How can we support health workers? Invest in them.

Four years ago, the Clinton Health Access Initiative, Inc. (CHAI) commemorated World Health Worker week by thanking health workers for their service to the public. In particular, we celebrated those in Liberia addressing a new surge in cases two years into the Ebola virus epidemic. This year during World Health Worker week, as the global coronavirus pandemic continues to escalate, we once again pause to thank health workers worldwide for their selfless service.

Health workers are showing up to increasingly stretched and perilous work environments with decreasing certainty of adequate funding, infrastructure or even protective equipment to swab, examine, or care for the hundreds of thousands of patients suffering from COVID-19 worldwide.

From specialist doctors providing telemedicine consultations without hope of compensation, to nurses re-using masks, to laboratory technicians working extraordinary hours, to retired health professionals volunteering their time, health professions students contributing to screening and triage efforts, and community health workers performing invaluable education, screening and contact tracing, health workers of all stripes are rising to the momentous challenge of COVID-19 with courage and heartening conviction.

We at CHAI extend our heartfelt gratitude to health workers worldwide for their resolution to overcome difficult circumstances and provide essential care to patients who need it.

Yet, the functioning of health systems, the control of epidemics, and the provision of quality care, should never hinge on health worker’s proven willingness to shoulder great risk and personal sacrifice.

Therefore, we also take this week to reflect on what we as individuals, we as CHAI, and the wider circles of global health and governance can do to make the work of providing healthcare less personally burdensome and less dangerous for practitioners.

While reflecting on the 2014-2016 Ebola epidemic in a recent article in TIME, Ellen Johnson Sirleaf, former President of Liberia and World Health Organization (WHO) Goodwill Ambassador for Health Workforce, and Dr. Raj Panjabi, CEO of Last Mile Health, wrote, “A nurse without a mask is like a soldier without a helmet.” They noted that, due to inadequate personal protective equipment (PPE), Ebola killed nearly 1 in 10 of Liberia’s healthcare workers. Already, in Lombardy, Italy, a global epicenter of the coronavirus outbreak, 12 percent of health workers have been infected compared to 1 percent of the general population.

Scaling up the distribution of protective gear ultimately reduced the rate of Ebola infections among health workers. Unfortunately, this strategy is jeopardized in the fight against COVID-19 as individuals, networks of facilities, and wealthy nations stockpile PPE and exacerbate global shortages.

In addition to practicing social distancing and conscientious handwashing with soap and water, not hoarding PPE is one thing all of us as individuals can do to support health workers during the pandemic response.

To acutely address the COVID-19 pandemic, we call on our partners, governments, and public health organizations to take the following actionable steps to protect and support health workers by:

  1. Engaging the private and defense sectors to accelerate global production of PPE
  2. Avoiding stockpiling and facilitating the distribution of PPE to health workers responsive to need both within systems and across borders
  3. Confronting opportunistic hyper-inflation of prices for PPE and medical equipment by producers and logistics service providers
  4. Alleviating strain on understaffed health systems through well-considered task-shifting and the responsible engagement of additional cadres of health workers, military personnel, and/or volunteers
  5. Ensuring that all health workers are trained to safely and effectively care for patients
  6. Whenever possible, compensating health workers engaged in the response fairly for their time, including community-based health workers called upon for surveillance and contact-tracing
  7. Prioritizing health workers during vaccine roll-out

We must also not forget about the otherwise routine health services that are at risk when health systems are overburdened, especially in times of pandemic.

Mothers will deliver babies, children will need to be immunized against preventable illnesses, patients with HIV, TB, and malaria will need access to lifesaving therapeutics, and injuries will necessitate safe, hygienic surgeries. The need for high-quality healthcare long predates and will long outlive COVID-19.

The best thing we can do now, to both prevent future pandemics and ensure that healthcare is delivered as a human right worldwide, is to continue making thoughtful investments in strengthening health systems, even while coronavirus threatens to engulf our collective attention. President Sirleaf and Dr. Panjabi highlight this as one of the five key lessons from the Liberian government’s experience in the Ebola epidemic as well: “Liberia,” they recall, “began to plan for Post-Ebola Recovery during the crisis.”

CHAI will continue to support our partner governments in long-term planning and resource-mobilization for health systems strengthening, including efforts to develop their domestic health workforce. Whether this involves co-designing a comprehensive program to scale domestic training capacity for health workers in Rwanda, strengthening training pipelines for pediatric specialists in Zambia, or supporting strategic planning for a nationally integrated community health worker program in Zimbabwe, we support governments to train, deploy, and retain health workers at all levels of health systems.

CHAI is also convening governments, funding partners, and implementation experts to develop a global investment case for health workforce development. This case will aid governments in mobilizing new and existing resources toward developing their health workforces in a strategic, long-term effort to build strong health systems.

A similar investment case specific to community health workers produced in 2015 by a coalition of national political leaders, academics, NGO implementers, and United Nations (UN) representatives estimated that investment in community health worker programs yielded a 10:1 economic return. Incidentally, the same investment case found that an additional 734,000 community health workers worldwide would reduce the economic damage of a severe global pandemic by $37 billion. Building off this and other research, CHAI is working to make the case for investment across a broader range of health worker cadres that staff health systems worldwide.

Global demand for informed investment in health workforce has never been greater.

As more countries push to achieve universal health coverage, the need for appropriately trained and adequately resourced health workers is widely acknowledged as one of the biggest constraints to achieving this goal.

The WHO projects a shortfall of 18 million health workers by 2030, which is expected to be most severe in low- and lower-middle income countries. Shortfalls in domestic health workforce not only jeopardize the availability and quality of care patients can access, but also increase the workplace strain and hazards health workers are likely to face. From unjust compensation to unsafe, stressful, or even traumatic working conditions, health worker shortages create and exacerbate all manner of hardships that we should not rely on health workers to bear.

We thank the doctors, nurses, midwives, physicians’ assistants, clinical officers, laboratory technicians, home health aides, community health workers, and all cadres of health workers who care for others through both daily difficulties and times of extraordinary crisis.

To governments, funders, NGOs, and global agenda-setting organizations, let’s consider what we can do to be allies to our health workers on the frontlines today, how we can rise to meet the expected shortfall in health workers globally, and how we can emerge from this crisis with stronger, more resilient health systems.