the first point of care for communities. They are the backbone of effective health systems and often come from the very communities they serve.

They are the first and often the only link to health care for millions of people. Frontline health workers provide immunizations and treat common infections. They are on the frontlines of battling deadly diseases diseases like Ebola and HIV/AIDS, and many families rely on them as trusted sources of information for preventing, treating and managing a variety of leading killers including diarrhea, pneumonia, malaria and tuberculosis.

Honor health workers in your community (or communities you work in) by sharing their story. Participate in our ‘#HealthWorkersCount because…’ campaign. Download our template or make your own, but share your reasons using the hashtags #WHWWeek and #HealthWorkersCount. You can also use these hashtags to participate in our WHWW Twitter Chat on April 4 at 1pm EDT.

Organize events, local advocacy campaigns and other activities calling global leaders to prioritize health workforce strengthening.

World Health Worker Week is only seven days, but here is how you can take action and make a difference year round:

Follow us on Twitter and Facebook to get updates of our activities, news and ways to get involved. 

The Global Health Workforce Alliance operates within WHO as a global mechanism for stakeholder consultation, dialogue and coordination on comprehensive and coherent health workforce policies in support of the implementation of the Global Strategy on Human Resources for Health: Workforce 2030 and the recommendations of the High-Level Commission on Health Employment and Economic Growth.

Let your member of Congress know how important frontline health workers are to saving lives and increasing security from global health threats worldwide. Refer to our brief on the Global Health Council’s ‘Global Health Works’ Report for basic facts and recommendations to highlight your message.

Advocacy organizations like the ONE Campaign and RESULTS provide direct actions you can take to raise awareness and urge your policymakers to support US global health efforts. Get involved today and spread the word that #HealthWorkersCount.



All photos in this page are by Trevor Snapp, Clement Tardiffe and Jonathan Torgovnik, courtesy of IntraHealth International, unless otherwise noted. 

World Social Work Day Reinforces Need for a Strong Social Service Workforce to Attain Our Global Goals

by Nicole Brown, Global Social Service Workforce Alliance

Today we mark World Social Work Day to increase attention and political will for greater planning, development and support to the social service workforce. Celebrated the second Tuesday in March annually since 1983, World Social Work Day celebrates the achievements of social workers and other vital cadres of the social service workforce in improving the health and well-being of individuals and communities where they live and work. The social service workforce, comprised of social workers and many other paid and unpaid governmental and non-governmental workers, is often undervalued and doesn’t receive the national and global recognition and support needed to ensure an appropriate number of trained workers are available to meet the needs of their communities.

Sustainable Development Goal 16.2 calls for ending all forms of violence against children. Approximately 1 billion children worldwide have experienced physical, sexual, or psychological violence in the last year alone. This places a huge burden upon the social service workforce. The consequences of physical, psychological, and sexual violence against children can be as high as $7 trillion. In the East Asia and Pacific US, the cost is equivalent to 2 percent of the region’s GDP. Social workers and others in the social service workforce play a vital role in preventing and addressing violence. Collaboration with other allied workforces is necessary to link children to services, including health care, mental health, and psychosocial support, HIV-related services, child protection, legal assistance, and government benefits they may be entitled to.

In 2013, UNICEF launched the #ENDViolence initiative and developed the Ending Violence Against Children: Six Strategies for Action.Community volunteers, para professional workers, child and youth care workers, child protection officers and social workers, among other specialized frontline social service workers, have an important role in implementation of these strategies. They live and work in the community and are first responders in helping vulnerable children and families. During the 34th regular session of the Human Rights Council, the Special Representative of the Secretary General on Violence against Children, Maria Santos Pais, outlined the importance of strengthening multisectoral partnerships and mobilizing significant resources to meet violence-related targets set in the 2030 Agenda. Data has been gathered through national child protection surveys in 14 countries to document the magnitude, nature, and impact of violence against children. The data is intended to inform policy, planning and budgeting.

Yet the social service workforce needs greater planning, development, and support to ensure the right number of workers with appropriate training are positioned to meet the needs of vulnerable populations. In Indonesia, for example, according to The State of the Social Service Workforce 2015 Report the current ratio of 1 social service worker for every 38,551 people is inadequate. To raise the profile of these workers, the Association of Social Workers in Indonesia is launching a campaign to time with World Social Work Day to attract more social work students.

In Cambodia, there are only three higher degree programs for social work students. Limited university-level training has resulted in a lack of recognition and support for the social work profession from communities, NGOs, and the government. Social Services of Cambodia is partnering with other NGOs on a year-long advocacy campaign, launching this month, aimed at increasing public understanding, and appreciation of the social service workforce.

The National Association of Social Workers in the United States is the largest social work association in the world, with 120,000 members. Their month-long advocacy campaign, “Social Workers Stand Up,” demonstrates how social workers stand up for vulnerable groups. The campaign includes proclamations, public service announcements and infographics aimed at promoting national legislation of interest to the profession. Advocacy campaign materials and ideas were shared during a recent webinar hosted by the Alliance.

The Global Social Service Workforce Alliance aims to support this work through bringing together groups and individuals in order to provide a forum for discussion, sharing of promising practices and tools, and exchanging innovative approaches toward advocacy, all with the aim of strengthening the social service workforce. To aid members’ efforts in effectively advocating at the national level, the Alliance is creating an advocacy toolkit. As part of this work, it has developed an infographic aimed at depicting how a strong social service workforce is vital to achieving the Sustainable Development Goals.

When these workers are best positioned to protect the youngest, most vulnerable members of the community, the global community benefits. Let’s support the social service workforce in ensuring that a childhood free of violence is not a dream but rather a reality for all children.

Established in June 2013, the Global Social Service Workforce Alliance currently has 1,200 members across 100 countries. Learn more on how to support efforts to strengthen this important workforce at

Unlikely health workers in Bangladesh: Celebrating female frontline health workers on International Women’s Day

By Rina Rani Paul, CARE Bangladesh, and Mariela Rodriguez, CARE USA

Every year, on International Women’s Day, the global health community takes the opportunity to celebrate the progress made for gender equality and women’s health and rights around the world. To ensure that the lived experiences of women are celebrated on this day, let’s also celebrate the female health workers—the women fighting for gender equality and women’s health and rights on the frontlines.

On this International Women’s Day, CARE celebrates Rohima and Sharmin. Two women from the same remote communities in Bangladesh whose lives intertwined in a unique way.

Rohima lived in a very remote region of Bangladesh that flooded half the year. She had just found out she was pregnant and instead of feeling excitement, she felt anxiety. Two years prior, Rohima had lost her first child at birth and her only attendant during birth was a neighbor with no training or skills. The nearest health facility was and still is 2 hours away, and the only way to get there is by boat.

Sharmin lives in Rohima’s community and is a housewife with basic education. She had watched as women in her community continued to die because they were not receiving the skilled and quality maternal health care they needed.

One day Sharmin received the opportunity that changed her life, the life of her family, and Rohima’s life. Sharmin enrolled in a 6-month program in her community to be trained as a skilled birth attendant. She met the rigorous criteria for this curriculum promoted by the Ministry of Health and the National Nursing Council. Beyond that, she had the willingness to answer the phone in the middle of night for mothers who needed her; she would meet with community members at any time, and helped women deliver their babies safely.

Sharmin. Photo courtesy of CARE.

Across this region of Bangladesh, there are 300 ‘Sharmins’: private, frontline community health providers working in remote areas of the country, each providing 100 health services per month. Training in social entrepreneurship is part of the curriculum Sharmin and women like her receive. These women are not only skilled health workers; they are businesswomen as well. The services they provide are affordable and the prices are set by local government through community consultation. Their services are within the reach of average women, like Rohima.

To address the health service gap for 2.8 million people in 11 sub-districts of this remote district, Sunamganj, CARE, with funding by GlaxoSmithKline, is developing women like Sharmin as skilled frontline health workers training them in primary health services and skilled delivery. These women are filling a gap in the remote areas where otherwise skilled providers would not go, generating demand and providing quality and skilled health care for their communities. 

Rohima with her family and baby. Photo courtesy of CARE.

Since CARE started training these skilled providers, service coverage has increased threefold in two years. More than 60% of the families they serve are poor or ultra-poor. Most women like Sharmin are earning $70 in a month, which makes a significant contribution to their household and their new found income is extremely motivating. Their work is also gratifying and a dignified profession.

On this International Women’s Day, CARE celebrates Sharmin and Rohima. Sharmin delivered Rohima’s baby girl. The story of these women demonstrate how investment in the health workforce in Bangladesh can create long-term improvements in the provision of health services and transform the health and rights of women.

The Female-Dominated Health Sector Needs More Women

By Corinne Mahoney, IntraHealth International

A lot has changed in health care since Peter Abwao grew up in a rural village in Kenya. Back then you couldn’t use a cell phone to beckon a health worker in the middle of the night. There was no website a parent could consult about a child’s symptoms, and electricity in rural health facilities was exceedingly rare.

But much remains the same since that night in 1986 when young Peter ran through darkness to rouse Winifred, the local nurse, to tend to his baby sister. Young boys are still afraid of the dark and growling dogs. Parents everywhere still worry when an infant’s fever will not relent. And health care today, like it was back then, remains largely the domain of women.

Women in Health Care

Winnie Koech a nurse at Tenwek Mission Hostpital in Bomet County, Kenya. Photo by Georgina Goodwin for IntraHealth International.

Women carry the heaviest burden when it comes to family caretaking duties and also make up the vast majority of frontline health workers around the world. In a sample of 123 countries, women made up 67% of employment in the health and social sectors, compared with 41% of employment across all sectors. In the US, 80% of the health workforce and 90% of registered nurses, but only 40% of executives, are women. And we know that community health workers—those most likely to provide primary health care to populations most in need—are mainly women.

Women have made great strides in securing opportunities for education and employment. Health employment provides stable, remunerative careers that women (and men) can pursue while providing care to families and contributing to the physical and economic health of their communities. In fact, our health systems would collapse without women.

So are we doing enough to support them?

It is not surprising that community health workers, many of whom receive limited training and little or no pay, are largely women. And, in most cases, these roles are among the few opportunities available in the health workforce.

For many, it’s a calling. For some, it’s their only opportunity to work outside the home, participate in paid work, or earn the respect of their families and communities. We rely on the women who operate in this capacity to bring services to the most vulnerable.

But are they getting the support they need to provide the best care? Are we integrating their roles into the formal health system and ensuring fair compensation? And are the young girls in their communities able to set their sights on jobs as health workers?

Sadly, the answer is often no.

Obstacles to Health Workforce Development

Thirty-one million girls around the world are not completing their primary education. Another 32 million do not make it through lower secondary school. That’s 63 million girls removed from the potential pool of highly trained health workers.

But for those who are able to continue their studies, the obstacles pile up. Families in many countries are less likely to invest in girls’ education than boys’. Many young women drop out of health training schools because they can’t afford it or they become pregnant or they get married. Societal norms and, in many cases, draconian policies are working against them. And female students and health workers frequently face unbridled sexual harassment and discrimination.

And then there is the pay gap. Women in the health industry are routinely paid less than their male counterparts across many different roles.

High-Level Commission: Health Employment Drives Economic Growth & Gender Equality

Women currently provide the lioness’s share of primary health care services.  But these services still aren’t available to all who need them, and that gap could widen if we don’t do something about it. The World Health Organization projects a shortfall of 18 million health workers that would be needed by 2030 to deliver essential health services to the more than 400 million people worldwide currently without access if we do not act.

Women are key to solving this problem. In fact, the United Nations Secretary-General’s High-Level Commission on Health Employment and Economic Growth (or HEEG Commission) recommends focusing on gender equality and rights as one of its ten leading recommendations to address the shortage and, in turn, strengthen the health workforce needed to achieve the Sustainable Development Goals.

The commission recommends countries and institutions do more to empower women and maximize their economic participation. It calls for more women in meaningful leadership roles in the health sector and for addressing gender biases and inequities in education, the health labor market, and in health reform processes. Investing in women will stoke the global economic engine that health workers have become. Research associated with the HEEG Commission report found a nine to one return on investment in health.

Women like Winifred (who still advises her community in Kenya today) are saving lives every day. On International Women’s Day, policymakers would be wise to focus on the investments and policies needed to enable the next generation of women to transform the health sector—and lives of the people in their communities.

For over 35 years in more than 100 countries, IntraHealth International has partnered with local communities to make sure health workers are present where they’re needed most, ready to do the job, connected to the technology they need, and safe to do their very best work. IntraHealth houses the secretariat of the Frontline Health Workers Coalition, an alliance of public and private United States-based 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.

March 8 marks International Women’s Day. In collaboration with partners, Johnson & Johnson is sharing the stories of women on the front lines of care, and the ways in which inspiring women are improving health for their families and communities. Share your story during the Storytelling Hour on March 7 at 11am EST, by following #WomenInspire on Twitter.

Task Sharing in Tanzania: The Expanded Role of Nurses in HIV/AIDS Care

By Kathryn Utan and Ronald Nakaka, American International Health Alliance

Thanks to Tanzania’s new task sharing policy, enrolled nurses such as Mwanamshamu Jangama (right) and other community- or district-level health or social service personnel have been empowered to provide critical treatment and care to patients with HIV and other conditions in rural, underserved areas throughout the country. Photo Courtesy of American International Health Alliance.

Mkuranga is one of six districts along the coast of the Indian Ocean that form Tanzania’s Pwani Region just south of Dar es Salaam,. About 190,000 people live in the 15 wards and 101 villages that make up the diminutive district.

Despite Mkuranga’s small size, the clinic providing HIV/AIDS-related services at the local district hospital is busy. An average of 40 patients seek treatment there each day, according to Mwanamshamu Jangama, an enrolled nurse who graduated with a certificate in nursing and midwifery from Mkomaindo School of Nursing and Midwifery in 2003.

When Jangama began working at the hospital, her duties focused largely on maternal, neonatal, and child health services. She started working in the HIV/AIDS clinic in 2007.

“It’s a one-stop center for comprehensive HIV services ranging from counseling and testing and provision of antiretroviral therapy (ART) to screening for TB and other opportunistic infections and adherence support,” Ms. Jangama explains.

She admits that due to severe understaffing, she and the other nurses have long had to take on these and other critical duties even though they were beyond their scope of practice as enrolled nurses. Otherwise, patients would not have continued access to the HIV care and treatment services they needed.

In early 2016, Tanzania formalized task sharing through an official policy coupled with a number of interventions to support the reallocation of specific tasks among health workers at varying qualification levels. This policy was enacted to address Tanzania’s severe shortage of human resources for health, particularly in rural areas.

“Task sharing is a systematic process in which specific clinical tasks normally performed solely by health personnel with extensive qualifications are shared with health personnel that have lower qualifications, less specialization, or limited scopes of training,” explains Lena M. Mfalila, Registrar of the Tanzania Nursing and Midwifery Council (TNMC).

“This approach involves the rational redistribution of tasks among health workforce teams, and is one method of strengthening and expanding the health workforce to rapidly increase access to health services,” Mfalila continues, noting that task sharing is helping Tanzania more efficiently use its limited pool of available human resources for health.

Task sharing is a critical mechanism helping Tanzania achieve the UNAIDS 90-90-90 targets of getting 90% of all of people living with HIV aware of their status, 90% of those diagnosed on sustained ARV treatment, and 90% of those on treatment maintaining durable viral suppression by 2020. It also supports the goals of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) to achieve an AIDS-free generation.

Through the Tanzania Nursing Initiative (TNI), the American International Health Alliance (AIHA) has been supporting advocacy efforts to develop a robust and comprehensive task sharing policy in Tanzania since 2011. Now that the policy is operational, AIHA continues to work with the Ministry of Health, TNMC, and national leadership of the country’s nursing and social work cadres to effectively implement the new guidelines within these critical segments of the health and social services workforce.

Stressing that task sharing underscores the expanded role of the nursing and midwifery professions in Tanzania’s health system. Mfalila says that the policy can only be effectively and safely implemented if there is a system that regulates those functions.

With that in mind, AIHA is working with the ministry to roll out revised scopes of practice and implement continuous professional development and supportive supervision and mentorship programs for nurses and social workers.

At the Mkuranga HIV/AIDS Clinic, Jangama says she is confident in her ability to provide quality clinical services for people living with HIV thanks to the in-service training she has received in subjects such as TB, HIV, family planning, and cervical cancer.

“I now perform other tasks crucial for the management of HIV, including viral load monitoring, screening for opportunistic infections, and adherence to ART,” she reports, noting that she provides enhanced counseling for patients with high viral load and prescribes new medication when it’s necessary to change treatment regimens to achieve better patient outcomes.

Jangama underscores the importance of providing support by way of ongoing training, mentorship, and professional development for enrolled nurses and other care providers with expanded roles. She says it’s also critical to address the barriers that make their working environment difficult, andto keep them motivated.

Moving forward, AIHA will support professional development and regulation of healthcare workers as a way to ensure quality of care. Other priorities will be to rapidly address any challenges that emerge during the process of operationalizing the expanded scope of practice for nurses and social workers, as well as to find strategic ways to motivate these frontline health workers for the additional duties they are being asked to take on.

AIHA’s national-level work to strengthen Tanzania’s nursing and social work cadres is supported by the American people with funding from the US President’s Emergency Plan for AIDS Relief (PEPFAR) through the US Centers for Disease Control and Prevention (CDC), Tanzania. Both projects are implemented through AIHA’s HIV/AIDS Twinning Center Program, which is funded through a cooperative agreement with the US Department of Health and Human Services, Health Resources and Services Administration (HRSA).

One Family’s Quiet Quest for Namibia’s HIV-Free Generation

By Margarite Nathe, IntraHealth International

It’s delicate work, talking with clients who’ve stopped taking their HIV medicines, says Loide Iikuyu, a community health worker at Onandjokwe Hospital in remote northern Namibia.

“I talk with them so peacefully,” she says. “You must talk, slowly by slowly, to find out what are the reasons they are defaulting on their medications.”

Part of Loide’s job is to seek out clients who, according to Onandjokwe Hospital’s records, have stopped coming in to collect their HIV meds. And she has to convince them—in her naturally quiet, gentle voice—to start back up, both to stay healthy and to avoid transmitting the virus to others. And she has to do it without chastising them, or making them feel worse than they often already do.

Loide Iikuyu, center, talks with health workers at Shanamutango HIV clinic at Onandjokwe Hospital, Namibia. Photo by Morgana Wingard for IntraHealth International.

Sometimes Loide finds the reason someone has stopped coming in is because they can’t find transportation from their homes to the faraway hospital. Others have died. And some have stopped because taking their antiretroviral drugs on an empty stomach makes them feel sick—this reason has come up a lot this year, she says, as a terrible drought has devastated crops in the north, where HIV rates are particularly high, reaching 22.6% in Onandjokwe district.

Loide sits with her two daughters at Onandjokwe Hospital as she tells us about her work. One of the girls is 18, and also named Loide. The other—little Selma—is 4. Both share their mother’s air of calm and her quiet voice. But only Loide shares her mother’s HIV-positive status.

The elder Loide became a regular at Onandjokwe Hospital long before her paid job as a community health worker began two months ago. Before that, she was a volunteer, and before that, a patient.

Back in 1998, when Loide gave birth to her namesake, she didn’t know that her husband had contracted HIV, or that he had transmitted the virus to her, or that she had unknowingly transmitted it to her newborn daughter. It was years before the World Health Organization offered guidelines for what’s now known as PMTCT, the steps that can prevent mother-to-child HIV transmission.

“I didn’t have the information to prevent it,” Loide says today.

Her husband died shortly after baby Loide was born. “He never went for testing because he didn’t want to know his HIV status,” the elder Loide says. “He was scared to know.”

But once she learned that both she and her daughter were HIV-positive, Loide began seeking care and taking HIV medication regularly. And when Selma was born in 2012, she was born HIV-negative, thanks to PMTCT services at Shanamutango, the HIV clinic at Onandjokwe Hospital.

Today, all three are healthy and smiling.

Loide Iikuyu, right, with her daughters Loide (left) and Selma. When the younger Loide was 10 years old, her mother explained to her how and why she came to be HIV-positive. “I told her it was because of mother-to-child transmission,” the elder Loide says, “and that it was not her fault.” Photo by Morgana Wingard for IntraHealth International.

The year Selma was born was a tough one at Onandjokwe. A staff shortage had left Shanamutango clinic with just one doctor and five nurses to care for over 10,000 clients per month. That’s when IntraHealth International, supported by USAID through PEPFAR, set to work helping the team at Shanamutango redistribute tasks through task sharing, revamp their internal processes, and set up satellite facilities in the surrounding areas to prevent new infections and make HIV care more widely available to the local communities.

Between October 2015 and September 2016, IntraHealth helped train 16 nurses from Onandjokwe district’s 8 primary health care clinics to provide HIV services, including ART management. And now we’ve worked with Onandjokwe district to add 42 much-needed staff members.

The results are shorter wait times, happier health workers, and better-quality care for clients like Loide.

Today Loide counsels clients with the same kindness and insight Meme Nandina—the health worker who first cared for her at Shanamutango many years ago—showed her, and encourages her clients to come for PMTCT services when they need them. New improvements and additional staff at the hospital make this easier than ever for clients, and allow Onandjokwe to offer the kind of outreach Loide conducts.

 “Don’t be afraid.”

When the younger Loide was 10 years old, her mother explained to her how and why she came to be HIV-positive. “I told her it was because of mother-to-child transmission,” the elder Loide says, “and that it was not her fault.”

“She told me to focus on my books and be like other kids who are not positive,” the younger Loide says. “She encouraged me, and said ‘Don’t be afraid.’ To other children who live with HIV, I just want to say you must not be afraid of being HIV-positive, or of being bullied at school. You must have courage.”

Loide watches the delicate work her mother does every day, and sees the people she helps. Someday, young Loide says, she’d like to become a nurse so she can help people, too. She nods and says quietly, “I would very much like that.”

IntraHealth is working with the government of Namibia to increase the number of health workers providing HIV services and provide the support and training they need to reach the country’s goal of an AIDS-free generation. IntraHealth’s USAID HIV Clinical Services Technical Assistance Project in Namibia is funded by the US Agency for International Development through the President’s Emergency Plan for AIDS Response (PEPFAR). Read more about IntraHealth’s work in Namibia.

Malawi Tracks Essential Health Service Delivery Through USAID-Backed Integrated Supportive Supervision System

By Sarah Dominis, Abt Associates

The responsibility of the Malawian Ministry of Health to save and improve the lives of its people relies on data from even the most remote health centers on the quality of services they provide. Thanks in part to the USAID-supported Support for Service Delivery Integration-Systems (SSDI-Systems) project, led by Abt Associates, that data is now flowing in through an integrated electronic system, and service delivery outcomes have already improved in seven Malawian districts.

A key aspect of ensuring quality services is through supportive supervision—regularly visiting health facilities to support the health workers to provide better care. For years, the Ministry’s supervision system relied on multiple visits to facilities by different health programs and focused on inspecting the facility rather than helping frontline health workers solve problems. The system was also paper-based, which led to long delays in providing feedback on performance and little progress in acting upon recommendations.

To address the problems with the system, the Ministry integrated the supportive supervision guidelines from multiple health programs into a single tool.

Dr. Rabson Kachala, Deputy Director of Sector Wide Approach, explaining supportive supervision results to Dr. Owen Chikhwaza of the Balaka District Health Office. Photo courtesy of Abt Associates.

Although the new supportive supervision framework was much improved, the SSDI-Systems project saw that continuing to manage the system using paper-based tools would limit its effectiveness.

Together with the Ministry, SSDI-Systems developed an innovative, smartphone-based tool that was easy for district health officers to use when visiting facilities and gives immediate information on about facility performance to decision-makers.

SSDI-Systems trained nearly 450 Ministry staff in the use of the system, which was rolled-out across the country.

The tool guides the supervisors throughout their visit so that they can support the facility in a holistic way, and uptake has been high. Dr. Owen Chikhwaza of the Balaka District Health Office noted, “Supervision was being conducted by the malaria coordinator, but some important areas were overlooked due to limitations in the paper checklist. We thank SSDI-Systems for introducing the use of smart phone supervision which has revealed the areas which our ordinary checklists were not able to identify.”

The results for each area evaluated are shown immediately to the supervisors in a simple color-coded format so they can provide feedback before leaving the facility. Once the phone is connected to the internet, the results of the supervision visit are uploaded to an online database. An automatic email alert is sent to Ministry-authorized stakeholders.

The Supportive Supervision dashboard, which shows the progress Districts are making in key health areas. Image courtesy of Abt Associates.

In Balaka District, the system has already increased immunization coverage for children under age 1 by strengthening health surveillance supervision in outreach clinics.

Courtesy of Abt Associates.

In several districts, the supportive supervision visits uncovered supplies and equipment that were missing, compromising health services. For example, in Sorgin Health Centre, unsterilized equipment was used on women in labor due to a broken sterilizer, while in Kalemba Community Hospital, the labor and delivery unit did not have a vacuum extractor. Women with obstructed labor (5 out of every 100 in the facility) had to undergo emergency transfers to the district hospital. For both these facilities, once the problem was identified with the help of the supportive supervision tool, the district health management teams were able to purchase the equipment and train frontline health workers in its use.

In another facility, supervisors found that babies were being left, wrapped and without identification, for several hours on tables in the labor ward while waiting for nurses to come and return them to their mothers post cesarean-section. The supervisors helped the hospital develop a system to ensure babies were promptly identified and reunited with their mothers. In follow-up visits, the supervisors found all babies were returned to their mothers within the 60-minute standard. 

The system has also increased the number of supervision visits conducted. In June 2014, before implementation, only 20% of targeted district hospitals had received supervision from the zonal health support offices. By October 2016, after the intervention, 87% of the hospitals and 86% of all targeted facilities had received supervision.

With the integrated supportive supervision tool, the Ministry knows the performance of even the most remote health centers on delivery of essential services needed to save and improve lives. Frontline health workers are now receiving the support they need to improve their performance, and improve health outcomes.

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.