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On the Rocky Road to Universal Health Coverage

This post originally appeared on the Global Health Council blog.

If you look at the regions of the world that have made the greatest progress in family planning—India and Bangladesh come to mind—you will see that all of their strategies have included strong community health workforces. That’s because the role of the health worker is crucial.

We in the field of global health know that we have unfinished business when it comes to family planning. Globally, the use of modern contraception rose sluggishly between 1990 and 2012, from 54% to 57% over 22 years. Today 800 women will die due to causes related to pregnancy or childbirth, partly because they do not yet have access to or freedom to use the family planning methods they want and need. The number of children under five who will die is much higher—29,000 every day, mostly due to preventable causes.

Investing in the health workforce is the smartest, most cost-effective choice any of us can make, not only for family planning but for health care of all kinds. If any progress is to be made in making sure that all 7 billion of us have access to care, it will be through health workers.

In a few months, I will be joining global health experts from around the world in Recife, Brazil, for the Third Global Forum on Human Resources for Health. As a cosponsor, IntraHealth will play an exciting role. We’re managing a vital theme of the conference: empowering health workers.

That same week, IntraHealth will also be taking part in the 2013 International Conference on Family Planning in Addis Ababa, Ethiopia, where we will join the global health community in focusing on the needs of young people. The global health community should be watching and listening during these two major events.

In global health, we have a lot to celebrate—maternal mortality is down, child mortality is down, vaccine distribution is up. But family planning remains a challenge. The best way to sustain the momentum we have in global health—and to improve family planning—is to further invest in the health workforce.

In the past, the conversation around health workers at these conferences has been somewhat negative, focusing on how health workers can be an obstacle to care. We have talked about provider bias, about bad attitudes when it comes to family planning, and about health workers who are poorly paid and work in challenging conditions and end up taking out their frustrations on their clients—or simply leaving.

But I think this is the wrong focus. Yes, we must have the difficult conversations about the difficult problems. This year, though, we should emphasize the positive achievements of health workers and celebrate their potential contributions. We should recognize their difficult working conditions and focus on how we can better support and empower them. We should recognize health workers who are making family planning methods available in their communities, and learn from them.

In this way, the goals of these two conferences are intrinsically linked.

A major topic of conversation in Recife will be universal health coverage, a goal that according to the World Health Organization would essentially make vital services accessible and affordable to entire nations. This doesn’t mean that all types of care would be free to all—that is not sustainable. Instead, universal health coverage would involve making sure that no one dies due to a lack of basic care and that health workers are available and ready to provide care where they’re needed most.

The road to universal health coverage is a rocky one. At IntraHealth, we want to help countries travel down that road by producing and retaining more, better trained, more productive health workers. Often, we tend to focus on the numbers—a shortage of over 4 million health workers, for instance, or the fact that we need at least 2.3 health workers for every 1,000 people.

But statistics don’t tell the whole story.

This year we should seize the opportunity to focus on the person rather than the numbers. Our focus should be on the health worker who has a voice and a set of needs, the health worker who must be present, ready, connected, and safe to do the job.

And we must be deliberate about it. We must encourage countries to increase their own investments in their health workforces, make viable plans for their health sectors, and make sure health workers are a part of their normal budget allocations

.This is the way we are going to achieve universal health coverage and make family planning available to all. This November, we hope the world is watching—and ready to act.

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