Monthly Archives: November 2011

Successful advocacy often happens when the same issue can be raised at different levels of decision making.  Recently, I was in Bangladesh and spent time with VSO partner the Health Rights Movement Bangladesh (HRMB). I was able to see an example of this joined up work at different levels.

At a national level, HRMB lobbies for an increase in the recruitment of health workers and improvements in the terms and conditions so that nurses, midwives and others stay in the profession.  However, the biggest problem is the unequal distribution of health workers in rural and urban areas.

“Trying to get doctors to stay in rural areas is like trying to make a river flow upstream,” Nitai Kanti Das, of HRMB told me.  However HRMB have achieved some successes: “After some research with health workers, we made a recommendation to the ministry… if health workers stay three years in a rural placement, then the state will pay for further education”. The Ministry of Health has put this in action.

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By Emily Wooster: November 9th, 2011

Travelling around Cambodia to talk to health workers for the Valuing Health Workers research, I was often puzzled at how each hospital or health centre had communicated the research and our presence, to their staff.

When we arrived at the first hospital, we were met with surprise and also a hint of trepidation – it was interpreted to me that the staff weren’t expecting us. I looked at my colleague expressing silent surprise; remembering the previous meeting we had with the hospital director, arranging the day and time.

However, the director kindly accommodated us into his working day and we were sent off to find people to talk to. When we finally got a small group of nurses together, I explained the purpose of the research and that everything they told us would be anonymous and confidential.

When the group of nurses started to talk about their day-to-day working lives, the low and late disbursement of their salaries, the lack of equipment and drugs and how they had worked without electricity, we soon forgot about our sweaty backs, lack of sleep and the 11-hour journey to get there.

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The UN estimates that there is currently a gap of 3.5 million health workers in low-income countries. Skilled health workers are desperately needed there. However, skilled and fully trained workers require extensive training and support as well as functioning health systems to work in – which takes time. Some people don’t have that time. Health care is particularly scant in rural and indigenous communities where there are no or under-resourced health facilities, most notably for maternal health and childbirth. This is where the work of Health Poverty Action comes in; we support communities which have usually been forgotten by their government’s development of health services. With only four years left for the Millennium Development Goals there is somewhat of a last minute panic to achieve them. But – apart from many countries not being able to achieve the goals – all that is required is submit overall national figures. Unfortunately this does not reflect the marginalisation of rural and indigenous communities who have little or no access to health care. Health Poverty Action has been working alongside those poor and marginalised communities in developing countries to train Traditional Birth Attendants (TBAs) to ensure that every mother is getting a fair chance. Read more

By Katy Woods, Global Mobilisation Coordinator, The White Ribbon Alliance for Safe Motherhood

As I arrived into Entebbe airport, the grin grew across my face as I was greeted by the warmth of the African sun and the Ugandan smile.

One more reason to grin is that I am back in the ‘Pearl of Africa’, in part, to record a success story. Since launching a district level campaign to promote recruitment and retention of midwives back in May, WRA Uganda has seen impressive increases in the numbers of health workers with midwifery skills.

In Kabale, a district on the border with Rwanda, and a tourism hotspot for gorilla trekking, women walk for 5 hours over extremely rough terrain, impassable by standard public transport, to get to a health clinic. They could hire the jeeps, common to ‘muzungo’ tours, but the cost of this is more than a whole month’s wages for many.

So they walk… and when they get to the clinic they need to be in luck to be met by a midwife. There should be 89 midwives in the region according to government indicators and before WRA began its campaign, there were only 12.  Due to intense advocacy work by the members in the region and engagement with key players such as the District Health Officer, Dr Patrick Tusiime – the number of midwives deployed has trebled in just 6 months. It’s a huge achievement – but celebrations can’t start too quickly when it is understood that this is still less than 50% of the required amount. All the same, it is much needed progress.

Barely two months ago, President Museveni made a commitment on the world stage to the mothers and children of Uganda at the UN Secretary General’s Strategy for Women and Children. He promised that his government would ‘ensure that comprehensive Emergency Obstetric and Newborn Care (EmONC) services in hospitals increase from 70% to 100% and in health centers from 17% to 50%’.

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• Pneumonia kills 1.5 million children under five every year; that’s one child every twenty seconds.
• There are affordable, proven solutions: we know that education about breastfeeding, early diagnosis and vaccines can stop children dying and that all three require ready access to trained health workers.
• There is thus no excuse why pneumonia continues to claim so many lives; urgent action is required to put an end to this situation.

On November 12^thSave the Children is joining forces with the Global Coalition against Child Pneumonia to mark World Pneumonia Day, calling for governments to take decisive and urgent action to address this critical issue. Pneumonia is the single biggest killer of children in the world today, claiming the lives of 1.5 million children under five every year, and yet preventing and treating it is simple and cost effective. It isn’t happening because vital health workers are either not in place or they lack the antibiotics and training to be effective. Read more

Content: John Butler, Save the Children International

At the United Nations General Assembly, Government leaders, the private sector and civil society united to make commitments on health workers to ensure that mothers and children live through child birth.

Challenges like this are not won in New York though and we know that to ensure success, concerted high level advocacy must be conducted continually at the international, regional, national and local level. It is important that at every possible juncture, the health workers count ensures that for the health Millennium Development Goals to be met; health workers are the critical component.

The Commonwealth Heads of Government Meeting offered a different opportunity to the UNGA. While political commitments are rare, there is greater space and capacity for organised coalitions to leave their footprint. Working in coalition with groups like the End Polio Coalition and the Commonwealth Youth Forum ensured our access to key meetings with leaders where we discussed the role of health workers and the need to ensure that the 3.5 million gap in health workers is closed. Polio eradication was discussed in great length and the health workers count ensured that leaders understood the link between eradicating polio and the need to have skilled health workers to administer immunisations.

We came into CHOGM with an inspirational health worker from Nigeria, a country which has 816,000 child deaths a year. Catherine Ojo (pictured below), is Save the Children’s Midwife of the Year and one of the strongest advocates I’ve ever met. Whether she was speaking to the CHOGM host Prime Minister, Julia Gillard, her own President, Goodluck Jonathon, or as warm up to Foreign Minister Kevin Rudd at a festival of 5,000 people; Catherine personifies the power of skilled health workers to save lives. She’s seen the devastation of a baby or their mum dying in child birth and she’s also saved children and mothers from certain death against the odds. The calm determination she possesses to save children in Zaria, northern Nigeria, is matched by her ability to speak to leaders about the need for them to increase the number and improve the quality of health workers across the world.

Catherine’s conversations with the leaders from across the Commonwealth underlines the importance that world leaders are giving to the health worker issue and with the messages and quotes below, we have the building blocks to ensure that these leaders are champions for health workers to ensure the 3.5 million health gap is closed and child and maternal mortality is consigned to the history books. Read more

Commonwealth Heads of Government Meeting in Perth has shined a light on the need for more health workers, better supported.

But vaccines don’t inject themselves.

In order to protect babies and children from the diseases, illnesses and conditions that claimed more than 7.6 million lives last year, we need more than just vaccines. We need health workers.

Health workers, properly trained, supported, equipped and paid, can prevent most child deaths. They play a central and critical role in improving access and quality health care for a population. Health workers are the backbone of healthcare – essential for diagnosing illnesses, dispensing treatment, assisting at births and providing immunisations to children.

In short, there is no health care without health workers.

Excerpt from Save the Children Australia’s CEO Suzanne Dvorak on ABC’s ‘The Drum’. Read more

Related blog by Nicole Cardinal – Rock Stars Catherine and Kevin Rudd Supporting Health Workers to End Polio