To continue our interview series on the necessity of acquiring data on community health workers, this week the Campaign spoke to Julia Bluestone, Sr. Technical Advisor at Jhpiego and Chair of the Frontline Health Worker Coalition. A senior public health official and certified nurse-midwife, Ms. Bluestone has had 15 years of experience in international education and training implementation, working with national Ministries of Health and professional associations to improve national education and training efforts in African countries.
What are the most pressing challenges in the development of scale-up of CHW programs today?
The most pressing challenges are rationalization and harmonization of partners and approaches. The harmonization framework rightly points out the need for partners to align and harmonize so ministries of health can select a rational skill mix of health workers based on their national health priorities and burden of disease. When multiple partners support a variety of CHWs with varied skills and compensation (or lack thereof), scale up is not feasible. I see adherence to a core set of expected skills, with some room for variation, obviously, key for countries to be able to rationally determine how to involve CHWs in the community health team. What CHW skill set will best complement, support and extend services provided by nurses and midwives in communities? Health workers do not work in isolation but in team. The global community needs to work together to overcome gaps and fragmented program efforts. Policies and actions that are integrated and harmonized will undoubtedly produce greater results than if each partner acted on its own. Tapping into our synergy will facilitate sustainable scale-up.
Why is data on frontline health workers, particularly CHWs, important?
As a nurse-midwife, I think data on all health workers is critical. During my time improving health worker education and training efforts around the world, I have seen firsthand how access to properly trained frontline health workers can save lives and foster healthier, safer and more prosperous communities. As countries seek to extend service into communities, they need accurate data on their workforce. Without this data governments can’t make rational, data driven decisions. How many health workers do they have? What skills do they provide? How quickly do they turn over? How many do they need? All of this needs to be calculated into future health workforce projections. The answers to these questions are essential.
In your opinion, what type are the largest gaps in data on frontline health workers, particularly CHWs, right now?
The main challenge with CHW data is that unlike data concerning health professionals, CHW data is often not tracked at a central or national level. This means that governments are blind to what they have and don’t have available for their health workforce projections. And if CHWs are not counted at the national level, they do not count. If CHWs are not salaried, it becomes even harder to count them. I see the largest gaps being first in sheer numbers—questions such as, how many do they have, how long are they retained, what is the return on investment, and secondly being in varying roles and responsibilities. Some countries have established CHW cadres with a clear scope of work, but many do not, and without information on skill mix, governments can’t plan for their health workforce.
In what ways is your organization using innovative solutions to collect data on frontline health workers?
In Pakistan and in other countries, we are using tablets to collect data on CHW performance, including locations served and services provided. Mobile technology is a powerful tool that can support health workers, efficiently share information, track services and service coverage and support adherence to national guidelines or care protocols such as mother-to-child transmission of HIV, essential newborn care, pneumonia treatment and immunization. I think many countries are exploring use of mobile technology to support and track delivery of services and frontline health workers.
With better information and data, how could NGOs and governments overcome these challenges to improve CHW programs and programmatic decision-making?
As stated earlier, the harmonization framework and related monitoring and accountability framework does a lovely job of providing recommendations on CHW programs, and I won’t repeat them here. My bias, given my past work in health professional regulation, is that CHWs should have an agreed upon expected core competency set, and that set is used by countries as the starting point from which to modify and adjust competencies to meet their burden of disease. The ILO CHW competencies are a good starting point. I know that many argue that CHWs can’t be held to a specific set of skills, but understanding expected performance is critical for any decisions about appropriate skill mix for health teams. Countries that want to move services into communities will need to know what CHWs can perform and how they work with nurses and midwives on the health team. Having data on both numbers needed, and understanding how to rationally integrate CHWs based on national health needs is the cornerstone for improving CHW programs and decision-making.