About: Kathryn Campbell

Dr. Amal forms part of the first (of two) mobile health teams that support ten health centres in four districts in Amran. She has worked for Save the Children for two month. (Ala’a Aleryani / Save the Children)

 As part of Save the Children’s life-saving work in Yemen we are responding to the chronic lack of health workers and health facilities by providing child focused health and nutrition services in 19 sites across Amran.  Dr. Amal forms part of one of these teams that support ten health centers in four districts in Amran.  

Malnutrition levels remain critical in Yemen

Political instability, conflict, fuel shortages and high food prices have left almost 10 million people without enough to eat and 967,000 children’s lives at risk.

Malnutrition rates amongst children under-five are escalating beyond emergency levels – in some areas over a quarter of all children are malnourished.^[1]  Children across Yemen are suffering from malnutrition are more likely to become ill with diarrhoea, pneumonia, malaria, measles and AIDS.  Malnutrition compromises a child’s immunity so that an episode of illness tends to last longer or be more severe.

Chronic under-funding, mass displacement of people and a prioritization of urban over rural delivery of health services have left the most vulnerable people in remote regions without access to lifesaving care.

Currently in Yemen there is one health center per 30,000 people. After conducting a health facility assessment in Amran and Sa’ada governorates (two of the conflict-affected areas of Yemen), Save the Children found that 80% of facilities could not provide basic health services due to the lack of medical equipment, drugs, health staff, and furniture. Read more

Guest post: Oying Rimon, The Bill and Melinda Gates Foundation, Impatient Optimists

Around the world, frontline health workers are often the first link to lifesaving care and supplies, and in some cases they are the only link for families and communities in rural and impoverished areas. This is also where most of the world’s unmet need for family planning resides. More than 200 million women in developing countries want to delay or avoid pregnancy but lack access to modern methods of contraception.

Family planning and frontline health workers: worth the investment

In just a few short weeks, the foundation, together with the UK government and other partners, will host the London Summit on Family Planning. It will be a groundbreaking global convening of developed and developing country government and civil society leaders, who will pledge to address the contraceptive needs of an additional 120 million women in the world’s poorest countries by 2020. The summit will also focus on tackling cultural barriers to contraception and encourage countries to adopt a rights-based approach, which enables women to decide whether, when, and how many children to have. At the foundation, we often talk about how frontline health workers and family planning are extremely cost-effective strategies to save lives, and improve health and development broadly. For instance, every three seconds a child’s life is saved thanks to the care provided by a frontline worker (PDF), who can be provided basic training for as little as $300 (U.S.). Likewise, investing in family planning services has a proven cost-benefit return for both developing and developed country governments, and addressing current unmet contraceptive need could prevent one in three maternal deaths and one in four infant deaths.

A personal connection

For me, frontline health workers are not just a smart investment, but also a community I feel personally committed to. Back in the 1970s, one of my first jobs was as manager of a national family planning program in my native country of the Philippines, which included more than 4,500 outreach workers and 50,000 community-based volunteers providing information and services to couples in their neighborhoods. I met with many of these highly committed community-based workers and saw first-hand how crucial a role they played for the country’s population, nearly half of which resides in urban slums.

In the Philippines, this first-string of health providers, mostly midwives and barangay (village) health workers, fills the gaps of an overwhelmed healthcare system and provides critical health. As of 2012, contraception use in the country, which is 80 percent Catholic, is just 34 percent. Yet current political leadership is committed to bringing family planning services closer to the people. Recently, I was on a personal visit there and was pleasantly surprised to see many of the same individuals I used to know, still working for their communities–although many now qualify for senior citizen discounts!

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Guest Post: by Laura Hoemeke, IntraHealth International

During last year’s International Conference on Family Planning, IntraHealth promoted health worker empowerment with the slogan “Family Planning: It Takes a Health Worker.” We had the phrase printed on posters and buttons, proudly displayed at our booth and on our lapels. We posited that all of the contraceptive technologies in the world will not make a difference if there are not skilled health workers to deliver them. Visitors to our booth, seeing our theme, sometimes laughed and said, “Well, technically it doesn’t take a health worker to put on a condom or promote abstinence.”

Health worker with supplies in a clinic near Dakar, Senegal.

During the conference, I responded — and continue to assert — that it does take a health worker, or more accurately millions of health workers, to meet the need that hundreds of millions of couples worldwide have for family planning. It takes a health worker not only to administer most modern methods of contraception but also to provide counseling and services in a holistic way, and to offer reproductive and other health services throughout the life cycle of both women and men.

A new report issued by the Guttmacher Institute and UNFPA this week, Adding It Up: Costs and Benefits of Contraceptive Services—Estimates for 2012, supports that notion. Guttmacher and UNFPA released the report in preparation for next month’s Family Planning Summit to be held on July 11 in London with the support of the Government of the United Kingdom and the Bill & Melinda Gates Foundation. The summit aims to mobilize new partners and more resources to address family planning needs, especially in the developing world. Labor — or salaries of health workers — currently accounts for an estimated $0.7 billion of the $4 billion spent on family planning in developing countries in 2012, but we need to invest more, globally, to ensure that health workers are there to expand access and offer services. At IntraHealth, we truly hope that the summit also will focus on the need for health workers — not only in numbers but also in training, deployment, and ongoing support.

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Louise Holly, Save the Children United Kingdom

This Saturday, May 5, is International Day of the Midwife. It’s the prefect opportunity to acknowledge the vital work that midwives do around the world each and every day.

Catherine, who works at a special care baby unit in Nigeria, gives an insight into one day in her life in this video:

Performing miracles

Even in the most difficult circumstances, midwives everywhere are performing miracles to support safe deliveries and ensure that babies have the best start in life.

The world needs more midwives and governments need to do more to ensure that midwives everywhere are supported to do their jobs effectively.

Read our report Missing Midwives to learn more about the global shortage and the actions needed to address it.

British midwives help to Build it for Babies

This week I had the opportunity to meet up with a group of British midwives who are supporting our Build it for Babies campaign to raise funds for seven health clinics in Bangladesh.

It was impossible not to be impressed and inspired by the enthusiasm and commitment that each of the women had for providing the best possible care to mums and babies. Our discussion confirmed my assumption that being generally lovely must be part of a midwife’s job description.

Supporting midwives abroad

Watch our slideshow of midwives at work across the world

What was even more amazing was to hear that not only do the midwives do an amazing job delivering babies in the UK, but many of them are also volunteering their time to train and support midwives in other countries too.

They talked about the contrast in the midwifery services available in the UK with those available in countries like Bangladesh, Sierra Leone, Liberia and Ethiopia.

For many women in these countries only the most basic care is available at what can be the most dangerous time in the life of a mother and her newborn baby.

Missing midwives

There’s a global shortage of at least 350,000 midwives and this means that many women and babies die from complications that could be easily prevented by a health worker with the right midwifery skills, equipment and support.

By supporting our Build it for Babies campaign you can help ensure that seven new maternal health clinics in the north east of Bangladesh are fully staffed.

By doing so, you’ll help more than 3,500 newborn babies each year survive their first crucial weeks of life.

You can also show your support for #midwives and other #healthworkers on May 5 (and every day!) through your social media channels.

Visit our virtual clinic to buy anything from a stethoscope to a midwife’s salary for our Build it for Babies appeal

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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• 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

Our first health centre was at Baiima, it is one of 35 where we have trained staff and community volunteers and completely refurbished and re-equipped the health centre.

The chief proudly told me that ‘our future leaders are being born here’.

Despite reports of drugs getting stuck at ports and there were many of the drugs you would expect to be available from asthma treatment to antibiotics – as a mother of a 5 year-old, I reflected that I had used them all at some point.

The health worker effect

We moved on to Levuma and encountered two beautiful and healthy newborns with their mums – safely delivered just hours ago.

This is a real turnaround from 18 months ago as previously these women had no-where to go and no skilled help on hand.

But whilst Levuma gave me a real sense that women and children have much better life chances it also reminded me there is still so much to be done.

A mother who was chatting with us at a community meeting proudly handed me her 5 month old sleeping son, her delightful baby Abou.

Saving a child

But within a few minutes I realised this child was really sick – his breathing was too rapid and he was in a stupor.

I asked the Save the Children midwife who was travelling with us to examine him, she instantly diagnosed him with pneumonia.

His mother was oblivious which is shocking and sad but with the low levels of educated women we probably shouldn’t be surprised.

Thanks to the Save the Children midwife, little baby Abou escaped one of the biggest child killers,  right there and then in this remote outpost she had almost certainly saved his life.

Content by Tanya Steele – Save the Children UK

Friday 21st October

In Nepal, Banas Ram and his wife Khetrani were blessed with a baby boy after 20 years of marriage but their happiness had a complicated twist. Khetrani was brought to the hospital in a bullock cart from her village almost an hour away from the health post in Dhodari in Bardiya district. Her baby had suffocated and the placenta had already detached.

Auxiliary Nurse Midwife Pushpa and Jhamkali, Maternal and Child Health Worker helped her give birth but the baby was not breathing. While Pushpa worked on saving the mother, Jhamkali started cleaning the baby’s wind pipe. After being assured that the mother would live, Pushpa and Jhamkali started resuscitating the baby with ‘bag and mask’ but could not revive the baby after 20 minutes. They didn’t give up. With permission from the father who was waiting outside the labour room, Pushpa decided to try for another 15 minutes.

The baby started breathing and crying after 35 minutes of resuscitating. The two health workers immediately called an ambulance to avert any danger to the baby. Pushpa went along with the mother and father to the Bheri Zonal Hospital, the biggest hospital in the region at 1 in the morning, admitted the baby at the Neonatal Intensive Care Unit to make sure that the baby got the best possible chance at living.

This is why we need more health workers, better trained in every village so that ever baby born has an equal chance of surviving.

Photos and text by Sanjana Shrestha.