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Today we know how to eradicate polio, how to tackle malaria, how to ward off maternal deaths. We can even see our way to an AIDS-free generation.
These are things we couldn’t say 50 years ago—or in the case of AIDS, even 10 years ago.
Still, we’ve got a long way to go. One billion of us live below the poverty line, with little or no access to basic health services. We need greater coordination, economic stability, and stronger health systems before universal health coverage will come into view.
And new challenges are looming. As our life expectancies rise and economies grow, so do rates of noncommunicable diseases such as cancer, heart disease, and stroke. The World Health Organization estimates that in Africa, diabetes deaths will increase by 42% over the next 10 years. In fact, WHO says deaths from chronic diseases will outstrip those from infectious diseases, maternal and perinatal conditions, and nutritional deficiencies more than four-fold, killing 28 million Africans in a decade.
Our ability to finish the work we’ve started with polio, malaria, and other communicable diseases—and to prepare for the work ahead—depends on the individuals who work at the front lines of health care, and those who work behind the scenes to support them.
IntraHealth International and other organizations that focus their efforts on the health workforce are part of a growing field called human resources for health, or HRH for short.
HRH is not a sexy term. The field’s name and acronym have an unfortunate tendency to obscure its significance for those who don’t spend their days thinking about it. It’s difficult to see where people fit in. But in fact, people are the very definition of human resources for health.
HRH boils down to this: Human beings are the most valuable resource we have when it comes to fighting disease and improving health. They can be nimble, efficient, brilliant. But they can also be overworked, undersupervised, and lacking in up-to-date knowledge and skills. For health workers—that is, the human resources in HRH—to be effective, the health sectors in which they work must be solid.
The World Health Organization estimates a global shortage of at least 7.2 million doctors, nurses, and midwives today. We need strong political leadership to train and support more of them. We also need to make the most of those we have. That means making sure health workers are where they’re needed most, and making sure they have access to the training, tools, and resources they need.
New technology is making this easier than ever. Today, a midwife in rural Guatemala can reach out to faraway colleagues for advice. A clinic manager in Senegal can track the use of essential drugs and supplies. And a state official in Laos can see where all the country’s pharmacists are situated with just a few keystrokes.
Such technology means that investments in human resources have never been more cost-effective, or extended farther into the hard-to-reach places of the world.
Say a government realizes that illness and preventable deaths are keeping its population from thriving economically. So it decides to really beef up the country’s health system—make sure clinics are stocked and staffed, recruit new workers—the whole nine yards.
Before the government can do any of that, it needs information.
How many health workers are in the country? Where are they? Are they working where they’re most needed? Or are they clustered in the cities, turning rural areas into health care deserts? What services are they qualified to provide? Are they licensed and registered? Is their training up to date? Does the country need more health workers? Where and of what types?
These are powerful data points that many countries simply don’t have. But digitized, streamlined human resources information systems are offering governments the tools to capture these data, analyze them, and use them to plan and budget for their health sectors.
iHRIS (pronounced “iris”) is one such tool. It’s a suite of free, open source software applications that IntraHealth has been developing over the last 10 years, most recently through the U.S. Agency for International Development-supported CapacityPlus project. iHRIS helps countries around the world to gather, wrangle, and control their own health-sector data.
These information systems take the place of the scattershot, paper-based filing systems that fill entire rooms in many health facilities and government buildings. Using iHRIS, government officials and clinic workers alike can easily find, share, manage, and update personnel files. The software is customizable, so users can tweak it to fit their own data needs. It interoperates with other information systems such as OpenMRS and DHIS 2. And technologists in-country are learning to use and maintain iHRIS, cultivating a thriving community of pros who can collaborate internationally.
So far, 19 countries are using iHRIS to track over 950,000 health worker records worldwide. It would have cost these countries $177 million in licensing fees alone to do that with proprietary software.
These tools are allowing low- and middle-income countries to take control of their health sectors sustainably and make sure care is available where it’s needed most.
Health workers are lifelong learners. They have to be, given how quickly their field changes.
But for those stationed in remote areas, mid-career classroom learning is often impossible. There are logistical challenges—who will staff the clinic while they’re gone?—as well as insurmountable travel expenses. As a result, both health workers and their clients often miss out on any benefits that come with new techniques and best practices.
Fortunately, eLearning is changing that. The Global Health eLearning Center, for example, and CapacityPlus’s HRH Global Resource Center—both funded by USAID—offer free, high-quality eLearning courses on global health, HRH, health informatics, health service delivery, and more.
And the Ministry of Health in Kenya is now using eLearning to conduct orientations for new health sector employees, cutting down on the expense and time it takes to orient new health workers.
The eLearning industry is expanding. Self-paced eLearning is growing annually at a rate of 15.4% in Africa and 17.3% in Asia. Computer-based training allows health workers to update their skills on their own time and at their own pace.
And their communities reap the benefits.
Imagine you’re the only nurse—or maybe even the only health worker—in a village in rural India. You’ve got no boss, no colleagues to support you, no one to offer you advice on tough cases. You can’t leave town to update your training, because that would leave the clinic unstaffed and anyone who needed urgent care would have no one to turn to.
Now imagine how a simple mobile phone could change that.
Not only are mobile phones connecting health workers to faraway colleagues and new communities of practice, but the devices are also helping workers provide better health services during their interactions with clients.
Mobile health, or mHealth, is the growing practice of using mobile devices to support health care. There are mobile apps that help clients remember their clinic appointments or to take medication. And there are apps for health workers too, which help them to update their training, make diagnoses, or get in-the-moment guidance about how to handle certain situations.
mHealth can be essential during crises, too—including in the ongoing Ebola outbreak. There are plenty of guidelines out there for health workers around Ebola safety and care, but the challenge is getting information to the hard-to-reach areas where many work. Two new mHealth courses by IntraHealth offer a way to do that through SMS text messages or through interactive voice response on simple mobile phones.
Many other organizations and networks such as Medic Mobile, Dimagi, the mHealth Alliance, mPowering Frontline Health Workers, and the mHealth Working Group are working to get mobile technology into the hands of health workers who can use it. And so are national governments.
For example, India—a country of 1.2 billion—has nearly one billion mobile phone subscribers, and growing smartphone sales will make it the second-largest country for smartphone use in the world in 2014 (just ahead of the US and just behind China). It also has the greatest number of maternal deaths in the world.
So when the government began looking for ways to harness mobile technology to improve health care, IntraHealth responded with mSakhi, a mobile phone app that helps community health workers called ASHAs (or accredited social health activists) to better care for women and newborns.
The app helps ASHAs in the state of Uttar Pradesh counsel families on everything from birth preparedness to caring for sick newborns. Many ASHAs lack literacy skills, so mSakhi is designed to be highly visual and auditory.
Since 2006, the government of India has invested in over 820,000 ASHAs, training them to provide care in the country’s most impoverished, remote communities. And the country’s investments are paying off; the maternal mortality ratio has dropped from 280 maternal deaths per 100,000 live births in 2005 to 190 in 2013.
When you’re sick and need to see a doctor, chances are your mind is on recovery—not on whether the doctor who’s treating you is a quack.
Quacks—or those who work as health care providers but don’t have the appropriate licensing—are a problem in many countries, including Uganda. They’re known to con clients into paying for ineffective treatments and even to cause harm with their care.
That’s why the Uganda Medical and Dental Practitioners Council decided to move away from the paper-based filing system it had been using to keep track of registration and licensing information for its members, and to implement iHRIS instead. Now the council uses iHRIS Qualify to track data for over 4,000 health workers.
The council easily shares its data with the Ministry of Health, which then uses the information to plan and budget for Uganda’s health workforce.
But even better for the Ugandan public, the information is available online and through a mobile directory. Clients in Uganda now have the power to check the credentials of over 4,000 doctors and dentists.
To use the system, a client simply sends a text message to the council with the word “doctor” and a practitioner’s name. A message then comes back from the council to indicate whether the worker is registered and licensed.
Thousands more health workers have complied with registration and licensing requirements, thanks to the directory. And when they don’t, clients can be sure to look elsewhere for care.
Textbooks and written information aren’t always the best way to train. Not all health workers can read, for instance, and many speak languages that are not often written.
That’s one reason the Ministry of Health in Senegal is taking a close look at its mHealth initiatives and exploring new ways to use the technology more widely—and more creatively.
In Thiès, Senegal, IntraHealth worked with health officials to pilot an interactive voice response program that helps nurses and midwives update their training in family planning services. The USAID-supported initiative, which is the first of its kind, works with a simple mobile phone and uses a question-and-answer approach that’s scientifically proven to help students retain information better than more traditional learning methods.
The program uses a technology that’s been around since the advent of touchtone phones. (If you’ve ever called a bank and heard a voice say, “Press one to hear bank hours,” you get the idea.)
Training programs that use interactive voice response can be recorded in any language. And users like the flexibility—they can update their training any time that’s convenient for them, without leaving their clinics unstaffed.
Technology is not, in and of itself, the solution to our global health challenges. It’s useless without human beings, but incredibly useful as a human being’s tool.
Solutions that are designed by and for the health workers who use them are the innovations that will help us to finish what we’ve started in global health, and allow us to face the challenges ahead. We can reach new levels of health and well-being by investing in sustainable, country-owned systems that make HRH—that is, health workers—a priority.
It’s time to invest in our human resources. After all, they’re the most valuable tools we’ve got.
By Margarite Nathe, senior editor/writer, IntraHealth International