Dear Colleagues,

This discussion is trending today. How can we use this debate to improve health outcomes for all?

The current global debate on racism provides an opportunity to discuss the contribution of racism and other forms of sectarianism to population health outcomes. The WHO Commission on Social Determinants of Health and other studies have pointed out racial discrimination as a key social determinant and driver of racial health inequities. This is mediated by direct and indirect pathways such as differential access to societal resources, education, employment and living conditions.

The world has been gripped by the reaction of disgust expressed through widespread global protests in over 60 countries against the killing of Floyd George a black man by a white policeman in Minneapolis, USA. This incident took place in broad daylight and was vividly captured in a live video recording that went viral and touched the hearts of many around the world. This global reaction is a vivid illustration of our humanity at work where we feel the pain of another human being and respond to stop the same from happening again to others. It is this humanity that has enabled our species homo sapiens to collaborate, learn together and prosper by turning planetary resources to our advantage.

Dear Colleagues,

Here is a subject dear to my heart and critical for achieving global health equity.

“Health Workers for All and All for Health Workers’ was the slogan of First Global Forum on Human Resources for Health, March 2008, Kampala, Uganda.

The COVID -19 pandemic has once again exposed the global health workforce (HWF) crisis that is characterized by wide spread shortages, mal-distribution and poor working conditions. This HWF crisis was documented by the report of the Joint Learning Initiative on Human Resources for Health in 2004. The HWF shortages have today resulted in a silent scramble to recruit health workers from poor countries by the richer countries. This scramble is inspired by the urgent needed to fill gaps in the scaled up COVID -19 responses and to address long standing HWF shortages.

Visa requirements for health workers have been eased and I have seen recruitment agencies openly advertising for health workers from Africa, Asia and the Caribbean in web posts of some government agencies and in social media. These agencies are convening meetings in poor countries to pirate away health workers who are needed more in their home countries. Significantly, some African and Caribbean countries have formally protested against these clandestine recruitment but have been ignored. These countries have been left to appeal to the patriotism of their HWF to mitigate the dreaded exodus that would cripple health systems during these times of crisis.

This piracy of health workers, left uncontrolled, carries a public health threat to all countries of the world and is untenable. The pivotal role played by the HWF in public health and health emergencies as exposed by the COVID -19 pandemic is sufficient to classify health workers as a Global Public Health Good at par with or ahead of vaccines and drugs. The G20 leaders met recently with the WHO and agreed to collaborate in urgently in developing and equitably sharing new technologies including vaccines and therapies for COVID -19. They should also have included HWF in these discussions and it is regrettable that global support for the HWF agenda has declined. So what is the problem?

Dear Colleagues,

Here is a pertinent and timely discussion on how to get out of the challenge of lock down from Dr. Patrick Kadama from ACHEST. Enjoy!

The Corona virus (SARS – CoV2) which causes the Corona Virus Disease 2019 (COVID-19) is not going to go away. People are going to have to learn to live with it; doing business and having social relations as, for example like they did with HIV/AIDS. Presently however COVID-19 has no cure or vaccine and as a result countries have sought to slow down the spread of the infection by instituting “lock downs ” to protect people and prevent their healthcare systems from becoming overwhelmed.

Lock downs impose stressful conditions on society and countries are now looking for measures to exit the unsustainable current socio-economic restrictions. A practical approach is to establish a system of National Alerts, with indicators as triggers for easing restrictions such as the New Zealand alert system for COVID-19. Given the limited knowledge about the new disease, the exit will be pragmatic and step wise, focusing on a multi-sector framework based on the following three objectives:

a) Get people back to work to revive economic activities and support livelihoods. (b) Minimize transmission of SARS-CoV2 infection under the new normal; (c) Institute Governance and leadership measures, for strengthening stewardship capability for social services to manage new norms.

Get people back to work to revive social and economic activities:

Opening up economic activities should be gradual and not allowed to cause a flare up in infections. This will be achieved through scale up and strengthening of health and safety measures in workplaces prior to easing restrictions. Populations need to comply with new workplace hygiene and safety measures including sustaining new social conduct standards at work. Health and safety measures for public and private transport also need re-definition.

The return of economic activities should at best be prioritized and phased by sub-population risk profile. Age based relaxations can also start early allowing the young to go back to work, while shielding the seniors and those with underlying health conditions. African countries have up to 80% of the population young and living in sparsely populated rural settings. These should be among the first to benefit from relaxation of restrictions.

Dear Colleagues,

Here is a submission on how to continue training health professionals during the COVID -19 imposed lock down. The author is Dr. Elsie Kiguli-Malwadde, Director, Health Workforce Education and Development at ACHEST.

E-Learning is the utilization of electronic technologies to access educational materials outside of the traditional classrooms. E- Learning has emerged as an important tool for Continuous Professional Development for health workers and students of health Professions’ institutions in the COVID Era.
Considering that health professions education institutions have been closed and face to face Continuous Professional Development (CPD) activities like global, regional and national conferences have been cancelled.  Health professions have to adopt creative ways of sharing education materials. To this extent, creative strategies have to be adopted to ensure that learning continues despite the pandemic. There is also an urgent need to train health workers on COVID 19 and to keep them updated on its spread.

Currently global health has been threatened by the COVID 19 pandemic and Global Health Security has been challenged as the disease spreads across all continents.  Many people have lost the state of complete physical wellness; fear has gripped the whole world, affecting the mental well-being of the populations.  Our social well-being has been disrupted by various control measures including physical/social distancing, avoidance of hugs, no touching and wearing masks among others.  In a bid to restrict gatherings and therefore keep people at home, schools and universities including health professions education institutions have been closed.

“Health Workers for All and All for Health Workers” Slogan of the First Global Forum on Human Resources for Health
“Our job is to ensure access to a skilled, supported and motivated health worker for every person in every village everywhere” Dr. J W Lee, former WHO Director General.
In these trying times of the COVID -19 pandemic, there are Health Workforce (HWF) issues that keep recurring in all countries. Yet HWF is one of the most critical inputs into the pandemic control response. This message needs to be appreciated by all intersetoral actors in governments and the general population. There are persistent complaints about lack of protective equipment, long working hours, hazards of travel to and from work in the face of lock down regulations and lack of support to undertake non COVID related medical work leading to collateral damage to public health.
“Health Workers for All and All for Health Workers” was the slogan of the First Global Forum on Human Resources for Health in 2008. Another related trending theme at that time and still relevant today is the quote from Dr. J W Lee that “Our job is to ensure access to a skilled, supported and motivated health worker for every person in every village everywhere”.
Let us take the discussion forward based on this quotation:
1. Skilled HWF need general knowledge, attitudes and skills for good and bad times and the required competencies for this are:
• Prepared to work where services are most needed: selection process, attitudes, socially accountable
• Able to respond to health needs of community: training in real life situations in community
• Able to deliver quality care with available (limited) resources. (Achieving the most with available resources.)
• Clinical excellence as foundation for teaching and research.
• Able to be leader, manager , teacher and change agent: mentors
• Continuous self-directed learners
• Effective communicators: team based learning, practice
The HWF also needs to be prepared and fit for purpose to handle the special skills for COVID-19 and the required competencies are:
• Full understanding of Infection control practices including correct use of PPEs
• Knowledge of Novel Corona virus behavior and its manifestations especially modes of transmission, symptoms, signs and complications
• Team work and empathy with ability to delegate skills through Task Shifting approach

2. Supported HWF should have:
• Enjoy the full support of political leadership with established structures for HWF planning and management embracing all relevant sectors
• Enjoy full support supervision of competent technical leaders with clear structures for dialogue and communication
• Enjoy the full support and understanding of the general population
• Have access to the tools that they require for their work such as PPEs, supplies,
• Organized and well led HWF with a critical mass of individuals professional associations and other institutions that work with their respective governments as both support and accountability agents, for sustaining highly performing health systems