Frontline Health Workers: Key Players in Disease Outbreak Control

THE ROLE OF THE FRONTLINE HEALTH WORKER IN CONTROLLING DISEASE OUTBREAKS Andrew Kitua

FRONTLINE HEALTH WORKERS: DEFINITION Frontline health workers : The ground soldiers and backbone of effective health systems; Key to achieving universal health coverage The core foundation of the intelligence for disease and disease outbreak prevention. Link communities to health care facilities and speak for the comminities Definition. Community Health Workers (CHWs) are trusted, knowledgeable health personnel, come from the communities they serve, bridge cultural and linguistic barriers, expand access to coverage and care, and improve health outcomes.

THE ROLES OF FRONTLINE HEALTH WORKERS KEY TO UNIVERSAL ACCESS TO HEALTH SERVICES: Expertise, care and efficiency CORE OF OUTBREAK AND DISEASE INTELLIGENCE : They look and listen on behalf of the rest of the health care team FUNDERMENTAL TO HEALTH EDUCATION, ADVOCACY AND CHANGE OF BEHAVIOR AND PRACTICES: communication channel and instrument of health care implementation

ROLE IN UNIVERSAL ACCESS TO HEALTH SERVICES Provide families and communities access to proven, cost-effective, affordable lifesaving care: Access to proven interventions to prevent and treat infections Increase coverage of vaccines Ensure healthy outcomes for mothers and newborns Reach most remote and hard to reach communities Therefore they must be supported to maintain high standards in Expertise, care and efficiency

FUNDERMENTAL TO HEALTH EDUCATION, ADVOCACY AND CHANGE OF BEHAVIOR AND PRACTICES Communication channel Clear interpretation of messages Trusted and belong to communities: Build trust and service acceptability Instrumental to behavior change Instrumental to Implementation of Essential Interventions

CORE OF OUTBREAK AND DISEASE INTELLIGENCE PRESENT, LIVE AND WORK WITH THE COMMUNITIES Have ears on the ground to listen on behalf of the rest of the health care team -Rumors and early outbreak signals, community News -Alerting the health system Have the eyes and can see happenings First hand impression of events Act and provide the initial actions at source prevent spread, care for victims, prevent panicky, guide communities

FRONTLINE HEALTH WORKERS ROLES IN APPLYING THE ONE HEALTH APPROACH Building the intelligence to prevent emergency of diseases and outbreaks Stop outbreaks at source - multi-sectoral concerted actions involving a minimum of environment, animal and human sectors. Requires extending their roles to - Environmental intelligence and data collection (TO ENABLE trends and predictions of extraordinary weather and environmental changes) - Linking with Veterinary and wildlife frontline workers How can we forge MULTISECTORAL Linkages and Coordinate the intelligence DATA ANALYSIS/INTEPRETATION AND COMMUNICATION ?

CURRENT PREDICAMENTS OF FRONTLINE HEALTH WORKERS POORLY RESOURCED IN TERMS OF HUMAN RESOURCE DEVELOPMENT - Poorly paid - Inadequate training - Inadequate supervision and field support - Often not recognized and not paid. Voluntary services providers

CURRENT PREDICAMENTS OF FRONTLINE HEALTH WORKERS POORLY RESOURCED IN TERMS OF EXPERTISE, CARE AND EFFICIENCY - Not assured of standard Equipment and tools to perform their work safely - Provision of personal protection poor - Not well equipped and supported to adhere to SOPs

PREVENTION MEANS ADDRESSING THE CAUSE OF INCIDENCE PERCEIVED VALUE AND POSITION OF PHC AND FRONTLINE HEALTH WORKERS IN HEALTH SYSTEMS VALUE, ATTENTION AND RESOURCE ALLOCATION IN HEALTH SYSTEMS CENTRAL CENTRAL DISTRICT DISTRICT COMMUNITY COMMUNITY

SUCCESS STORIES: ETHIOPIA Ethiopia s new program has trained more than 38,000 frontline health workers. Results: -doubling of the rates of young children who have been immunized, treated for pneumonia, and given vitamin A to prevent blindness and build their immune systems. -Four fold rise in the use of modern contraception - Reports from the communities indicate that not only are children healthier, they are also doing better in school. -Children s ability to concentrate in class has improved and they miss fewer days of school due to illness.

SUCCESS STORIES: MALAWI Malawi, improvements in the survival chances of children can be attributed in part to the health promotion work of more than 10,000 health surveillance assistants who are deployed in rural areas of the country. Trained, salaried outreach workers deliver preventative health care such as oral immunizations, treat common killers like diarrhea, pneumonia and malaria, and care for mothers and babies before and after birth. Use of Ambu bags and penguin sucker for asphyxia They are key to promotion and provision of contraception, which is helping to reduce maternal and child death rates, and also reduce the numbers of children born HIV positive. They are key to promoting voluntary counseling and testing for HIV and to providing treatment for children and parents who are affected. Malawi, has reaped enormous rewards for its smart investments in frontline health care by cutting its under-5 death rate by more than half since 1990.

SUCCESS STORIES: CUBA Life expectancy is 78 years and infant mortality rate is 4.2 per thousand births. Cuba is the best performer in America and in the Third World. Cuba s health care system is based on preventive medicine and the results achieved are outstanding, Despite extremely limited resources WHO Director General Cuba is the only country that has a health care system closely linked to research and development. This is the way to go, because human health can only improve through innovation, In 2013 Cuba inked a deal with the Brazilian Health Ministry to send 4,000 Cuban doctors to underserved regions of Brazil by the end of the year worth as much as $270 million a year

RATIONALE FOR PRIORITIZATION AND RESOURCE ALLOCATION The 2010 United States National Security Strategy calls for strengthening health systems and investing in global health interventions as crucial to counter security threats. Investments in Frontline Health Workers Promote National Security and Economic Growth Healthy populations are more associated with productive, prosperous, and peaceful nations, while countries with poorer health are more associated with instability and conflict, terrorism, and dictatorships.

WAY FORWARD Learn that poor access to health care does not only arise from lack of resources. It rather reflects, a lack of political will on the part of leaders to protect their most vulnerable populations GET HEALTH ENSHRINED IN OUR CONSTITUTIONS AS A HUMAN RIGHT Urge countries to invest in PHC and build an army of Frontline Health workers to save money by preventing diseases and ill health hence invigorate economies WE MUST DEVELOP EFFECTIVE STRATEGIES TO BUILD SUFFICIENT NUMBERS OF TRAINED FRONTLINE HEALTH WORKERS LEARNING FROM SUCCESS STORIES

TANZANIA Hosting the One Million Community Health Workerws in Tanzania, the deputy minister for health stated We have to recognise that advances towards the Millennium Development Goals (MDGs) can be greatly accelerated by urgently expanding primary health care service delivery capacity across Sub-Saharan Africa. Community Health Workers are foundational to this strategy Beyond just improving health outcomes, they give their communities a voice and a connection to local government It is essential that we increase and support community health workers who form an essential link in service delivery between the primary health facilities and the communities They are the unsung heroes of our success whom we have been taking for granted for many years. http://www.who.int/bulletin/volumes/91/11/13-118745/en/ It is the responsibility of every national government to establish guidelines for scaling up CHW programmes that respond to local needs and realities. USAID :Health Workers Are the Unsung Heroes of Global Health Progress

DEFINITION Many are community health workers and midwives, though they can also include local pharmacists, nurses and doctors who serve in community clinics near people in need. They are the first and often the only link to health care for millions of people, are relatively inexpensive to train and support, and are capable of providing many life-saving interventions.