One Million Community Health Workers

This week in our Data for Decision Making Series, we interviewed Michael Bzdak, Ph.D., Executive Director of Corporate Contributions at Johnson & Johnson. Dr. Bzdak is responsible for driving the company’s strategy around strengthening the health care workforce, manages its volunteer support program, and oversees philanthropic support of K-12 education. He serves on the New Jersey Governor’s Advisory Council for volunteerism and community service and on the advisory board for the 1mCHW Campaign. Dr. Bzdak is also a visiting part-time lecturer in the School of Communications and Information Studies at Rutgers University and an adjunct faculty member at New York University.

1. What are the most pressing challenges in the development of scale-up of CHW programs today?

While there are many projects in existence today, the evidence base on “what works” is not always being used to scale-up the most effective programs. Additionally, we are missing critical information on the existing health workforce. I am concerned with the WHO Global Health Observatory report that 53 of 186 countries have fewer than 7 annual data points on midwives, nurses and physicians across the past 20 years – let along information on CHWs. When you look at data reporting on overall health workforce, you see an overall lack of standard definitions and of registry. There is also no real standardization of training across the board for CHWs, nor is there any validation or accreditation on what it means to be a CHW. This information is so important when it comes to understanding country health workforce needs and filling the gaps. We have the ability to remedy some of these challenges if we use all of the intelligence available to us, such as information on labor economics and other disciplines, to inform the appropriate scale-up of CHW programs. I also contend that the private sector has a great deal to contribute to this dialogue.

2. Why is data on frontline health workers, particularly CHWs, important?

The data on frontline health workers is essential as it gives us a view to where they are working and how effectively their skills and services are utilized within the community and health systems. Overall we do not have enough data, so we have to better understand who does have access to data and how it is being utilized. Programs like the Operations Room, for example, are critical as they provide everyone a democratic view of the current situation involving CHWs. I am also encouraged by the recent Health Measurement and Accountability Post 2015: Five Point Call to Action put forward by the World Bank, USAID, and WHO, which commits to a strategic approach to strengthening country health information systems.

3. In your opinion, what type are the largest gaps in data on frontline health workers, particularly CHWs, right now?

One of the most important gaps today is the lack of raw numbers of CHWs. Another issue is that the data that we have does not provide an accurate view, for most countries, as to the pipeline of frontline health workers. While we do have this information on traditional doctors for many countries, including what factors affect their retention currently, it is not mapped out where CHWs are on this chain. For example, in Kenya we know that, because of attrition and migration, we have to train three doctors to get one practicing doctor. However, we do not have this information for other cadres of health workers. By knowing this information, we can strengthen training and development plans to improve retention, and more effectively utilize and direct resources.

4. In what ways is your organization using innovative solutions to collect data on frontline health workers?

At Johnson & Johnson, in addition to our role as a funder, we view our role as being a convener. We work to bring together various organizations doing great work separately to spark new collaborations that can bring forward further innovations to use data to strengthen health systems.

One of the projects that Johnson & Johnson is working on involves bringing together education workforce and health workforce organizations. For example, we facilitated a meeting between IntraHealth and FHI 360 to create an avenue in which the skills and data sources that FHI 360 was using in their analysis of education in Kenya could be applied to issues in the health workforce. IntraHealth’s nurse leadership program will also be enhanced with knowledge from the Touch Foundation’s work in Tanzania and by building capacity utilizing the experience of many partners.

Currently, we are at a juncture where global health funding is changing at the same time that we are seeing an increased focus on producing, sharing and using health data. Many countries that have been recipients of aid are graduating from low to middle-income status. Their local governments are now beginning to manage the various programs on the ground and determining for themselves how funds should be allocated. This means that the call for well-trained professionals and for tools to plan, implement, and monitor health delivery, is critical.