“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.