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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.
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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: 

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GHC NEWS FLASH: GLOBAL HEALTH ROUNDUP 5/01/2017

GHC Reflects on its Own First 100 Days
In global health, we know benchmarks matter. They’re the difference between whether a child reaches his or her 5th birthday or dies of a vaccine-preventable illness. They signal how a health system would respond to the next pandemic or humanitarian crisis. What gets measured gets done, and saves lives. That’s why GHC has been paying attention these first 100 days of 2017. We looked at what we’ve done to serve our members, and opportunities to make the greatest impact. Thank you to all of the global health advocates who have joined us so far. Read more.


GHC Hosts Discussion on U.S. Leadership and Engagement at WHA
On April 25, GHC convened various stakeholders for a critical dialogue on the U.S. government’s priorities at the Seventieth World Health Assembly (WHA70). The one-hour webinar, which attracted over 60 participants from the non-profit, academia, international development, and government sectors, was the second in a series of WHA Policy Scrums organized by GHC in preparation for WHA70. We were honored to have special guest speakers with strong government backgrounds and experience at WHA participate in our webinar and share their insights on the best way for civil society to engage at WHA70. You can view brief notes or watch the full webinar recording that provide a recap of this important conversation. Please join us for our final WHA Policy Scrum and New Delegate Webinar on May 9. Registration details.


A New Malaria Vaccine Implementation Program in Africa
The World Health Organization Regional Office for Africa (WHO/AFRO) announced that Ghana, Kenya, and Malawi will participate in the WHO-coordinated pilot implementation of the RTS,S malaria vaccine. RTS,S was developed to protect young children from infection by Plasmodium falciparum, the deadliest of the malaria parasites affecting humans. It is the first malaria vaccine candidate to be recommended for pilot implementation by WHO, and the first to receive a positive opinion from a stringent regulatory authority, the European Medicines Agency (EMA). The Malaria Vaccine Implementation Program (MVIP) is being coordinated and led by WHO in close collaboration with Ministries of Health in the participating countries and a range of in-country and international partners. Learn more.


Call for Nongovernmental Organizations to apply for Consultative Status with the United Nations
The United Nations invites nongovernmental organizations (NGOs) to apply for consultative status with its Economic and Social Council (ECOSOC) if they wish to be considered by the NGO Committee in 2018. NGOs that are accredited with ECOSOC can participate in a number of events including, but not limited to, regular sessions of ECOSOC, its functional commissions, and its other subsidiary bodies. Consultative relationships may be established with international, regional, sub-regional, and national non-governmental, non-profit public, or voluntary organizations. Those interested should submit their application and required documents by June 1. View the call for applications.


Global Resolve to End Neglected Tropical Diseases
The NTD Summit 2017, held between April 19 – 22, drew attention to the unprecedented progress and milestones that have been reached in efforts to control, eliminate, and eradicate neglected tropical diseases (NTDs) over the last five years. For several decades, development of new drugs and vaccines to target the most debilitating NTDs, categorically described as diseases of poverty, stalled because there was simply no business incentive to do so. Since the signing of the London Declaration on NTDs in 2012, pharmaceutical companies, academic institutions, NGOs, and other partners have joined forces to bring treatment to millions of people afflicted by NTDs. NTDs kill, disable, disfigure, stigmatize, and cost developing economies billions of dollars every year in lost productivity. Progress in NTD eradication has been touted as a remarkable display of how U.S. foreign assistance works to eliminate obstacles to development. Read more.


Registration is Now Open for the Women Leaders in Global Health Conference
Women in Global Health (WGH) is a movement of dynamic professionals around the world, of all genders and backgrounds, working within many different areas of global health looking to achieve gender equality in global health leadership. WGH believes that diverse, gender-balanced leadership is key for achieving the sustainable development goals (SDGs), improving health and well-being, and are working to give all genders an equitable voice in the global health arena. WGH is pleased to partner with Stanford University’s Center for Innovation in Global Health to present the Women Leaders in Global Health Conference this October 12. Registration is now open for this inaugural event. The conference builds on the global movement to press for gender equity in global health leadership by celebrating great works of emerging and established women in the field and cultivating the next generation of women leaders. More details.

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If not now, then when? Women Leading Bravely in Global Health

This guest post has been provided by GlobeMed. It was originally published on the organization’s website.

Contributors: Roopa Dhatt, Alyssa Smaldino, Paurvi Bhatt, Bonnie Koenig

Did you know that 80% of students in global health are women, but less than 25% go on to lead global health efforts? Evidence suggests women in the global health field are often not visible or publicly recognized for their contributions. They often become discouraged for a multitude of factors and barriers – career, work-life balance, personal security, displacement, physical, cultural, economic, environmental – and many more.

The context of global health leadership is critical to set the stage for the future of global health from the perspective of advancing equity through an intersectional lens. Leadership in global health should consider geography, gender, and generation, as each perspective adds value to how we define problems and seek solutions. But how do we have these conversations? How do we take the seat and orchestrate solutions?

After an energizing GlobeMed Summit in downtown Chicago that acclaimed the need for #LeadingBravely, a dozen women leaders met for the first time on April 2, 2017 in an inaugural effort to challenge these issues and address how leadership in global health can fast-forward progress to realize gender equity in the next by 2030. This meeting about ‘Courage and Companionship in Global Health Leadership’ was attended by representatives from GlobeMedWomen in Global HealthGlobal Health Fellows Program IIGlobal Health Council, Medtronic Philanthropy, Global Health Corps, Timmy Global Health, Accenture, and Going International.

As organizations working on leadership and with track records of collaborating effectively, we asked ourselves: What can our organizations do to collectively address the leadership gap in gender equality and more broadly diversity – as organizations that work on capacity building, collective learning, advocacy, and more? We shared the many collaborative initiatives we are already co-leading, and the holistic and equity-focused approaches we are taking that would lend themselves to enhanced collaborations, including events such as the The Future of Global Heath (TFGH), trainings (i.e. GlobeMed Leadership Institutes) and other platforms.

Based on our individual and organizational experiences, a few realizations emerged:

Women have made progress in becoming highly trained and qualified, yet stagnation is high in leadership positions. Women have been outnumbering men on college campuses in the US since 1988. Today we earn almost 60% of all bachelor’s and master’s degrees and 50% of all doctorates, law, and medical degrees[1]. In global health, across all sectors, women hold 38% of the top positions, and in the sectors with the most influence and power – academia, government, and private sector – the numbers range from 10 to 25%[2]. While women have been 1:1 in qualifications in many fields since the 1980s, today we still are 1:4, and sometimes 1:20, in opportunities to lead.

Women are graduating from public health and global health programs and participating in global health leadership development at higher numbers. There are more women than men in the global health talent pool, but it is a talent pipeline where men rise to top leadership positions in some of the highest numbers and get paid more.

Women’s leadership in global health is crucial from a rights perspective and for better health outcomes. While global health is a field committed to achieving health and well-being for all, including dedication to women’s health, the progress continues to be slow. In certain settings, such as family services and sexual and reproductive health and rights, a rollback is occurring. Women around the world seem to face a multitude of setbacks: higher burden of disease, inability to make their own choices on their health and family planning, violence, child marriage, human trafficking, gender discrimination, and economic disempowerment. Extra attention must go toward developing women as leaders in order for us to overcome these burdens.

If not now, then when? Most discussions on women’s leadership take place in rooms full of women, and focus on building talent in the global health leadership pipeline. Women must be given space to more publicly and openly discuss the realities of a field that is failing in women’s empowerment in order for all of us to reach our maximum potential.

While data and evidence are needed, we can still work collaboratively to troubleshoot and close the gender gaps we know to be fact. Even with all the training, skills development, and research into how gender parity results in higher economic return and sustained growth (estimates show that the global economy would grow 28 trillion, which is by 26% globally[3]), it is unlikely that the women we train will receive a “fair, equal” paycheck before they retire. We have a responsibility to do something about this.

Building on our current collaborative efforts and what we have learned, we converged on focusing on how we equip the next generation of women global health leaders with the tools they need to move into leadership roles. It is clear that after formal leadership development in global health, students, trainees, members, and fellows are likely to enter settings where they are the minority for either their background or their mindset. What can we do to prepare them and what are we doing to disrupt or challenge the status quo of leadership in these settings? Pooling resources in curriculum, advocacy, convening, and other organizational knowledge is an important first step. In a time where women’s leadership is stagnant in global health, being disruptive may be the only way to correct for the sharp decline of gender equity in global health. It is important to be influencers for change.

This was the first opportunity to have a conversation on this critical theme, and we aim to maintain momentum on addressing this issue. In the spirit of GlobeMed and #LeadingBravely, we worked to AWAKEN global health leadership on that Sunday afternoon, and now as we reflect, may we be leaders that INNOVATE, BUILD, and EMPOWER to advance a healthier world.

[1] American Progress and Pew Social Trends: Women Leadership Gaps, The Data on Women Leaders, Women’s Leadership.

[2] Source: Just Actions, Date: 2016. Women in Global Health Data from 2016.

[3] Source: McKinsey, Date: 2015.

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Q&A with Executive Director of Global Health Council – Women Leader in Global Health Loyce Pace

This Q&A was provided by Women in Global Health, a co-collaborator on the Women Leaders in Global Health Initiative, and originally appeared on their website.

GHC President and Executive Director Loyce Pace

1. Please tell us a little about your global health career path that led you to this position as Executive Director of Global Health Council.

I’ve heard people talk about two types of professional journeys: The traditional “ladder” or the less-predictable “jungle gym.” Mine has been more the latter, for sure. I always had a heart for health problems, thinking I would find myself in medicine, but being discouraged by the US healthcare system, I focused more on policy and social determinants of health. That first led me to pursue a career in education that eventually morphed into community outreach, trainings, and mobilization. I guess that’s when my inner-advocate was born. All the while, I was going back and forth between domestic and international settings, leveraging endless parallels between the many issues we face worldwide. In the end, I knew one thing that was very important to me was connecting the dots – across what we care about, how we address it, and who takes part. It’s never really anyone’s job per se to collaborate but it’s so critical to everything we do. Working for GHC gives me an opportunity to spend 100% of my time bringing our community together.

2. Please tell us more about your background and what led you to global health.

I believe firmly that health is wealth. Coming from an inner-city in the U.S. with the typical lack of quality services and infrastructure, I saw firsthand how difficult it was for people to live healthy lifestyles and prevent disease. It wasn’t about choice, it was about access. My parents didn’t allow me to visit the local parks because of violence, and had to drive to neighboring wealthier cities on weekends for better grocery options. There was a hospital within a mile of our house with a mortality rate so high its nickname was, “Killer King.” It was obvious to me how this led to other social and economic setbacks in our community, so I was determined to focus on health and wellness as a baseline of growth and opportunity.

As for the “global” side of things, I found myself circumnavigating the globe in college, visiting countries throughout Asia, Africa, and the Middle East. It was a fascinating experience that sparked a keen interest in exploring other parts of the world and working in different communities. Living in East Asia and West Africa later in life solidified those interests and exposed me to even more valuable lessons about how flat this world really is. More than being about charity or “helping” others, I saw that we all could learn from one another how to solve our mutual problems and celebrate our collective success. And isn’t it better to think about an army of people trained on the same solutions to face problems we all face? We are definitely not alone!

3. Have you ever had a moment where you found you were held back or extra challenged due to your gender? Did you notice there was a glass ceiling you had to break in order to advance?

Honestly, it wasn’t terribly apparent to me and I think that’s partly cultural. I somehow expected to be further behind and needed to work that much harder because it’s just the way things always were. To be clear, my family was incredibly encouraging. There was just nothing around me that said, “You can be or do anything” or “This will come naturally for you.” At some point, maybe in my late-20s, I realized that I was often the only person in the room with an advanced degree and international experience or a top-tier education and foreign-language proficiency. And I was often the only woman or person of color anywhere in sight. It only takes one time to notice something like that but once you notice it, then you see it all around you. I didn’t like thinking I was being held to a different standard because of who I was, often needing to justify in interviews or meetings why I was there. (“No, I won’t be taking minutes or ordering lunch. Perhaps you can.”) But, you know, my family is full of fighters. My mother integrated her school for heaven’s sake so I guess it’s in my blood to see a glass ceiling and just break right through it. If anyone cared, maybe they would’ve used cement.

4. During your career path, did you find that mentorship or networking with other leaders helped your own career? Elaborate if have a specific story about being a female leader and how mentorship or networking especially projected your career forward.

I think one advantage of working in health is that there are so many women in the profession. I’ve admired many leaders, along the way, and appreciate those that have encouraged me to see myself as one of them. In my experience, I’ve seen this in male and female leaders alike.

There was one woman, though, that greatly changed my perspective on women in the workplace. She’d been an executive at a sports organization and taught me the value of being assertive and outspoken. It took me a while to become comfortable with the approach and I don’t often tap into that personality, but at least I know how when it is required. I think even if you don’t have a formal mentor those types of models are good to watch.

5. Do you see that there is a gender inequality in global health leadership? What tactics do you think organizations and individuals can do/invest in in order to address this problem?

There are organizations in both the public and private sector addressing gender inequality, which is great. Of course, it’s encouraging that people are becoming more sensitive to gender equity in the global health profession. The thing we have to avoid is feeling like everyone is just checking a box. It’s not only important to have a woman or someone from the “global south” on your board or executive team, you need to recognize the value of diverse perspectives and that they can bring new contributions to the table that enhance your organization’s impact. That’s why it matters so much.

6. As a women leader in global health, what advice do you have for middle-career or emerging global health workers who are looking to climb the career ladder?

I’m not sure I could say something other than what we’ve all heard from others in this space. First of all, the whole ladder concept could probably be revisited and re-thought. You likely will walk a winding zigzag path and that’s fine, as long as it makes sense to you. Find a way to tell your story and own it.

Another thing to keep in mind is that mentors often find you and not the other way around. It’s fine to seek out people for support – never be afraid to ask for help – but also pay attention for someone to take an interest in you without you expecting it. Your biggest champion might not be the person you were looking for.

The last piece of advice I’d echo is to be honest about what success looks like for you. It might sound surprising, but I didn’t always want to lead an organization and I’m happy about that. I think if my whole end game were to reach this point, what would be left? There was definitely a point in my career when I felt I’d hit a wall and realized it was because I was so focused on getting a certain point up the proverbial ladder. Then, I ran out of rungs and didn’t have a plan for what was next. It turned out I was so focused on what mattered to other people that I forgot to check in with myself whether that was where I wanted to be. So, it sounds cliché but staying true to oneself is the best thing you can do!

Follow Loyce on Twitter at @GlobalGameChngr

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