The key element of any health system is the people who run it. Nowhere is this more true than in countries in the midst of, or recovering from, conflict. Indirect or direct threats faced by health workers exacerbate a population’s challenges in seeking and receiving health care.

In conflict settings, health workers may be forced to flee to safe havens as refugees, internally displaced people, or leave the country as migrants—if they have the means to do so. Some of the most capable are absorbed into international agencies. Those who remain frequently have insufficient resources to perform their jobs and must carry on as best as they can under daunting circumstances.

This situation has worsened in recent years with a growing number of direct attacks on health workers in fragile states, such as those against polio vaccinators [10] in Pakistan and Nigeria. These blatant violations of the Geneva Conventions [11] inhibit an already difficult environment for the delivery of health services and the recovery or development of the health system.

This blog post is part of a series leading up to the 67^th World Health Assembly (WHA) in Geneva, Switzerland from May 19 – 24, 2014. In conjunction with the WHA, the Leadership, Management & Governance (LMG) Project will host a side session with global health leaders titled, “Governance for Health: Priorities for Post-2015 and Beyond” [14]. This blog series will offer insight on how good governance in the health system can result in stronger health impact as we move beyond the Millennium Development Goals. This post originally appeared on the LMGforHealth Blog [15].

While substantial progress in the Millennium Development Goals will have been achieved in many countries by 2015, reductions in preventable maternal and infant deaths lags, and the persistent struggle of disease burdens from communicable and non-communicable diseases is worrying.

It can be easy to take healthcare workers for granted. For the majority of us living in the United States, you know that a trained doctor and nurse will see you when you need assistance; a lab technician will do your blood work; and a certified pharmacist will dispense your prescriptions. But imagine going into labor and not knowing if a midwife or doctor will be present? Or, if you need a medication and there is no pharmacy to provide it?

These are the challenges facing millions of people in low- and middle-income countries—and the problems are made worse for those living in rural areas and/or fragile states.

Training health workers

To address this ongoing challenge, MSH, with International Medical Corps [20] and the Frontline Health Workers Coalition [21], organized a Congressional briefing with the Congressional Women’s Caucus on March 26: “Saving Women’s and Children’s Lives: Strengthening the Health Workforce in Fragile Countries [22].”

At the heart of the discussion was the acknowledgement that to save lives you must have a strong health system and a strong health workforce.

Knowledge is power, so the saying goes.

No one understands that more than Teberih Tsegay, Almaz Haile, Jember Alemayehu, and Yeshi Derebew, of Korem Town, Ethiopia, who have used their knowledge to save the lives of babies in their community. "Some years back there was no one to teach us, so we gave birth to HIV-positive children. But now we can teach others so no child will be born with the virus," said Jember.

Seeing the toll HIV had taken on their communities—but empowered with knowledge and skills to stop its further spread—the four women began working with the Korem Health Center as Mother Mentors in 2010. They teach HIV-positive pregnant women and their husbands about the steps necessary to keep their babies safe from the virus.

Remarkably, since they began their work three years ago, only one child has been born HIV-positive in Korem Town.

MSH's current newsletter [30] (November/December 2013) features stories about the people on the frontlines improving health and saving lives: health workers.

A Note from Dr. Jonathan D. Quick

My MSH colleagues Mary O'Neil [31] and Jonathan Jay [32] blog about what we can learn from the Third Global Forum on Human Resources for Health, held this November in Recife, Brazil:

Recife Top Ten: Together Toward Health for All [31]

The Third Global Forum on Human Resources for Health [34] (HRH Forum) brought together some 2,000 representatives of government, academia, professional associations, and civil society from 93 World Health Organization (WHO) Member States. Participants took stock of the current state of the global health workforce and committed to working toward universal health coverage [32] (UHC), culminating in adoption of the Recife Declaration [35] (PDF). "Country after country has outlined actions that will ultimately transform and improve the landscape for health workers, and prioritize their needs in a world with ever growing demands being placed on them," said Dr. Marie-Paule Kieny [36], WHO Assistant Director-General for Health Systems and Innovation and Executive Director a.i. of the Global Health Workforce Alliance.

This post also appeared on Gates Foundation's Impatient Optimists Blog [39] and on Frontline Health Workers Coalition's website [40].

In a week and a half, as a team of our colleagues arrive in Ethiopia for this year’s International Conference on Family Planning, others will already be in Brazil for the Third Global Forum on Human Resources for Health. This year’s HRH Forum addresses universal health coverage (UHC), a concept which continues to gain momentum as the focus of global health efforts from institutions like the World Bank and World Health Organization (WHO).

It’s symbolic that these two meetings are happening half a world apart: as movements around family planning, health workforce and UHC have advanced, there has been too little dialogue and collaboration across these communities.

A new global network for addressing critical social service workforce issues has formed, called the Global Social Service Workforce Alliance [43] (@SSWAlliance" href="https://twitter.com/SSWAlliance">@SSWAlliance [44]). Comprised of organizations and individuals, the SSWAlliance: "recognizes the key challenges facing this workforce and aims to promote the knowledge and evidence, resources and tools and political will and action needed to address them, especially within low to middle income countries."  

Amy Bess, coordinator, introduced [45] the SSWAlliance via webinars on June 6 and 7, 2013.

Ummuro Adano, a steering committee member of the SSWAlliance, and a principal technical advisor at MSH, said:

Maintaining state-of-the-art skills and knowledge is crucial for physicians. But in most developing countries, the lack of structured or ongoing educational activities has pushed medical doctors to travel abroad to benefit from the most recent expertise.

To solve that problem---and improve Rwanda's health system---the Rwanda Medical Council (RMC) launched the continuing professional development program in 2011. The continuing professional development sustains practitioners' knowledge through workshops, seminars, practical sessions, and research.

The USAID [49] Integrated Health Systems Strengthening Project [50] (IHSSP), led by Management Sciences for Health, provided technical and financial support to the RMC for the implementation of the continuing professional development program by developing strategic and monitoring and evaluation plans, helping to run an office, accrediting health professional societies as continuing professional development providers, and preparing the national sensitization campaign.

In my 35 years working in international health, I've attended hundreds of conferences. Conferences are opportunities to exchange ideas and form connections. They’re often fascinating. But once in a while a conference itself can be a pivotal moment. A great example was last year’s International AIDS Conference [54], the first held in the United States after President Obama finally lifted the longstanding travel ban against foreigners living with HIV.

And recently, people around MSH, and throughout the Kenya health community, have been talking about Kenya’s First National Conference on Health Leadership, Management and Governance [55]. The conference, held in early February, demonstrated the long-term vision of the Kenyans who are running the health system. These leaders understand the value of training health systems managers to improve the quality of service delivery [56].