Many global health donors are focused on providing medicines, paying for diagnostic technologies, and building hospitals and clinics in places where few health care resources exist. These items are critical to diagnosis and care, and are relatively easy to measure. Donors like to fund them because they can be counted and named, and their benefits are well-known. The problem is that providing for only these tangible things does not by itself build the kind of global health architecture that can react to changing needs and new diseases.
Global health advocates have long sought funding and support for a range of additional interventions, together known as "health systems strengthening," to better address known and unforseen health threats. A key part of health systems strenghtening is in developing a qualified health workforce that, in the words of IntraHealth International CEO Pape Gaye, is "present, prepared, connected and safe." According to the World Health Organization, there is a huge deficit of healthcare workers, at least one million worldwide. The problem is especially acute in Africa, where just 1.3 percent of the world's healthcare workers live, and are dealing with approximately a quarter of the world's disease burden.
A new initiative launched today, known as the Frontline Health Workers Coalition, is shedding further light on this problem, and on developing support for new investments in the global health workforce, particularly those working at the community level who are the first and often the only link to health care for millions of people. [Public Health Institute where I work is a founding member of the Frontline Health Workers Coalition].
One of the targets of the Coalition's work is the US Government. As the largest donor to global health programs worldwide, the US Government has a special responsibility to help build and sustain a qualified global health workforce. At today's launch, Anita McBride, former First Lady Laura Bush's Chief of Staff, said that creating a global health workforce is in the best interest of the United States from a security and economic point of view. McBride, who is now executive in residence at the Center for Congressional and Presidential Studies (CCPS) at American University’s School of Public Affairs, said that this is an area where the United States should lead, but shouldn't "do it alone." She noted that the private sector, foundations, and other donor governments can and are also playing prominent roles.
From the public health point of view, this makes good sense. Investments in frontline health workers can be especially important in improving prevention efforts. When health workers are well trained, motivated, and connected with referral systems, they can catalyze communities and individuals to be aware of and minimize the effects of challenges like unplanned pregnancies, chronic illnesses, and infectious diseases. Investments in global health workers may not always be as "measurable" as doses of vaccines or bricks built into clinics, but they can help significantly in changing the global health dynamic and sustaining positive change for the future. Investments in global health prevention, including through training and supporting frontline health workers, are a comparatively good value.
Fortunately, there are signs that the Obama Administration and the US Congress are coming to adopt the same view. USAID's Assistant Administrator for Global Health, Dr. Ariel Pablos-Méndez, spoke at today's event about his agency's longterm support for health systems strengthening. He plans, for example, to create a new office within the agency explicity to focus on this issue.
And Ambassador Eric Goosby, who directs the Office of Global AIDS Coordination (OGAC) within the Department of State, wrote a blog today supporting the creation of the Coalition. "As we have moved from an emergency response toward a more sustainable, country-owned approach [to the AIDS epidemic]," he wrote, "we have been strengthening health systems as the foundation to achieving long-term health objectives -- such as the goal Secretary [of State Hillary] Clinton announced in November of an AIDS-free generation." OGAC, which administers the President's Emergency Plan for AIDS Relief (PEPFAR) together with the Fogarty Center at the National Institutes for Health, is investing in education for health workers through two initiatives: the Medical Education Partnership Initiative, and the Nursing Education Partnership Initiative.
As well, the US Department of Health and Human Services, last week released a new Global Health Strategy, one objective of which is to "identify and exchange best practices to strenghten health systems."
But much more is needed. Dr. Peter Ngatia, director of capacity building at AMREF, said today that "I have spoken with a doctor in Ethiopia who tells me that with another pair of hands, he could have saved twice as many lives in his clinic." Those hands could do much more than applaud.