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Community Health Workers: A Priority for Universal Health Coverage?

This guest post was written by Colin Gilmartin, Senior Technical Officer at Management Sciences for Health (MSH), a nonprofit global health organization and GHC member organization. Gilmartin specializes in health care financing and the planning and costing of community-based services. He can be followed on Twitter, @colingilmartin. MSH’s mission is saving lives and improving the health of the world’s poorest and most vulnerable people by closing the gap between knowledge and action in public health.

Community Health Volunteer in a remote village of Tulear, Madagascar, giving instructions to a client on the use of pregnancy tests. Image by Samy Rakotoniaina/MSH

How countries can move toward building sustainable community health programs.

Universal health coverage (UHC) is increasingly recognized as the best way to achieve the Sustainable Development Goal targets on health. But with 400 million people lacking access to essential health services and a projected shortage of 18 million health workers, it will take unprecedented effort and funding. Community health workers (CHWs) could be an important part of the solution—but without effective investments and sound planning, we will fall short of achieving UHC.

Many low- and middle-income countries rely on a robust community health workforce, but few are self-sustaining and many rely heavily on external donors. CHWs fill critical gaps while delivering quality, affordable services closer to underserved patients. Even during crises, such as West Africa’s Ebola outbreak, CHWs can ensure the continuity of services while helping to stop epidemics.

As a 2015 report shows, CHWs can also yield a sound 10-to-1 return on investment, when accounting for a healthier population’s increased productivity and formal employment and the prevention of costly health crises. Expanding access to community services could prevent up to 3 million deaths annually while substantially reducing patients’ out-of-pocket costs.

Recognizing these benefits, low- and high-income countries alike are developing and expanding CHW programs. In Ethiopia, Community Health Extension Workers (CHEWs) proved instrumental in reducing maternal and child deaths and in meeting nearly all of the country’s 2015 Millennium Development Goals on health. Countries including Ghana and Sierra Leone are training and deploying a combined 35,000 CHWs to bridge gaps. Even in American cities like Philadelphia, CHWs are delivering evidence-based health interventions to high-risk patients while reducing overall health care costs.

While CHWs are not a new concept, the recent momentum for scaling CHWs raises an important question: will they be a long-term investment or simply a palliative solution to achieve short-term results?

Amid competing funding priorities and uncertainty around foreign assistance, countries show reluctance to invest in community health systems. CHWs are often unpaid volunteers, lack a career path, and are rarely considered part of the formal health workforce. These factors, combined with growing demand for their time, contribute to high rates of attrition. Further, in the absence of proper planning, frequently there is no funding for ongoing training, program support, and supervision of CHWs. This can lead to low-quality services or, worse, a complete stoppage of services in the most challenged communities.

To achieve UHC and the health SDG targets, long-term community health planning is essential—and along with helping countries identify solutions to meet health goals, it provides an opportunity to evaluate progress and make improvements. Planning can also help countries identify the costs and resource needs to sustain CHWs, including medicines and supplies; equipment; incentives; training; as well as program management, supervision, and reporting. It also cuts down on duplicative efforts among partners.

To facilitate this process, the NGO where I work, Management Sciences for Health, partnered with UNICEF to create a Community Health Planning and Costing Tool that helps calculate the costs of delivering comprehensive community health services for up to 10 years. To-date, the tool has helped plan the long-term implementation of national community health programs in Madagascar, Malawi, and Sierra Leone.

Understanding the costs and required financing for large-scale community health programs helps governments more effectively advocate for domestic and external funding sources, including the private sector. Plus, identifying funding gaps can help countries pool different sources to ensure that health programs operate fully and consistently.

As countries move toward building and sustaining national community health programs, they should consider a few key takeaways.

First, long-term financing plans should be developed to support continuous services and funding for all elements of a community health program. While domestically-financed programs may prove unrealistic for many countries, there are opportunities to leverage existing initiatives and donor funding. For example, in Rwanda, CHWs are integrated into the country’s national performance-based financing scheme, which provides incentives to fund income-generating activities. Other countries leveraged multi-year Global Fund support to cover antimalarial medicines, rapid diagnostic tests, training, and incentives.

Community health program funding should work to strengthen health systems overall. Embedded in weak health systems, CHWs programs will be ineffective and investments will fall flat. CHWs will only succeed when all building blocks are performing. For example, programs must reinforce strong supply chains, a dynamic supervisory and management workforce, and an effective flow of health information.

As frontline health workers, the CHW role should also be institutionalized in national health systems. Along with clearly defined responsibilities, they should receive ample recognition, incentives, and professional development opportunities. By doing so, countries can improve the quality of service delivery, ensure greater accountability to their communities, and increase CHW retention.

Lastly, we must continue to demonstrate the impact of CHWs and draw lessons. To strengthen the investment case for CHWs, we must go beyond demonstrating achievements of process indicators and coverage metrics and document how effectively CHWs improve patient outcomes, reduce costs to health systems and patients, and contribute to health milestones and targets. By sharing experiences and lessons-learned, other countries might avoid shortcomings and adapt program successes to address their health priorities.

This article was originally published in Global Health NOW. Join the thousands of subscribers who rely on Global Health NOW summaries and exclusive articles for the latest public health news. Sign up for the free weekday e-newsletter, and please share the link with friends and colleagues: http://www.globalhealthnow.org/subscribe.html.

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NCD Child’s Approach to Advocacy: Putting Children First

This guest post was written by, Jonathan D Klein, MD, MPH, FAAP, Executive Director, NCD Childa a global multi-stakeholder coalition championing the rights and needs of children, adolescents, and young people living with or at risk of developing non-communicable diseases (NCDs). NCD Child is a member of the Global Health Council.

NCD Child is a global multi-stakeholder coalition championing the rights and needs of children, adolescents, and young people living with or at risk of developing non-communicable diseases (NCDs).  Our message to civil society, governments, and WHO is unwavering – children are not small adults.  They require unique services, yet many national and global health policies fail to adequately account for these distinctive needs.  NCD Child actively engages and collaborates with governments, multilateral organizations (ie, WHO, UNICEF, other UN agencies), civil society, the private sector, and academic institutions to promote awareness, education, prevention, and treatment of NCDs in children, adolescents, and young people.  We support child health advocacy and policy at the global level via WHO and the UN as well as at the country-level through civil society and individual champions.  We are committed to involving youth voices across all our work, from engagement in the NCD and Sustainable Development Goal (SDG) agendas to our own governance and program activities.

Young people’s access to essential medicines and technologies for special health care needs are a particularly alarming and growing concern.  To tackle this challenge, NCD Child launched a Taskforce on Essential Medicines and Technologies during the 2017 World Health Assembly.  Whether it is insulin, an asthma inhaler, chemotherapy, heart surgery, or simple antibiotics, poor access or lack of availability to safe and appropriate medicines and technologies for children, adolescents, and young people hinders their chances of living healthy, productive and long lives.  There are several challenges to consistent, safe access to essential medicines and technologies – drug shortages, appropriate dosages for children, challenges in drug delivery, technology incompatible with systems, and products excluded from the WHO Essential Medicines for children lists.  The new taskforce, chaired by Dr. Kate Armstrong, Executive Director of CLAN (Caring & Living as Neighbors) and founding Executive Director of NCD Child, includes a diverse group of experts from government, academia, and civil society.  Kate’s vision that all children living with chronic health conditions should be afforded the same opportunities and quality of life as other children, helped NCD Child frame our mission and goals towards a rights-based approach to universal access and population health.  For the taskforce, this means addressing consistent, equitable, and affordable access to essential medicines and equipment for all children, adolescents, and young people living with NCDs – including attention to the rights and needs of all young people with special health care needs.  Its initial report, scheduled for 2018, will discuss common barriers to access and propose collaborative, practical strategies to address the gaps.

Practically, this means we want policies ensuring the health needs of young people are always included in health systems planning and accountability.  We recognize to affect policy, governments and other advocates need to fully appreciate why it is important to include children, adolescents, and young people.  How do current policies and frameworks exclude them?  What is the potential impact of not tailoring policies, health education, and health systems?  How many lives can be saved, improved, and extended if policies addressed the needs of all ages across the entire life-course?  The taskforce will serve to amplify NCD Child’s concerns by developing resources to educate governments, help guide policy development, and contribute to the WHO Essential Medicines list.

Prevention and treatment of NCDs helps children, adolescents, and young people live life to their fullest potential. These investments are also critical to successfully addressing preventable maternal and child deaths, and to effective, sustainable development.  At the July High Level Political Forum on SDGs, Dr Nata Menabde, Executive Director of WHO at the United Nations, closed the review of the health goal by noting that “every minister should be a health minister.”  When it comes to health in all policies, “put children first” is essential to all plans, whether for health systems, NCDs, or other global goals.

For more information and to sign up for the NCD Child listserv, visit www.ncdchild.org.

 

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Cents and Sensibility: U.S. International Family Planning Assistance from 1965 to the Present

Despite representing a miniscule fraction of overall discretionary spending by the federal government—six one-hundredths of one percent (0.06%) in FY 2017—U.S. international FP/RH assistance has generated disproportionate political opposition from anti-contraception activists both inside and outside the U.S. government. At the same time, the program has delivered innumerable health, social, and economic benefits to women around the world.

Global Health Council (GHC) member PAI has an interactive graph to view the historical trends in U.S. government financial support for international family planning and reproductive health (FP/RH) programs. Interact with the tool.

 

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Defeating malaria through pharmaceutical systems strengthening

This guest post has been provided by GHC-member Management Sciences for Health (MSH). MSH works with health leaders throughout the world on global health’s biggest challenges, with a focus on HIV & AIDS, TB, malaria, chronic diseases, family planning,  and maternal and child health.

A technician tests a child for malaria at a health center in Kinshasa, DRC. Photo credit: Aubrey Clark

Between 2000 and 2015, great strides have been made in fighting malaria. Globally, malaria case incidences declined by 41% and mortality rates by 62%. However, approximately 212 million people were infected and 429,000 people died in 2015, with the majority being children under the age of 5 in sub-Saharan Africa. Malaria also places a great financial burden on individuals and health systems. In sub-Saharan Africa alone, the annual cost of case management related to malaria is estimated at USD 300 million.

Much has been done since 2000 to eliminate this disease, and ensuring improved access to and appropriate use of quality-assured malaria medicines is necessary to sustain these gains.

The USAID-funded Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program recently published the results of its activities in eight countries (Angola, Burundi, the Democratic Republic of the Congo, Ethiopia, Kenya, Guinea, Mali, and South Sudan) to control malaria.

This report summarizes systems strengthening interventions that support the prevention and treatment of malaria. With funding from the US President’s Malaria Initiative (PMI) and based on PMI’s priorities, SIAPS provided assistance to build capacity to manage malaria products and to strengthen financing strategies and mechanisms that would improve access to malaria medicines and the quality of pharmaceutical services for malaria patients. SIAPS also collaborated with national malaria control programs and central medical stores to develop and implement activities aimed at strengthening the pharmaceutical management of antimalarial products.

A significant challenge for countries is the lack of accurate and timely information that would enable a steady supply of medicines and accurate quantification and procurement for medicines and other health supplies. To facilitate the use of logistics data, the development of electronic early warning systems must be encouraged.

SIAPS launched the End Use Verification (EUV) tool to help assess malaria commodity stock status and malaria case management practices. Data collected using this tool have helped to monitor and avoid stock-outs and disseminate relevant information that directly supports the availability of commodities at the right place and time. In Ethiopia, as a result of findings from EUV surveys, a manual to guide redistribution of antimalarial medicines among public health facilities was developed to help facilities maintain acceptable stock levels and reduce expiries. In Burundi, the introduction of the EUV tool decreased the time needed for the medicine requisition process from two weeks to two days.

Another issue highlighted in this review is constraints caused by weak human resource capacity, poorly defined supply chain operating procedures, inadequate infrastructure, and poor medicine storage conditions and practices. To reduce malaria mortality, antimalarial medicines must also be provided through systems and services that ensure that the medicines themselves are safe and of good quality. For this reason, medicines need to be properly stored to maintain their quality.

In Angola, SIAPS provided support to reorganize the national central medical store to align with key warehouse functions. SIAPS also conducted trainings on good warehousing practices to support staff capacity and performance. These trainings and the reorganization of the medical store, which integrated and improved supply systems for essential commodities, made the entire warehousing processes more effective and efficient.

Strengthening health systems takes time, but controlling and eliminating malaria is possible. Strong partnerships among stakeholders, web-based tools, and ensuring sustained achievements for a strong and reliable supply chain of medicine help make it possible to increase and maintain effective interventions to support the prevention and treatment of malaria.

Read SIAPS’ full report here.


About SIAPS | The Systems for Improved Access to Pharmaceuticals and Services (SIAPS) program works to ensure access to quality pharmaceutical products and effective pharmaceutical services through systems-strengthening approaches to achieve positive and lasting health outcomes. SIAPS is funded by the US Agency for International Development (USAID) and implemented by Management Sciences for Health. For more information, visit www.SIAPSprogram.org.

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5 Reasons to Attend the Fall 2017 Global Health Practitioner Conference

This guest post has been provided by GHC-member CORE Group. CORE Group helps governments and NGOs effectively reach the community level, integrate community strategies into the national health plan, and respond to new and emerging health issues that arise. 

Panelists enjoy a light moment during the “Child Health Policy and Programming Transitions” plenary session at the Fall 2016 Global Health Practitioner Conference in Washington, DC.

In 2017, CORE Group is celebrating 20 years of strengthening global community health through collaboration. Together with our many members and partners, including Global Health Council, we have worked to foster collaboration and learning, strengthen technical capacity, develop innovative tools and resources, and scale up effective community-focused health approaches.

Participants collaborate in small group work during the “Multi-dimensional Programming: The Rubik’s Cube Challenge to Health Programming” plenary session at the Spring 2016 Global Health Practitioner Conference in Portland, OR.

Our bi-annual conferences have remained a key feature of our programming over the years. This fall, in honor of our anniversary, we are hosting an extra special conference to recognize our collective accomplishments from the last 20 years and look ahead to future opportunities.

The Fall 2017 Global Health Practitioner Conference will be held on September 25 – 29 at the Lord Baltimore Hotel in Baltimore, MD, focusing on the theme of “Collaborating for Health Communities: Results, Realities, and Opportunities.”

Here are the top five reasons to attend the conference:

  1. NETWORK

Bringing together over 350 of the world’s leading community health experts, the conference will feature a stimulating mix of NGO headquarters staff, civil society organizations, national leaders in global health, academics, advocates, donors, and private sector representatives.

We encourage conversations with old friends and new acquaintances throughout the conference, during breaks and lunch, in and out of sessions, and at our evening networking receptions.

The relationships you form at the conference will serve you for years to come, and with the family atmosphere our conferences are known for, you will be welcomed by all.

“I think this is an exceptional opportunity to bring people from very different backgrounds around the table in a setup that is very conducive for dialogue, and it has produced incredible discussion.”

– Emanuele Capobianco, Deputy Executive Director, Partnership for Maternal, Newborn and Child Health (PMNCH)

  1. LEARN

With the best minds in global community health all in one space, the possibilities are endless!

Dive into the conference theme throughout the week to identify and discuss results of collaborative action for community health; challenge realities of operations research, program approaches, and changing environments; and explore opportunities for new partnerships and emerging voices for building healthy communities worldwide.

Sessions will cover a wide range of topics, including:

  • The Child Health Agenda in the Context of the SDGs
  • Collaborating with the Private Sector to Advance Non-Communicable Disease Service Delivery
  • Integrating Fertility Awareness Into Cross-Sectoral Programming
  • Innovations in Community-Based Diagnosis and Treatment of Acute Malnutrition

The conference agenda is updated regularly online. View the latest version here.

  1. SHARE

Contribute your own expertise in breakout sessions, group discussions, and informal settings throughout the conference. With our signature participatory sessions, you will have numerous opportunities to share your experiences and gain valuable feedback from others.

To further increase the visibility of your organization or project, you can support the conference as a sponsor and highlight your work with an Expo Table during the conference.

  1. LEAD

With our focus on action, we don’t just talk about change at our conferences; we make change happen. You can influence future activities through involvement in our Working Groups, all of which will have a formal meeting time during the conference.

These groups include Child Health; Community-centered Health Systems Strengthening; Reproductive, Maternal, Adolescent and Newborn Health; Monitoring and Evaluation; Nutrition; Social and Behavior Change; and our new Humanitarian-Development Task Force.

“It’s a compounding draw that brings you back every year. It’s like-minded people getting together to discuss the latest issues, the emerging trends. It’s a great place to take stock, refresh, think about what you’ve done over the past year and what’s coming in the year ahead, and how you can connect your issues to the issues of other groups. There’s no other conference like it.

– Antony Duttine, Independent

  1. CELEBRATE

Join us for our 20th Anniversary Gala: An Evening of CORE Group Impact! On Thursday, September 28, at the Marriott Baltimore Waterfront Hotel, we will come together as a community to celebrate CORE Group’s community health impact over the last two decades and recognize all who have transformed CORE Group from an idea into the global force it is today.

The gala will be led by our Master of Ceremony Jackson Mvunganyi, youth advocate and host of Voice of America’s Upfront show. Additional honorees and special guests will be announced soon. Learn more and buy tickets here.

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