The numbers speak for themselves. With 10,587 deaths recorded as of 5 April 2015, the Ebola crisis of the past 14 months is by far the worst outbreak of the disease the world has ever seen. Its speed and scale sent shockwaves around the world, revealing how vulnerable human beings still are in the face of an epidemic.
If anything kills over 10 million people in the next few decades, it’s likely to be a highly infectious virus rather than a war. Not missiles, but microbes.”
As a result, while efforts continue to manage the aftermath of the outbreak in the worst-hit nations of Liberia, Sierra Leone and Guinea, strategists, NGOs and global health organisations have been looking to identify the steps that need to be taken to minimise the impact of future outbreaks of infectious disease. Strengthening healthcare systems in the world’s poorest countries through improving resourcing, staffing and infrastructure is high on the agenda. Recent research by Save the Children found that 28 countries have health systems that are less robust than Liberia’s. And while access to resources, equipment and technology that would improve the speed and accuracy of record-keeping are important, many agree that adequate numbers of frontline community health workers, such as midwives, are essential to reaching this goal.
Yet with the World Health Organisation predicting that the shortfall of health workers globally could reach 13 million in the next two decades, it’s clear that radical action is needed to achieve the universal health coverage crucial not only to containing epidemics but preventing and managing everyday health challenges too.
One part of the solution may lie in a scheme pioneered by GSK in partnership with NGOs Amref Health Africa, CARE International and Save the Children. Since 2009, GSK has reinvested 20% of the profits it has generated in the world’s least-developed countries back into projects to help strengthen those nations’ healthcare systems. The programmes, developed with national governments, have helped train 40,000 frontline health workers in 35 countries – from Liberia to Tanzania, Nepal and Bangladesh - reaching 11 million people.
Investing in frontline healthcare workers increases and strengthens health outcomes.
“It’s a win-win situation,” says Ramil Burden, vice-president for developing countries at GSK. “Investing in frontline healthcare workers increases and strengthens health outcomes. It introduces remote areas into the healthcare system and mobilises communities who become more demanding of healthcare. We all benefit if more people have information and are integrated into the system. That’s why we do it.”
Burden cites the example of GSK’s and CARE International’s programmes in Bangladesh, where work with the community and government has meant that salaries have been introduced for midwives, relieving health workers of having to earn a living by other means. Only 3-5% of trained community midwives drop out each year. Communities have rallied to support the work, sometimes providing free transport for health workers and clubbing together to pay for services for those most in need.
“All of a sudden, the whole community and its infrastructure are supporting these women to do their jobs,” says Burden. “If you do it in the right way, you get this huge engagement and it can be sustainable in the long run.”
The importance of community buy-in is something that Dr Mohammad Anwar is well aware of. In his capacity as head of the health unit for CARE Afghanistan, Anwar has seen the value of taking healthcare into people’s homes in the GSK-funded Opportunities for Mother and Infant Development programme in one sub-district of Kabul.
“Cultural factors keep the women away from health centres,” he says. “This is a big obstacle. Community and family influencers are not allowing women to go to receive health services, so the first thing is to break this barrier. The frontline health worker, working house to house and through community meetings, is one of the successful strategies.”
The benefits are clear: in the three years of the scheme, the neonatal death rate in that area has dropped from 18.3 per thousand births to 12.2. The programme is now set to be introduced in another sub-district and CARE and GSK are in talks with the government about doing more to link the community and formal healthcare systems, increasing security for female health workers, improving drug quality and prices, and developing a good health financing strategy.
“Advocacy is a really important factor,” says Peter Kiyonga, the Humanitarian Assistance for Women of Afghanistan (HAWA) programme coordinator for CARE Afghanistan’s Women’s Empowerment Programme.
It’s part of supporting the government to build capacity for frontline health workers.
This could mean improving funding, training and recruitment for these workers.
This advocacy can be particularly effective when it’s backed by the industry expertise of the private sector. Advising on supply chain management and the latest pharmaceutical and technological innovations, partners such as GSK can help ensure that the necessary drugs and equipment are available to meet the growing demand that investment in health systems inspires.
As Simon Wright, head of child survival at Save the Children, explains, this combination of advocacy with tangible results can lead to lasting change. Together, GSK and Save the Children have supported training of more than 5,000 health workers across countries in west and central Africa, including Liberia and the Democratic Republic of Congo. They are also working together to advocate for governments and leaders to tackle inequality of access to healthcare.
“In a lot of countries, getting healthcare is something that only the wealthy can do and people just think that’s the way things have to be,” Wright says. “They live with that kind of obscene inequality. The moment you change that dynamic and people expect their government to provide healthcare they have very different conversations with their elected representatives, with government officials and even with health workers themselves.”
The effects can go right to the top. In December 2014, Nigeria’s then-president Goodluck Jonathan signed into law the nation’s first ever national health bill, affirming healthcare as a right that the government has a duty to provide, following concerted efforts by Save the Children and other NGOs. If other nations follow suit, the goal of universal health coverage could be much closer to becoming a reality.
Judging by the ease with which the Ebola epidemic could have spread, far more people stand to benefit from strengthened healthcare infrastructures than just those in the world’s poorest regions.
We need to remember that weak healthcare systems in parts of the world such as west Africa have an impact globally. It’s in all our interests to tackle this.
This feature first appeared on The Guardian - www.guardian/gsk-change - as part of a series exploring global health challenges.
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