Let’s celebrate nurses and midwives, the superheroes of our health system

By Emily Katarikawe, Jhpiego Uganda

Nurses like Jackline are the backbone of Uganda’s health system and play a critical role in improving health outcomes and the overall cost-effectiveness of care. Photo Courtesy of Jhpiego.

Step into a health center anywhere across Uganda and you’ll likely find a talented team of nurses and midwives, running around in pink and white uniforms delivering babies, providing immunization, treating injuries and helping patients manage illnesses. These health workers are the backbone of our hospitals and clinics, providing essential day-to-day care to keep our communities healthy. These positions are also overwhelmingly filled by women.

More than 80 per cent of nurses and midwives in Uganda are women, many of whom face extraordinary challenges which can prevent them from doing their jobs effectively. Female healthcare workers often have to deal with health facilities that are understaffed, clinics that lack adequate resources, gender inequities and the pressures of balancing additional familial and societal responsibilities.

Jackline K., a midwife working in Isingiro District, is one of these frontline health workers. For many years, her health center didn’t have proper equipment to resuscitate newborns who couldn’t breathe or even running water in the maternity ward.

Despite these challenges, she worked day in and day out serving her community and providing essential care to help mothers and their babies survive. Female health workers, like Jackline, are critical catalysts for countries like Uganda to reach our national health goals as well as the goals that we have agreed upon as an international community.

The Sustainable Development Goals rightly place women and girls at the center and emphasize how empowering women across all segments of the workforce is critical to ending poverty and improving health outcomes. Women today are playing a larger role in both the formal and informal economy and policies must be in place to support and protect them – policies that empower them as leaders and protect their roles and rights in the workplace.

The responsibilities women have, and the huge amounts of work that they do within their families and communities, often go unrecognized and undocumented. Women’s unpaid work – cooking, cleaning and childcare – is valued at $10 trillion annually. For female health workers, that unpaid work falls on shoulders that are already working more than 10 hours a day caring for patients.

Through my work with Jhpiego, an international non-profit health organisation affiliated with Johns Hopkins University, I’ve had the privilege of getting to know many incredible women, like Jackline in Isingiro, who work tirelessly to improve the health and wellbeing of all Ugandans. I’ve met nurses in health centers across the country serving as the only staff available to provide maternal, newborn, child and reproductive health services. I have met midwives who deliver newborns by the sole light from their small cellphones (katorch). These women inspire me every day with their dedication and perseverance.

Jhpiego is committed to supporting female health workers across the world to build sustainable health systems. We partner with ministries of health to ensure the most underserved communities access life-saving commodities and services. We work with the whole spectrum of the health workforce to build competency and confidence, and provide quality health services. We ensure nurses and midwives have the skills and resources needed to save lives in some of the most difficult and remote locations.

At Jackline’s health facility in Isingiro, we worked to help them procure lifesaving equipment, like resuscitation tables and water tanks, and organized skills building sessions for the nurses and midwives on infection prevention and obstetric and newborn care.

To all of the nurses and midwives in Uganda, many of whom are leaders in their workplace: I applaud you. You make critical, life-saving decisions every day. You make unreserved sacrifices, in challenging work environments. You go above and beyond to give newborns and laboring mothers a chance to thrive.

One of my jobs is to ensure that female health workers are empowered and have the skills needed to take on leadership positions within the broader health system. I believe that if we empower frontline health workers, we are empowering women who will be leaders in their workplaces, families and communities. Let us commit to investing in transformative innovations and applying our expertise to improve healthcare services and health outcomes in Uganda. Together, we are making a difference – a difference that wouldn’t be possible without female health workers.

This piece originally appeared in the Daily Monitor and can be accessed here.

Jhpiego Uganda, in partnership with Seed Global Health, Peace Corps and VSO, will be hosting symposium for nurses and midwives later this month, which will seek to update nurses and midwives on the latest national and global RMNCH service delivery approaches and innovations, and spotlight their exceptional contribution to Uganda’s health sector.

Advocacy to Honor Health Workers for the 5th Annual World Health Worker Week

By Vince Blaser, Frontline Health Workers Coalition

As Maria Valenzuela wound down her story, she held up a necklace with the pebbles from all of the low-income communities in Phoenix she serves, telling the spellbound Capitol Hill crowd she has taken those communities and their voices with her to Washington DC.

Maria has been working as a community health worker for more than 20 years, and her story told at a Congressional Briefing on Wednesday illustrated the universality of impact that frontline health workers have, whether it be in her community in Phoenix or those in Latin America and Africa her organization Esperança serves.

From left: Vince Blaser (director, Frontline Health Workers Coalition), Barbara Stilwell (senior director for health workforce solutions, IntraHealth International), Erick Zeballos (deputy director, International Labour Organization, Washington), Michelle Korte (Global Health Corps Fellow, IntraHealth International), Casper Edmonds (senior programme and operations officer, International Labour Organization), and Jean Damascène Butera (chief of party, Guinea, Abt Associates).

Five years ago, members of the Frontline Health Workers Coalition (FHWC), which I’m proud to lead, wanted to dedicate a time every year to honor and celebrate health workers, and the first week of April around World Health Day seemed the perfect fit. We worked with the Global Health Workforce Network and the World Health Organization, and World Health Worker Week was born.

Erick Zeballos (ILO), Barbara Stilwell (IntraHealth) and Vince Blaser (FHWC).

Health workers like Maria deserve our honor, our support, and our advocacy every day. This week is about them and the heroic work they do. But as organizers of this awareness week – we’re often asked who we are and how we contribute.

Last week’s Congressional Briefing is a perfect example of our work in action. With a new Congress and new Administration here in Washington, the onus looms large to inform policymakers of the tremendous impact frontline health workers have in saving millions of lives, ensuring security from infectious disease threats like Ebola, and enabling inclusive economic growth. The briefing – sponsored by FHWC, IntraHealth International, and Abt Associates – and subsequent meetings with key Congressional offices aimed to do just that.

The impact and huge return on investment of frontline health workers is plainly evident to any regular reader of stories from our member organizations in FHWC’s blog. That evidence is crystalizing into global, country-led action to address the most acute health workforce gaps via global Workforce 2030 Strategy, and the developing 5-year Action Plan of the High-Level Commission on Health Workforce and Economic Growth. Jim Campbell of the World Health Organization and Casper Edmonds of the International Labour Organization strongly underscored the momentum and cross-sector work to make it happen at last week’s briefing.

From left: Barbara Stilwell, Pape Gaye (president & CEO, IntraHealth International), Maria Valenzuela (community health worker, Esperança), Jim Campbell (director of health workforce, World Health Organization), Casper Edmonds, Jean Damascène Butera, and Vince Blaser.

The United States has played a decisive leadership role in the tremendous progress we’ve had in global health in the two decades. Damas Butera of Abt Associates and Barbara Stillwell of IntraHealth beautifully illustrated US leadership and investment in action – whether it be battling and recovering from Ebola in Guinea, jump starting a midwifery training program to drive down the world’s worst maternal death ratio in Afghanistan, or empowering faculty at a nursing school in northern Mali, who later defiantly build back their school after it was razed during an extremist insurgency.

For these stories and that success to continue, robust leadership and investment from the United States to catalyze global action is simply a must. The people at the center of that progress – health workers on the frontlines of care like Maria – must also be the center of policymakers agendas. Our recommendations for how the United States can do that utilizing existing investments are here.

As World Health Worker Week passes, the millions of frontline health workers will continue their heroic daily work. If we are to truly honor them, we must continue to tell our policy makers over and over #HealthWorkersCount.

For more on how to engage in World Health Worker Week and beyond, visit https://www.frontlinehealthworkers.org/worldhealthworkerweek/.



Tanzania’s New Task Sharing Policy Puts Social Service Workers on the Frontlines of HIV/AIDS Care

By Ronald Nakaka and Kathryn Utan, American International Health Alliance (AIHA)

Stellah Kihombo provides social support services out of a small municipal office in Chanika ward, which is situated about 13 miles outside of Tanzania’s business capital of Dar es Salaam. The 34-year-old social worker serves her own community, along with eight neighboring villages within the ward. In each village, there is a para social worker — a community volunteer who has been trained to provide basic social welfare services at the household level — working under Stellah’s close supervision and mentorship.

As Tanzania looks to task sharing as a way to improve access to much-needed health and social support services, social service workers like Stellah Kihombo (left) play a crucial role in identifying people in need, providing psycho-social support, and linkages to crucial HIV/AIDS prevention, care, and treatment services for high-risk populations across the country. Courtesy AIHA.

“About five months ago, I received a call from one of the para social workers regarding a 16-year-old girl in need of an urgent intervention,” Stellah recounts. “The young girl exhibited what constituted risky behaviors that put her in danger of not only contracting HIV, but also going on to infect multiple people,” Stellah said, explaining that upon counseling the girl, she learned more about her circumstances.

“The girl was in a highly vulnerable situation because she had been a victim of rape at the delicate age of six. She lived in a poverty stricken, broken family and had experienced prolonged abuse,” Stellah said, noting that the girl was now engaged in commercial sex work and had dropped out of school.

“I provided psycho-social support to the girl, encouraged her to get tested for HIV, and referred her to a nearby health facility where she could receive more comprehensive care, including preventive care and other screening or treatment services,” Stellah explains. “I also linked her to a community-based organization that empowers young women to engage in dignified and sustainable livelihoods through training in tailoring and entrepreneurship,” she says, noting that she continues to work closely with the village parasocial worker to provide support to the young girl.

“She no longer lives as a sex worker,” Stellah reports happily.

In Tanzania, social service workers like Stellah have officially moved to the frontlines of the country’s war against HIV/AIDS thanks to a new task sharing policy launched in 2016.

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 antiretroviral  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.

The American International Health Alliance (AIHA) supported the roll out of a training program for social workers from more than 40 districts with high HIV/AIDS burden across Tanzania. The training helped these critical frontline caregivers develop unique competencies needed to provide client-friendly, stigma-free services to key populations, including female sex workers. It also provided useful strategies for effectively identifying and reaching out to female sex workers and other key populations.

Stellah reports that many barriers exist for at-risk populations looking to access HIV/AIDS services, including stigma and discrimination in the community and unfriendly political environment.

“I continue to educate my community, starting with village leaders, as a way to raise awareness and break down these barriers,” Stellah says. “I attended AIHA’s Comprehensive HIV/AIDS Services for Key Populations training program in February 2016. The training has made me a role model in my community, where I have received many invitations to share my knowledge about HIV/AIDS, gender-based violence, and child protection through various social spaces and platforms, including local churches,” she explains.

AIHA’s national-level work to strengthen Tanzania’s social work and nursing cadres — both critical to Tanzania’s task sharing strategy — is supported by the American people with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. 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 U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA).

From “Non” to “Oui”: How Community Health Workers are Revolutionizing Contraceptive Access, Use in Benin

By Tishina Okegbe, FHI360 and Nancy Pendarvis Harris, JSI

Benin  — a beautiful, small, Francophone West African country with 11 million inhabitants – has a history of low family planning use due in part to conservative cultural and social norms. With a current unmet need for family planning of 36.3%, and a contraceptive prevalence rate (CPR) for modern methods of 16.1%, Benin lags behind its sub-Saharan African peers in key reproductive health indicators.

Sources: Track20, Avenir Health (analysis); 2011 Benin Demographic and Health Survey

Usually, a combination of factors prevents women from seeking family planning services. Many women are geographically distant from traditional health facilities and providers. Many are unaware or misinformed of the benefits of contraceptives. Deeply ingrained cultural norms may prohibit them from seeking contraceptive services.

At the 2013 International Family Planning Conference in Addis Ababa, the Government of Benin pledged to increase its modern-method CPR from 7.9% in 2012 to 20% by 2018. In 2016, the Ministry of Health and the USAID-supported Advancing Partners & Communities (APC) project piloted a community-based access to injectables program in a rural municipality of approximately 80,000 people. Over the nine-month implementation of the program, 24 community health workers (CHWs) were trained to deliver Noristerat, a two-month, progestin-only injectable contraceptive. In a short period of time, more than 450 women received services and adopted Noristerat.

The pilot’s strategy reduced the burden on already overstretched higher-level service providers at health facilities, and leveraged CHWs by training them to provide information and contraceptives to women in communities where sexual and reproductive health services are hard to access, if they exist at all. CHWs can meet women in their homes to provide accurate information, counseling, and contraceptives. This intimate service provision allows women and men to decide for themselves, perhaps for the first time, the number, timing, and spacing of their children.

Relais communaitaire practicing a Sayana Press injection during training. Courtesy of JSI.

Today, Benin is preparing to introduce Sayana® Press, a new contraceptive delivery system that will expand the available method mix. Manufactured by Pfizer, Sayana Press has the potential to revolutionize community-based family planning. A small, prefilled, three-month progestin-only injectable contraceptive, Sayana Press is easy to use by lay health workers and, if properly trained to self-inject, by clients themselves. In collaboration with the Benin Ministry of Health and partners UNFPA, the Beninese Association for Family Planning, the URC-implemented Advancing Newborn, Child and Reproductive Health project, and PSI affiliate ABMS (Association Beninoise pour le Marketing Social), the APC project will train 1,000 relais communautaires, who are the lowest level cadre of CHW in Benin, to deliver Sayana® Press in communities in 10 health zones, covering nearly a third of the country. This high-impact practice is expected to increase access to and use of family planning, thus contributing to Benin’s goal of increased contraceptive prevalence.

Are these advances significant? Absolutely. Nearly 225 million women around the world lack access to modern methods of contraception to delay or avoid pregnancy. Furthermore, complications during pregnancy and childbirth, as well as unsafe abortions, contribute to approximately 300,000 maternal deaths each year. Easily accessible contraception is critical to stem the tide of unintended pregnancies, which contribute to poor maternal, newborn, and child health outcomes. And providing contraceptive and other services in communities gives women, youth, and couples an important chance to meet their reproductive needs.

To learn more about CBA2I in Benin or the APC project, please visit https://www.advancingpartners.org/.


Strengthening the global health workforce

By: Hunter Isgrig, FHI 360

This blog was originally posted on FHI 360’s blog, Degrees.

The World Health Organization estimates that the current shortage of global health care workers is 7.2 million. Without intervention, this number will soar to 18 million by 2030. Rachel Deussom, an FHI 360 expert on the health workforce and Senior Technical Officer, Human Resources for Health, Health Systems Strengthening, hosted a conversation with other FHI 360 colleagues to examine the shortage, its underlying causes and potential solutions.

She opened the conversation with a personal experience she had while visiting an FHI 360 health project in rural Sierra Leone. When health workers saw that she was pregnant, several said they hoped that her child would study hard, become a doctor and return to Sierra Leone to save lives. Clearly, those on the front lines recognize the struggle to develop a well-trained, well-distributed health workforce.

How do we respond to this growing crisis? Dr. Nadra Franklin, Director of Social and Economic Development, and Dr. Otto Chabikuli, Director of Global Health, Population and Nutrition, discussed the need for an integrated approach to solutions that will achieve health for all. One component of this approach is to address the root causes of the worker shortage, pinpointing where the jobs are now, where the jobs will be in the future, and the education and skills that are supplied by training institutes. Identifying and understanding the gaps between the education and training health workers currently receive and the skills that are in demand will help address this shortage.

Another component is examining all jobs along the workforce “value chain” — not just doctors and nurses providing direct services, but all workers performing jobs within a health care system. It is also important to acknowledge how technology has changed the way people work and the nature of the skills that employers seek. In addition, we must address local market forces — the distribution of health workers among rural and urban areas and among public and private sectors. Policymakers may need to step in and equalize the incentives in health care so that workers are attracted to underserved areas. Through an integrated approach, we can ensure that we are addressing the health worker shortage of today and planning for the demands of tomorrow.

Groups like the Frontline Health Workers Coalition, of which FHI 360 is a member, have taken advocacy roles with U.S. policymakers to encourage prioritization of and investment in the global health workforce. Placing a high value on trained health workers will not only address the immediate needs of the communities they serve, but it will also contribute to global health security. World Health Workers Week (#WHWWeek) is a prime opportunity to intensify our support of health workers and the need for more integrated solutions to address the crisis of the health worker shortage. We must show that health workers count (#HealthWorkersCount) because, without them, millions of children and families around the world will never have access to proper health care.

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.

Download our World Health Worker Week Toolkit for Engagement for more ideas!

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 Network 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 socialserviceworkforce.org.

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).