Improving access to health workers for mothers and children

The shortage of health workers remains a major barrier to improving maternal, newborn and child health. In addition, many countries find that existing health workers lack the right skills and motivation and are not working in the communities where the need is greatest.

These challenges are well known and documented. There’s also a growing body of evidence about different approaches employed by countries to strengthen their health workforces, particularly task-sharing and training community health workers.

Acting on what we know

Political will to address the health worker crisis is high: most countries with shortages have committed to tackle the issue and developed human resource plans. Further action is now needed to put commitments and policies into practice.

Save the Children was invited by Norad, Equinet, World Health Organisation (WHO) and other partners to co-organise a consultation in Nairobi focused on building on what we already know about improving access to health workers at the frontline for better maternal and child survival.

The meeting brought together stakeholders from ten African ministries of health; UN agencies; civil society; faith-based organisations; academic institutions; health professional organisations and regional organisations.

Saving lives on the frontline

‘Frontline’ health workers are a person’s first point of access with the health system. In many places with high maternal and child mortality, this first point of contact is not with a doctor or nurse, but a volunteer recruited from the community.

These non-professional health workers, collectively referred to as ‘community health workers’ (CHWs), were once seen as a temporary fix to the health worker shortage because they are quicker (and less expensive) to train than other cadres of health workers.

CHWs have been shown to be effective in providing a wide range of interventions, including prescribing antibiotics for childhood pneumonia, as well as mobilising communities to better understand their rights and responsibilities.

Despite taking on increasing responsibilities, CHWs are rarely paid a living wage or recognised and respected by professional health workers. The Nairobi consultation argued that more attention should now be placed on supporting CHWs to maximise their impact and integrating them into the formal health system.

Taking forward recommended actions

The consultation produced a set of recommendations particularly targeted at African governments, development partners and regional mechanisms.

These included increasing sustainable financing for health, improving evidence about the impact of different health worker cadres, strengthening mutual accountability mechanisms, and standardising training curricula and data collection across countries.

It was agreed that strategies to attract and retain more health workers should include appropriate remuneration for all health workers as well as improved training, support and career progression opportunities.

Policies on CHWs need to be developed or updated to clarify their functions, how their work will be regulated and supervised, and how CHWs can work most effectively with a wider team of health workers.

All delegates were charged with sharing the recommendations of the meeting with national governments and incorporating them into regional and global processes such as Every Woman, Every Child. It’s hoped that they will next be discussed at the African Ministers of Health and Finance conference taking place in July and the International AIDS Conference later thi month.