At the Source of Health Care, Health Workers

This post was originally published on VITAL, the blog of IntraHealth International.

Malik JafferMalik Jaffer is the deputy director of human resources for health and health systems strengthening for the IntraHealth International-led CapacityPlus project. I recently interviewed him about health worker heroes and what it’ll take to make more of them.

You’ve met a lot of amazing health workers over the past 20 years. Any who really inspired you?
Absolutely. For example, there’s a team of health workers in Soweto, South Africa, that work in a hospice. When I visited, the facility was full of men and women and a lot of children. I remember one baby that was suffering from AIDS. She looked about three months old and weighed only 10 or 12 pounds. She was tiny. But I came to find out she was a year old.

Those doctors and nurses at Soweto Hospice would frequently go out in the middle of the night to bring in people who were as sick as that baby girl. They worked with families—mothers and fathers and brothers and sisters—all in this situation. And they advocated strongly for access to HIV medication and access to a multidisciplinary team of health workers.

I had tears in my eyes because I thought that when I left this baby, it was the last time I was going to see her.

Months later, when I went back to the hospice, I asked about her. And nobody said anything. Instead they took me into the pediatric ward and there she was. She was alive, and not just lying on the bed, but standing and smiling. She had put on weight and I could hold her in my arms. She was a ray of sunshine. She was hope. She was everything that you want everything to be.

And it was all because she had access to people who were well-trained, in the right place, and dedicated to providing high-quality health care. We could see more health workers like this team if we create stronger health systems in countries around the world.

How do you think we can we create stronger health systems worldwide?

By helping health leaders have the information they need to make decisions. Health leaders—whether it’s a nurse running a clinic or a national-level manager—tend to make decisions about their human resources without adequate knowledge. For instance, they often don't have the right type of health workers posted in the right places. One clinic may need a nurse that specializes in tuberculosis, but there’s no one posted there with that specialized training.

Leaders don’t necessarily know the local disease patterns and without staffing databases, they don't necessarily know what staffing they have to draw upon. That’s where our iHRIS open source software or our leadership in management training really make a difference.

But how can data lead to better health care?

Here’s an example. In Accra, Ghana, the Ministry of Health and the Ghana Health Service will soon start entering records for some 10,000 health workers into iHRIS Manage. This will allow them to map all of the human resources in the area. In Ghana, approximately 40% of the entire health workforce is in the city of Accra, which means health care in other parts of the country is hard to come by.

Once leaders can see that workforce distribution, they can allocate staff according to disease patterns and vacancies and populations’ needs. They'll also be able to identify ghost workers (people who are no longer employed but are still receiving paychecks) and advocate for additional funding. CapacityPlus is providing technical assistance to roll out iHRIS and use data from the system. So my colleagues and I are empowering governments like Ghana’s to make choices based on data and evidence, rather than guesses and assumptions.

What are some other, lesser-known ways we could help health workers provide better care? 
One is by addressing the issue of stress. Based on the literature, we know that stress in health workers is higher than the population average. We also know that female health workers experience greater stress than male health workers. And we know that, particularly in Africa, the majority of nurses and community health workers are women.

So when we consider that the World Health Organization says that as much as 40% of all disease is attributable to stress, we realize that it’s a huge threat to these workers’ health, not to mention the care they provide for others. Health workers have heavy workloads, high mortality rates, and high illness rates. And many of them work in suboptimal—even dangerous—working environments. So the individual health toll can be dramatic.

We tend to see the health worker as separate from the patient. But health workers need safety and health care, too, and we should do more to give it to them.

Malik Jaffer has over 20 years of civil society, government, and private-sector experience in management, strategic planning, systems strengthening, human resources, and building alliances. Before joining IntraHealth, Jaffer served as the senior technical advisor for USAID/Southern Africa.

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Photo courtesy of Malik Jaffer