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Investing in frontline health workers

The power of frontline health workers to improve global health has been proven time and again. Yet the world continues to underestimate their capabilities and contributions, with severe consequences for them and the communities they serve.

Frontline health workers provide essential services – from administering vaccinations to collecting the data needed to anticipate disease outbreaks – where they are most needed. These workers brave difficult, often dangerous, conditions to reach the one billion people around the world with limited access to health services, whether in remote rural villages or conflict zones. And they are not getting enough support.

The power of frontline health workers to improve global health has been proven time and again. For example, in the early 2000s, Rwanda and Ethiopia recruited and trained thousands of such workers to lead the fight against malaria by educating communities on prevention and detection, distributing tools like bed nets, and administering treatment. As a result, the incidence of malaria fell by 75 per cent in the two countries from 2000 to 2015.

Yet the world continues consistently to underestimate the capabilities and contributions of frontline health workers. This not only undermines their ability to do their jobs effectively; it also puts them at significant risk, with widespread misinformation about vaccines, for example, fueling attacks against those who provide them.

Consider Pakistan, where hardline clerics and militants view polio vaccination programs as Western ploys to sterilise and spy on Muslims. In April, two gunmen attacked a team of health workers, killing one and critically injuring another. Similarly, in Nigeria, the Islamist militant group Boko Haram – which has claimed that the polio vaccine can lead to infertility and bone injuries – is credited with a 2013 attack on vaccination-team members that left nine dead.

Without enough frontline health workers, the world will not be able to fulfill the target of ending malaria, tuberculosis, and neglected tropical diseases by 2030 – part of United Nations Sustainable Development Goal (SDG) 3.

Such conditions are discouraging skilled people from joining the ranks of frontline health workers. The World Health Organization warns that, by 2030, there will be a shortfall of 18 million health workers, with low- and lower-middle-income countries hit especially hard.

Without enough frontline health workers, the world will not be able to fulfill the target of ending malaria, tuberculosis, and neglected tropical diseases by 2030 – part of United Nations Sustainable Development Goal (SDG) 3. The 2018 commitment by 53 leaders of the Commonwealth countries to halve the malaria burden by 2023 will also remain out of reach. In fact, by crippling primary health-care systems, a shortage of frontline health workers could reverse past progress, particularly in poor and marginalised communities.

Fortunately, the international community has started to recognise this. In May, the World Health Assembly concluded with three resolutions: on universal health coverage (focusing on community health workers), primary health care, and next month’s High-Level Meeting on Universal Health Coverage.

Moreover, on the WHA’s sidelines, the WHO co-organised, with the International Pharmaceutical Federation, a meeting to address the health-worker shortfall, producing six key messages to guide such efforts. The first message is to foster collaboration among health-care professional associations, in order to mobilise a multi-sector strategy.

Such cooperation is imperative. But to ensure adequate funding, it must go further. In the past, major donors like France, the United Kingdom, and the United States have played a significant role in driving progress in global health, both directly and through the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

Their work has been supplemented by non-governmental donors, such as the Bill & Melinda Gates Foundation, the Carter Center, and His Highness Sheikh Mohammed bin Zayed, Crown Prince of Abu Dhabi. More recently, the private sector has also been increasing its contributions; for example, some pharmaceutical companies have donated vaccines and medications.

Given the scale of the problem and the frequent scarcity of domestic funding, all stakeholders must ramp up their contributions. To that end, we must make better use of innovative financing mechanisms that mobilise private capital to support the creation of resilient health systems and a strong frontline health workforce.

At the same time, steps should be taken to ensure the most efficient possible use of funding. That means heeding another key message of May’s WHO meeting: “implement what works,” from community engagement to people-centered approaches.

Frontline health workers are crucial to such a strategy. That is why yet another key message is to “ensure decent work”: proper training, fair compensation, adequate support, and personal safety. Experts estimate that every dollar invested in the community health workforce could generate $10 in increased productivity.

The final piece of the puzzle is technology, which can support health workers on the ground. For example, mobile-phone apps can help connect workers to the most remote patients, enabling faster diagnosis and real-time health advice. Moreover, digital technology can facilitate accurate analysis of the data health workers collect, thereby strengthening service delivery and outbreak detection.

Frontline health workers are the unsung heroes of global health. It is time to sing their praises – and implement policies that reflect their value.

Maha Barakat, Board Chair of the RBM Partnership to End Malaria and Research Director at the Imperial College London Diabetes Centre in Abu Dhabi.

Copyright: Project Syndicate, 2019.
www.project-syndicate.org

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