Health workers count: The backbone of global health goals

By Patricia Vermeulen*

Last month, the World Health Worker Week took place. It offered the opportunity to mobilize communities, partners, and policy makers in support of health workers around the world. During this week much effort has been put into raising awareness of the challenges health workers face every day. We all have to recognize the dedication of health workers around the world who give so much of their time, passion and lives to helping others. Therefore, we highlight the importance of health workers in this article, because health workers count!

From our experiences across Africa, we know the difference that health workers can make. For example, the presence of a trained midwife during child-birth can mean the difference between life or death of a mother or child. Over 71% of births were assisted by skilled health workers globally in 2014. In comparison, that is an increase from 59% in 1990. Community health workers (CHWs) have great impact in the daily life and health situation in local communities at grass root level. They include many people in the health system, who otherwise would not be reached. Community health workers are the most affordable and available category of human resources for health in Africa. Another example of health workers who make a great difference are frontline health workers. They work in areas where primary healthcare is most needed. The World Health Worker Week is also a unique opportunity to put the spotlight on gaps that exist in the health workforce by calling on policymakers and influencers to ensure that health workers have the training, supplies and support they need to do their jobs safely and effectively.

Backbone of health systems

Frontline health workers are the backbone of effective health systems. They are directly responsible for providing services in, for example remote and rural areas, or marginalised urban areas. Often working in under resourced areas, they are the primary contact for millions of people in the provision of basic healthcare. Frontline health workers are capable of carrying out many life-saving treatments, for example they provide immunizations and treat common infections. They are on the frontlines of battling deadly diseases like Ebola and HIV. 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. Simply put, without frontline health workers, there would be no health care for millions of families in the developing world.

Economic value

The value of health workers for protecting, promoting and sustaining human health is clear. However, people are often less aware of the economic value they add. Health workers help keeping people healthy. Therefore people can stay at work, so they can contribute to productivity. In many countries around the world, the health sector has created jobs at a faster rate than other sectors over the past 10 years, particularly for women. In turn, this creates more resilient economies and societies that are able to withstand shocks such as outbreaks and natural disasters. In Western Africa, the Ebola outbreak overwhelmed the underpaid, ill-prepared and under-equipped health workers. The World Bank has estimated economic losses of $2.2 billion, including an economic decline of 24% in Sierra Leone.

Shortage of health workers

Although the number of employment in the health sector increases, the World Health Organisation (WHO) projects a shortage of the number of health workers required to achieve the Sustainable Development Goals. A shortage totalling 18 million health workers by 2030 across low and middle income countries. In January WHO’s Executive Board recommended “Workforce 2030”, a global strategy on human resources for health, which will be considered by the World Health Assembly this month. The strategy aims to accelerate progress towards universal health coverage and the Sustainable Development Goals by giving countries policy options to ensure all people can access health workers when and where they need them.

Fighting malaria

Milka Akinyi wakes up nauseous, feverish and too weak to walk to the nearest hospital, which is five kilometres away. She sends for Alice Aoko, the community health worker in her area.

Alice points at the data information board at a health centre. Milka’s symptoms are similar to those of malaria. To confirm or rule this out, Alice performs a test using the Rapid Diagnostic Test Kit. She pricks Milka’s middle finger, draws blood and places it on a strip. The reading is positive for malaria and Alice administers the malarial drug that is recommended.

According to the National Malaria Indicator Survey 2010, malaria is the leading cause of morbidity and mortality in Kenya. To increase effectiveness of malaria control activities in the country, the Ministry of Health, and development partners, like Amref Flying Doctors, came together. Recently, they introduced Community Case Management of Malaria (CCMM) which is being piloted in Nyanza and Western regions of the country. Community health workers are an integral part of Kenya’s health care delivery system, enhancing community access to health care by providing services at household and community levels. The CHWs carrying out this programme are selected by the local administration based on a set criteria and trained by the Ministry of Health in close collaboration with Community-Based Organisations with support from Global Fund for Malaria. They are trained to identify signs and symptoms of malaria and administer a basic malaria test using the Rapid Diagnostic Test kit. Complicated cases are referred to the health centres.

Results

The programme has not been without challenges. Some community members do not trust the community health workers’ ability to accurately test and treat them for malaria, since they view them as their neighbours and friends and not health workers. At the same time, they sometimes face hostility from health workers, for example when they go to collect drugs at the health facilities. Some of the health workers are unhappy about the increased responsibilities given to the community health workers. Global Fund Malaria Project Manager Jared Oule says that community campaigns and dialogue are organised to address misconceptions and to clarify the roles of the CHWs.

So far, 720 community health workers have been trained in community case management of malaria and it is hoped that they will help to reduce the 90,000 cases of malaria experienced annually in Nyanza and Western regions. The programme has already successfully been rolled out in Malindi and Lamu Counties in the Coast Region. According to the Malaria Journal, prompt access to timely and effective treatment was 5.7 times higher when community health workers were the source of care. It is envisaged that Nyanza and Western regions will benefit in a similar manner from the programme.

Already, benefits of the programme are being felt in Sitabicha and Tamulega community units in Western Region. Mrs Philomena Sande, who is in charge of Tamulega Dispensary, supervises community health workers and provides them with the testing kits, medicines and reporting tools. “Since the two community units rolled out home malaria management in June 2013, I have noted that there has been a reduction in the workload at the facility,’’ says Sande. She also adds that more community members are coming to the facility to seek treatment. “With regular supply of test kits, home malaria management will help reduce malaria cases at the community level”, she says. “Looking at malaria trends in Tamulega dispensary, we see that before the rolling out of the Community Case Management of Malaria programme, the malaria cases were high, with nearly 1,000 patients treated. After the introduction of the programme in 2013, the cases reduced to 400 patients. This shows that Community Case Management of Malaria has been a great success in this area.”

This is only one example of the impact that health workers, or in this case community health workers, have on local communities. These projects have an immediate result on the health situations and really make a change. The direct relation between reducing unemployment, greater economic growth, and improved social cohesion and stability are evident. Investing in health sector employment therefore offers the potential for a triple return for economies, for health and for women.

The story of Rose Thomas

Every day, hundreds of trained voluntary community health workers go on their way. This often means walking miles to reach the families that they have to visit. Therefore the community requested for bicycles for the community health workers. Many new bicycles were distributed in the Oloitokitok and Kibwezi districts. One of the trained community health workers who was attending this day was Rose Thomas. She is a volunteer from the Ngomano village in the Kibwezi district in Kenya. “An important part of my job as a volunteer is to make sure that the women and children from my community receive the professional health care they deserve, as well as knowing where they can get this care. For example, I refer pregnant women to the nearest health clinic for examinations and the child-birth,” she says.

Unfortunately, in some cases Rose does not arrive on time. “During one house visit, I discovered that the mother was already in labour. But something was wrong. The mother was panicking and it was too late for her to go to a health clinic. I went to the nearest clinic as fast as I could to get help. Walking. Only just in time, the midwife and I arrived back to help the pregnant woman to give birth to her baby. In this case, a bicycle would have enabled me to bring her to the clinic, or to return with help sooner,” she adds. “Therefore, I want to thank everybody who has contributed to this new bicycles. With my own bicycle I can reach families much quicker and I can save more lives!”

*Patricia Vermeulen is the CEO of Amref Flying Doctors in the Netherlands.

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