For Immediate Release
PHR has created a composite picture of what an effective program might look like in action. It illustrates a wide range of possible interventions; not all plans would use every single approach shown here. Yet most interventions described are already being used successfully in an African country.
Educating African Health Workers
An effective plan to build the health workforce and infrastructure in Africa would spur new construction to expand capacity of African medical, nursing, and other health professional schools, with new classrooms and lab space to accommodate more students. African teachers would be offered an incentive package to help retain them, and if there is one place where international volunteers are particularly useful, it is here, by supplementing national teaching staff until more health workers can be trained and retained. In some countries, work would begin on constructing new schools for health care workers.
Not only would health professionals schools be expanded, renovated, and even constructed. So too would training institutions for paraprofessionals and community health workers. These would be expanded to increase the number of health workers who can be quickly trained and deployed.
Innovations in Health Training Schools
When people graduate from these schools, they would maintain connections through distance-learning (such as the Internet or by receiving CDs in the mail) so that these institutions can support professional development of graduates for years to come. These schools, conscious of the opportunity presented to them to train the future health workforce, would offer scholarships and actively recruits students from rural and other underserved areas (who are far more likely than students from urban areas to return to these areas – 3 to 8 times more likely, according to a study of South African medical students), and would revise their curricula to be more attentive to the health conditions students in these countries are likely to face when they practice, including AIDS, TB, and malaria. Indeed, comprehensive HIV/AIDS management would become a standard part of curricula. The schools would also present students role models of health workers who are serving their communities, as schools endeavor to create a culture of national service, including to poor, rural, and other marginalized populations. No longer would it seem as though students are being trained to practice in the West, as is sometimes now the case.
Human Rights and Advocacy
Students would learn in school about human rights, Including the right to medical treatment, the right to confidentiality, and the right to not to face discrimination. They would be able to advocate for their patients, both on individual and policy levels. They could join large health worker activist groups such as those that already exist in Uganda and Kenya. Students would learn to advocate for their patients on both an individual and policy level.
Lives of the African Health Workers
The initiative would work to transform the lives of health professionals, to fundamentally change the health facilities from places of danger and despair to ones of hope and healing. Health workers would be asked about their needs, both to make their own jobs rewarding — as indeed for many they are not right now — and to provide their patients the best care possible.
Health facilities would have enough gloves and other protective gear so that health professionals could work in a safe environment. Health worker salaries would increase to a living wage. Psychosocial support would be made available to health workers. Special attention would be paid to developing strategies that increase the number of health workers receiving AIDS treatment. These include conducting trainings to reduce stigma among health workers and to increase patient confidentiality for health workers and others, and where needed, developing wellness centers that can attend to a range of health worker needs including HIV services, psychosocial support, and occupational safety. With less stigma, the number of health workers getting tested for HIV and treated would increase, and health worker mortality would diminish – and, as they have in Uganda, health workers could become community leaders in reducing stigma.
Funding and technical support would enable countries to maintain consistent supplies of essential medicines and other key items, and equipment that is in working order. Financial management could be improved so that funds move promptly from the central level to the provincial, district, and sub-district levels, from the treasury to the health facility.
Funds and technical expertise allow supportive supervision to health workers, helping them hone their skills, express their concerns, receive feedback on their work, and know that they have someone to turn to for help. Through internet-connected computers and cell phones, health workers in more remote areas could regularly contact supervisors and experts to get real-time answers to medical questions as well as to express concerns that require prompt attention.
Does It Take a Doctor to Draw Blood?
Clear job descriptions would be developed so health workers were sure of their role. In the process, policies would be reformed to ensure that health workers are using their skills, and minimizing time they spend doing things that health workers with less training could do. For example, six years of medical school (a physician’s training) are not needed to draw blood.
Nurses would be given greater authority, including to prescribe medication. In some countries, new categories (cadres) of health workers would be created. For example, HIV counselors could be trained to free nurses, who might otherwise have done the counseling, to engage in other activities that people with lesser training would be unable to do.
Getting Health Workers to Rural Areas
Special incentives could be provided for health workers to serve in rural areas, which might include housing and transportation loans and grants, and possibly other allowances. Special attention would be given to developing infrastructure in these facilities, including assuring that they have electricity and clean water. Cell phones would be given to staff both to reduce their social isolation, increase their contact with supervisors and other health workers both for medical advice and to ease referrals, and to improve their security.
Community Health Workers
Investments would be made at all levels of the health workforce. Special attention would be given to expanding access to health services, and thus to the needs of rural and other underserved populations. Along with above-mentioned strategies (e.g., rural incentives, recruitment from rural areas), community-level health workers would be supported so that every community has or can easily access a health worker who can be their entree into the health system. In some cases, these community-level health workers would be paraprofessionals with up to two years of training. Elsewhere, they would be community health workers with lesser levels of training — perhaps several months — but fully competent in the tasks that they perform.
The community-level health workers would be trained, paid, given career paths and ongoing training, and closely linked to their supervisors to ensure that their needs were met and that they provided quality care. Many of these health workers would be (and are) women and people living with HIV/AIDS. The work would afford them a job and respect in the community. While some community health workers would engage in a relatively narrow set of activities, such as supporting home-based care, many community health workers, as well as community-based paraprofessionals who have more training, would engage in a range of basic preventative and curative activities. In addition, they would be trained to recognize and fight AIDS stigma, whether it exists in their own ranks or among the communities they serve.
These community-level health workers would be an interface between community and the health system, increasing trust in the health system and increasing access. They would be engaged in key health issues in the community that go beyond the delivery of health services, including teaching people about hygiene and sanitation, helping ensure that they have access to clean water (being community advocates when they do not), and helping prevent, detect and address malnutrition. They would be engaged in HIV prevention education, treatment literacy, and a host of other activities. For patients with health conditions beyond their scope of service, the community-level health workers would refer patients to the next level of care.
Different communities and counties would use these community-level health workers in different ways. One solid model is to initially train community-level workers in a narrow set of activities, and once they become well-versed and comfortable in these activities, to provide further training; in this way gradually increasing the scope of their competency. In another successful model, community members with at least eight years of formal education are trained for two years, with classroom instruction in the morning — which often includes group discussion and role-playing — and field experience working alongside qualified rural health workers in the afternoon.
These community-level health workers can lead to rapid, dramatic improvements in health outcomes, as in Ghana, where community-level paraprofessionals known as Community Health Officers were deployed. In the Birim North district, the community health program which began there in 1999 has almost completely eradicated guinea worm, tripled childhood immunization coverage, improved tuberculosis treatment default rates from 73% in 2001 to 0% at the end of 2004, and significantly reduced maternal and child mortality rates.
What About All the Nurses Already in Africa Without Jobs?
Some countries have unemployed health workers because the government cannot afford to hire them, such as Kenya with approximately 5,000 unemployed nurses. An effort would be made to quickly reach out to and employ these health workers.
Physicians for Human Rights (PHR) is a New York-based advocacy organization that uses science and medicine to prevent mass atrocities and severe human rights violations. Learn more here.