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Why Investments in Frontline Health Workers Matter: Preventing needless deaths through trusted healthcare relationships

 This guest post has been co-authored by Samalie Kitooleko, Nurse In-Charge of Uganda Rheumatic Heart Disease Registry & and Belinda Ngongo, Global Health Leaders Fellow, Public Health Institute. Samalie is a recipient of the Heroines of Health Award 2017, and Belinda is a part of GHC’s delegation to the 70th World Health Assembly (WHA70)

Samalie Kitooleko during our panel session, Against All Odds: Strengthening Health Systems to Better Serve Women and Children

Samalie’s Story

It all started when I nursed a young female university student with Rheumatic Heart Disease (RHD). As a teen she had received a mechanical valve replacement requiring her to take an anticoagulant daily, which she did without fail. During her third year, she became pregnant and stopped taking her anticoagulant medication without medical consultation, thinking she was looking out for the best interest of her baby. Several days later, she lost her baby and I saw her passing away on her graduation day, suffering from valve thrombosis, a condition which could have easily been prevented if she hadn’t defaulted her medication. In that moment, I vowed to never see another woman die of preventable complications. No one should die because they lack appropriate healthcare knowledge in today’s world.

I began counselling women intending to undergo mechanical valve replacement, educating them about necessary medications and lifestyle changes. Initially, I dealt with very few women however in 2013, when the RHD register was established in Uganda, the numbers become rather overwhelming so I developed novel ways of addressing them at scale, forming a patient support group on WhatsApp. Patients used this platform as a way to pose questions to the broader group and it became an incredible group to share knowledge with.

As a nurse in Uganda, I spend most of my time caring for patients affected with chronic cardiovascular illnesses such as congenital heart disease, myocardial infarction, and rheumatic heart disease (RHD). My typical day starts at 7 AM and ends at 9 PM. During this time, my work involves updating the RHD registry with new patients, those that have died and identifying those that are lost to follow-up. I then spend the day in the outpatient clinic counseling patients, enrolling patients in the RHD registry, and administering Benzathine Penicillin injections in the Coumadin clinic which I run concurrently. Due to limited staff, I also work closely with patients affected by all other noncommunicable diseases including diabetes, hypertension and cancer. I’m proud to provide a patient-centered approach during delivery of care, spending time getting to know and following up with the women I serve.

The Case for Frontline Health Workers

Like Samalie, there are many other frontline health workers (FLHWs) in developing countries committed to caring for patients and pressured to work long hours under poor conditions in deplorable infrastructure and limited sundries. To make matters worse, their hard work is rarely recognized and they are compensated poorly for their incessant efforts to improve health and wellbeing of populations. The exodus of FLHWs from the health sector can be attributed to some of the current chaotic and constrained environment. The pursuit of non-health related employment opportunities compromises the quality of care already aggravated by the major shortage of staff in most health care facilities.  It is therefore important that we answer these questions – Why do we need to care about FLHWs? What do we need to do to retain, satisfy and support FLHWs?

Undoubtedly, to improve service delivery and lower staff turnover, appropriate compensation and recognition of frontlines’ efforts is imperative for increased motivation and morale. Such recognition can be in form of being acknowledged as best performers of a given period, promotions and better wages and including them in critical global health and health systems conversations. FLHWs need to be well equipped with knowledge and skills and understand trends and strategies to accelerate the implementation of appropriate interventions to effectively combat disease. They also need to be provided with ongoing training and career advancement opportunities in order to ensure persistent delivery of quality services.
One stumbling block in the health systems arises from the fact that FLHWs have limited decision making power and their potential contributions are hindered by certain rules and regulations. For example, in Uganda nurses are now allowed to provide a prescription but are limited to making a nursing diagnosis and care plan. Policies need to be reviewed and where appropriate influence of frontline should to be augmented and task shifting implemented. Promising models of how FLHWs are managing NCDs can be found here.

The gender lens aspect is important to ponder when alluding to FLHWs, especially since it is recognized that 75% of global health work is done by women. Women deliver the bulk of health care worldwide in the formal and informal sectors. Most FLHWs are women. They usually work under pressure to balance family and societal responsibilities in resource – limited settings, leaving their lives and those of their families at stake. Despite working tirelessly to restore the health of other people, on many occasions’ health and life of FLHWs are not carted and likewise despite their important contribution to global health and the dependence on women as providers of health care, according to a recent report women have very few leadership positions in the health systems.

FLHWs play a vital role in initiating the referral process through timely and comprehensive communication, provide ongoing support and care to patients and their families. Referral of patients may affect treatment and continuity of care and can affect clinical outcomes and costs thus  clear guidance from facility staff is critical. They need to be part of the referral process.

In summation, FLHWs deserve to be recognized for their dedicated and generous contribution towards the health and wellbeing of the populations they serve. In return, they also need to be healthy in all aspects, valued, respected, supported, protected, compensated adequately and work in appropriate.

This week, WHA70 gives us an opportunity to further elevate the voice of FLHWs to encourage further investment and support for those saving lives on the frontline. Join us in helping to elevate their voice!

Learn More: 

Gutting Global Health Programs Serves No One

Washington, DC (May 23, 2017) — Today the Trump administration released its proposed budget for Fiscal Year (FY) 2018 that contains a 26 percent decrease in global health funding at the U.S. Agency for International Development (USAID) and Department of State, as well as the elimination of development assistance. In addition, cuts were recommended for programs at the Department of Health and Human Services that support global health, global health research and development, and global health security. Of note, is the zeroing out of USAID’s family planning programs and critical partnerships through Fogarty International Center at the National Institutes of Health (NIH). These cuts will have a significant impact on current global health programs, and will have a devastating effect on the world’s poor as well as ripple effects for Americans.

Global Health Council is deeply concerned that these drastic budget cuts would impede efforts to fight diseases such as HIV/AIDS, malaria, and polio; improving maternal and child health; and strengthening global responses to disease outbreaks such as Zika and Ebola.

These cuts, coupled with the Trump’s administration proposal to reorganize and possibly eliminate federal agencies and programs, signal a shift away from the leadership role the United States has played in development. Gutting global health and development programs and drastically reducing the workforce will not balance the budget and will end up putting Americans at risk for the consequences of U.S. disengagement.

“What we’re dealing with is a public relations campaign, not sound policy. Declaring war on global health and development serves no one. It doesn’t balance the budget or generate jobs or benefit Americans in any meaningful way. These cuts the administration has proposed for agencies and programs only roll back progress we’ve made on making Americans safer from epidemics and instability or more prosperous from innovation and strong economies. We can either invest in what works today or pay many times over for the consequences tomorrow,” stated Loyce Pace, MPH, President and Executive Director of Global Health Council.

Foreign assistance, including global health, accounts for just 1% of the overall federal budget, but this low cost of life-saving programs yields a significant return on U.S. investments. What’s more: U.S. investments in global health work. With support from the United States, we are within sight of an AIDS-free generation; ending preventable child and maternal deaths; and eradicating polio, measles, and guinea worm. These investments in global health contribute to broader foreign policy goals, including stabilizing volatile areas, supporting overseas disaster response, and accelerating trade and development.

Global Health Council calls on Congress to continue to support global health programs, by supporting at a minimum, funding at the FY17 levels for FY2018, but for the greatest impact at least $10.5 billion, and $60 billion overall for the Foreign Affairs account. Funding these critical accounts that support health, WASH, education, nutrition, and gender programs, as well as humanitarian responses, ultimately strengthens U.S. leadership around the world and fosters a safer, more prosperous America.


About Global Health Council

Established in 1972, Global Health Council (GHC) is the leading membership organization supporting and connecting advocates, implementers, and stakeholders around global health priorities worldwide. GHC represents the collaborative voice of the community on key issues; we convene stakeholders around key priorities and actively engage with decision makers to influence global health policy. Learn more at Global Health Council published “Global Health Works: Maximizing U.S. Investments for Healthier and Stronger Communities,” comprehensive consensus recommendations and impact stories available at

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Media Contacts

Liz Kohlway, Communications & Member Engagement Manager
Global Health Council
(703) 717-5251

WHA Side-Event: Enabling Global Health Security Through Health Systems Strengthening: Perspectives from Women Leaders

This blog post was written by WHA Delegate Anne Bell, U.S. Pharmacopeial Convention.

As Tina Flores of Rabin Martin opened the panel on Enabling Global Health Security Through Health Systems Strengthening: Perspectives from Women Leaders, it was heartening to hear her tell the back story of how the panel came to be.  The inspiration began, not with the need to feature women leaders – but through a realization that a great panel put together for an earlier conference on Global Health Security, was, in fact, all women.

The panelists represented many sectors–government, security, private industry, and civil sector–yet it was clear during the discussion that they agreed on several key features.

Key takeaways from the panel include the need for:

Cross-sectoral collaboration that leverages a diverse array of skills and funding sources, from multiple sectors yet measures success against the same yardstick.

An understanding of health systems that goes beyond health care delivery to include strong laboratories that can detect disease quickly, global supply chains that can deliver quality-assured medicines, strong regulatory systems that can detect health threats and well-designed digital health projects that support diagnosis in a variety of settings.

Interventions that incorporate the diverse perspectives of the many sectors working within a country (diplomatic, public, private, civic) and that are based on a solid understanding of the underlying infrastructure of that country (transportation, communication technologies, regulatory systems as well as health systems.)

The Minister of Health of Uganda, Dr. Jane Aceng, reminded those in attendance that with people traveling more, a disease can be transported from one continent to another in less than 24 hours, so Global Health Security is critical. She credited the WHO International Health Regulations for providing a framework for preventing disease transfer across borders, and encouraging countries to strengthen health system capacities so that they can prevent, detect and respond to global health emergencies.

And throughout, the speakers and panelists pointed to the unique abilities and contributions of women and the importance that they are represented in all levels if we are to create the kind of robust health systems capable of responding to global health emergencies.

Diah Saminarsih, Special Adviser to the Minister of Health of Indonesia, urged those in attendance to go home, find and support those future women leaders. “If we increase the status of women, we will increase the health profile of a country.”

For more #WHA70 updates, check out GHC’s daily social media alerts.

WHA Side-Event: Attacks on healthcare. Where do we stand one year after the adoption of United Nations Security Council resolution 2286?

This post was written by GHC Board Member and WHA Delegate Len Rubenstein, Johns Hopkins Bloomberg School of Public Health, Chair, Safeguarding Health in Conflict Coalition.

Assaults on health workers and facilities in conflict has reached such crisis proportions that just before she was to give her opening address to the World Health Assembly, Director General Margaret Chan made a surprise appearance at a side event on the problem led by the governments of Switzerland and Canada.   She warned that these attacks make a mockery of international law and must be stopped.

The discussion focused on the global scope of the problem and the impunity enjoyed by perpetrators.  A recent report by the Safeguarding Health in Conflict Coalition found that in 2016 there were attacks on health services in 23 countries, including 10 countries where hospitals were bombed or shelled and 20 where health workers were arrested, abducted or killed.  Yves Daccord, Director-General of the International Committee of the Red Cross, explained how multifaceted the problem is, from bombings of hospitals to blockages of ambulances to arrests of health workers.  These arrests, Dr. Joanne Liu, International President of Médecins Sans Frontières, explained, were often the product of counter-terrorism laws that criminalized the provision of impartial health care. Panelists pointed out the horrific impact of attacks on health care, from precipitous decline of vaccinations of children in Syria to a cholera outbreak in Yemen.

There have some positive steps to address the problem.  Dr. Peter Salama, Executive Director of WHO’s Health Emergencies Program, said that WHO will shortly initiate systematic collection and dissemination of data on attacks on health care, information that is essential to understanding patterns of attacks, advancing prevention and developing political will for accountability.  But all panelists agreed that impunity for attacks remains the major obstacle to stopping them.  A year ago, the Security Council adopted resolution 2286, condemning attacks and committing to actions to protect health workers and facilities and ensure accountability for perpetrators.  But since the adoption of the resolution, the attacks have continued, in alarming number and intensity.  Indeed, MSF facilities were bombed within weeks of the resolution’s adoption. And the Security Council has taken no action to implement its resolution.

The panelists suggested a variety of steps toward ending attacks:  greater involvement of Ministries of Health in collecting data and mobilizing the health community to stigmatize perpetrators of attacks; adoption of recommendations of the Secretary-General to implement resolution 2286, which have sat on the shelf for over a year; and most of all, ending impunity by ensuring proper investigations of attacks and prosecution of perpetrators.  As Yves Daccord pointed out, fatalism about attacks on health care must be resisted, and in its place should be accountability.

For more #WHA70 updates, check out GHC’s daily social media alerts.

Trump Administration Releases FY18 Budget

On May 23, the Trump administration released its recommended budget for Fiscal Year (FY) 2018. “A New Foundation for American Greatness” includes sharp increases for defense and border security, while drastically cutting nondefense discretionary spending.

Overall Foreign Assistance was cut approximately 32 percent, with a cut of 26 percent to global health programs at USAID and the State Department. Of note, funding for family planning, vulnerable children, and the HIV/AIDS program at USAID were zeroed out.

Also of concern, is the zeroing out of the Development Assistance Account, USAID’s core poverty reduction tool and which includes programs for food security, WASH, and education among others. The administration proposes to roll development assistance into the Economic Support Funds to create a new account: Economic Support and Development Funds. This account would be administered by the State Department, which places more importance on strategic objectives and partnerships and minimizes the importance of development in how the U.S. engages globally.

Global health at the Department of Health and Human Services did not fare any better. The National Institutes of Health is facing a 21 percent cut, with the Fogarty International Center zeroed out. An approximate 20 percent cut was proposed for Global Health at the Centers for Disease Control and Prevention.

As the process moves to Capitol Hill, GHC will follow the appropriations process. From our meetings with Congressional offices, we know that global health and foreign assistance is widely supported, and the initial reaction from Congress to the President’s budget indicates that the final numbers will look much different.

Appropriations Budget Table (as of May 2017)

Key accounts (in thousands):

* Includes $250 million from remaining Ebola response funds
** Funding from remaining Ebola response funds
*** The International Organizations and Programs (IO&Ps) is zeroed out. UNICEF will most likely be funded through Maternal and Child Health.