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August 16, 2007, Issue No. 2
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What is this?
Each quarter, the Global Health Council posts this newsletter for communications professionals working in global health. Here you’ll find discussions of communications activities and message development on various global health issues, plus an upcoming calendar of events and cool new tools for communicators. We hope to focus on different core global health issues and bring the best thinking forward for everyone to learn from. This newsletter and the Council’s Communicators’ Working Group is a benefit available to members. We encourage you to contribute to the discussion around issues covered here and to suggest new topics.
To join the group, contact Dave Paprocki, Senior Communications Associate.
To post comments, e-mail them to the Global Health Communicators Listserve – globalhealthcommunicators@listserve.com.
Issue Focus: Health Care Workforce
The world needs an additional 4.3 million health care workers with the countries in sub-Saharan Africa in particularly short supply. The WHO’s 2006 World Health Report: Working Together for Health, dedicates its first chapter to this issue with a map showing the global distribution of health care workers. (See graphic above.) There is no easy solution to this problem, which may be part of the reason it has not risen to the top of the global health advocacy agenda, but more health organizations are realizing that it is an issue that needs to be addressed.
Three major forces have led to this health care shortage. The first has been the impact of HIV/AIDS which has increased the workloads of health care providers and exposed them to infection. Second is a history of chronic underinvestment. About 20 years of economic reform and restricted public expenditures froze salaries and reduced recruitment of new health employees in many developing nations. Systems were deprived of basic supplies and facilities became degraded. Structural adjustment programs imposed by financial institutions, which cut social service spending often in education and health, added to the deterioration. The third major reason for the health care worker shortage, is the accelerated migration of health professionals to wealthier nations where pay, lifestyle and opportunities are often more attractive than the situation in health providers’ home countries.
Other problems exacerbate the situation. Industrialized nations are actively recruiting health care workers from developing nations to make up for shortages in their own health systems. Recruiting workers has become such a drain on these poorer health systems that cooperative guidelines for ethical recruitment are being drafted by governments and health institutions around the world. In addition, the training that health workers get in developing nations is not aligned with the daily needs of the larger, and poorer, population. Likewise, health workers are often not distributed evenly among a country with many more located in urban areas where pay and quality of life is often better than in rural areas.
Many organizations have developed plans and strategies to address this issue. Most have addressed issues of better training, pay, and fairer treatment of medical professionals in developing nations and as well as incentives to attract them to rural areas. Likewise, it is commonly believed that industrialized nations should reduce their dependency on these workers by training more of their own health care workers and recruiting workers in ethical ways.
The Global Alliance of Health Care Workers, a WHO partnership organization made up of national governments, civil society, finance institutions, workers, international agencies, academic institutions and professional associations has put together an extensive set of recommendations and suggests some of the following solutions. They advocate accelerating work in developing nations by developing multi-sector national plans and strategies to engage as many stakeholders-
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- as possible, strengthening the technical content of health workforce training, improving management and striving for an equitable geographic and skill set distribution among workers. They also recommend that steps be taken to build knowledge and stimulate learning by promoting and commissioning key research, developing manuals and guidelines, and producing up-to-date data, research and analysis. The Alliance also considers it necessary to disseminate information through creating messages for the media, focusing on funding gaps, building a database of partner resources, and increasing donor investment in health resources. For a more extensive list of their recommendations see their Strategic Plan.
Problems and Solutions for Communicators:
The workforce issue has not received much attention in the media so providing the public with a lot of background education will be necessary before global health communicators can get them behind this issue. Furthermore, fixing the human resource infrastructure requires in-depth knowledge especially if health systems are discussed. This goes beyond what the average person cares to invest their time in learning. We need to educate the public on the need to remedy the worker shortage and poor health systems yet keep it simple enough not to overwhelm them.
Solutions to the issue is requires many stakeholders and is, therefore, hard to organize around. This in turn can make it difficult to establish support and funding. As larger implementers and donors start to act we’ll be able to draw more attention to it. We need to encourage these groups to be more aggressive on these efforts.
One example of an activity that got people on their feet in support of health care workers was the Empty White Coats Campaign that was staged at
a number of campuses on World AIDS Day in 2006 by the University Coalition for Global Health. Its goal was to get the White House and Congress to support 8 billion dollars over 5 years to train and retrain sufficient health workers to fight AIDS in Africa. Participants held up the empty, traditional white doctors coats to symbolize the need to fill them (see photograph above.)
Another grassroots movement used to emphasize this point has been the use of a “Die in” to show the amount of people that die each year for lack of access to a doctor. The Student Global AIDS Campaign has conducted this outside the White House and the University Coalition for Global Health uses it in their tool kit of activities.
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Making What We Do Compelling to Our Audience
By Bruce Curran, Media Advisor
Intrahealth International, Inc.
The major challenge for anyone writing about human resources for health, capacity building or workforce development is to find the compelling story in the maze of public health speak and acronyms. To get the message out we should not be striving to make what is complex and difficult compelling, rather we should be trying to make what is compelling relevant to the complex topic and to our audience.
In broad terms audiences are much more uniform than most media professionals seem to acknowledge. Targeted messaging for a specific purpose is reasonable but we forget that the majority people respond to a good story the same way. It really doesn’t matter if they are policymakers, jaded network reporters, the general public, or members of the public health community. When put in front of an engaging personalized story about one other individual or a group of people, we can all relate to it. When told that nearly 30,000 children die every day in developing countries or that we lose over 10 million children every year, we are staggered by the enormity of the numbers but are unable to relate emotionally to the scale of the tragedy.
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One child who has a name and a face provides a way to relate in human terms to this overwhelming statistic from WHO.
A good example of an intriguing and engaging story for capacity building is Intrahealth’s effort in Southern Sudan to increase the number of physicians in that country. The combined effects of poverty, underdevelopment and decades of war have produced a lack of human resources for health that is one of the most challenging in the world. Daniel Madit Thon Duop left the Sudan over 20 years ago as a teenager to obtain an education and someday return to help his country. Recently, he and 14 other young physicians have returned to Southern Sudan to start working in the south’s severely damaged health sector. Normally the addition of 15 doctors would not seem significant, but in a country where there are only 50 doctors for nearly 10 million people, that is a 30 percent increase in capacity. The simplicity of the story makes a point without getting tied up in the complexity of the development issue. We all have great stories like this to share; we simply need to find them.
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The PHR Approach to Health Workforce Issues
By Kate Krauss, Media Coordinator
Health Action AIDS Campaign, Physicians for Human Rights
Physicians for Human Rights launched its campaign to stop African brain drain in 2004 in a press conference at the Bangkok International AIDS Conference with the release of its 300-page report, “An Action Plan to Prevent Brain Drain: Building Equitable Health Systems in Africa.” “Health systems strengthening” may not be the most accessible or alluring policy goal, but we picked a real issue that no one else was working on; it resonated with doctors and nurses, health officials, decision makers, and the press. Members of our organization made themselves among the world’s top experts on the subject, and our report exhaustively catalogued not only contributing factors to the problem, but solutions as well.
The report included a plan for action - and we meant it. We targeted high-level Bush administration officials who could influence US aid and health policy. We educated members of Congress and NGOs about the problem. We made new friends who cared about AIDS in Africa and held an educational day on the Hill for evangelicals. If we needed to influence an administration official, we would publish an op-ed in the Washington Post, and then meet with the person, often accompanied by an African doctor colleague. If we needed specific backing from a member of Congress in Iowa, we would hold a town meeting in northern Iowa and place major articles on Africa’s health worker crisis in the local paper there. We cold-called the health minister of Malawi and co-wrote an op-ed in the International Herald Tribune
with him.
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We also rallied our medical student members to support their African colleagues. They pitched in by the hundreds, holding rallies, writing letters to the editor, contributing to blogs, writing their own op-eds. Established AIDS doctors signed op-eds and letters to the editor on the health worker crisis. At high-profile meetings like the G8, we pushed the issue into press coverage of the event. We got quoted in wire service stories, created blogs on brain drain, and bought display ads in key newspapers for the Gleneagles G8 meeting and this year’s G8 meeting in Germany.
 Before us, we have the African Health Capacity Investment Act which advocates expect to be introduced in the House of Representatives in August 2007. The bill needs co-sponsors, especially Republicans. The situation with the bill is fluid as it is attracting new support almost every week. Media coordinators can focus on getting editorials and op-eds in newspapers and radio coverage in key legislative districts asking members of Congress to co-sponsor the bill. They can e-mail bloggers who cover AIDS and ask them to blog about the issue, then offer comments about the blog entries. They can also write comments in response to newspaper articles published online in major outlets like the New York Times.
We are a long way from winning - there is still an enormous health worker crisis killing patients, but we are using the megaphone of our communications strategy to rally the world to solve it.
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Eye on the U.S. Congress:
The African Health Capacity Investment Act of 2007, S. 805, was introduced in the Senate on March 7, 2007, to help sub-Saharan African countries strengthen the capabilities of their health systems. This legislation addresses Africa's health workforce crisis, a central obstacle to scaling up essential health services and meeting global health commitments in areas like HIV/AIDS, tuberculosis, malaria and maternal and child health. This bill was introduced by senators Durbin, D-IL, Coleman, R-MN, Feingold, D-WI, Kerry, D-MA, Dodd, D-CT, and Bingaman, D-NM.
The Act proposes authorizing $150 million in FY'08, $200 million in FY'09, and $250 million in FY'10 to address the health workforce crisis in Africa by providing technical and financial assistance to:
- Develop and implement national health workforce plans
- Train and retain health professionals, paraprofessionals, and community health workers
- Improve working conditions and health workers’ safety; provide health workers salary incentives, continuous learning opportunities, and HIV services, including treatment, and; expand pre-service training possibilities
- Plan and manage the health workforce to improve productivity
- Strengthen health workforce in rural and other underserved areas, including through supporting community health workers
- Investing in public health capacity and basic health infrastructure
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The Act also seeks to mandate an analysis of how international financial institutions can expand public health and education spending while maintaining countries’ fiscal balance.
Furthermore it encourages the U.S. government to expand health worker training at home and programs, such as loan forgiveness, to encourage Americans to work in underserved areas in the United States.
The strength of this bill is that it provides a platform from which to raise awareness of the health systems and workforce issues. This bill addresses cross-cutting global health issues, rather than approaching the problem from a disease-specific perspective. The weakness of this bill is that it is ambitious and somewhat unfocused. It is asking for a lot with only a $150 million budget. A Republican sponsor from the House is critical to getting this bill moving forward on the House side, but more sponsors are needed in both houses. It is important that we keep this issue alive before Congress and you can help by issuing action alerts or letters to encourage more members to sign on. We can also promote it by integrating the health care workers shortage and health systems issues into other global health issues. To keep abreast of this issue or to get more involved you can join the Health Care Workers Group moderated by Smita Baruah at the Global Health Council.
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Global Health Calendar of Events September-October
| Sept. 26-28, 2007: | Clinton Global Initiative, Annual Meeting, New York City
The meeting features a special session on strengthening health systems on Sept. 27. |
| Oct. 18-20, 2007: | Women Deliver Conference, London
Its purpose: saving the lives of women, mothers and newborns by mobilizing increased investment and commitment on the part of governments, NGOs, and donors. |
Links to organizations involved in workforce issues:
Links to government organizations:
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