Global Health Risk Framework Resilient and Sustainable Health Systems to Respond to Global Infectious Disease Outbreaks: Workshop Summary (2016) / Chapter Skim
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3 Health Systems Strengthening: Building Day-to-Day Care and Public Health Capacities
3 Health Systems Strengthening: Building Day-to-Day Care and Public Health Capacities
Pages 33-56
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From page 33... ...
• Building a strong professional national health care workforce by investing in the "white economy" is a critical step in build ing day-to-day and public health systems capacity; once pro fessionalized, health care workers must receive job incentives such as fair compensation. (Awunyo-Akaba, Campbell, López Acuña, Panjabi)
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From page 34... ...
Components of a strong, resilient, and sustainable health system, suggested several participants, should encompass functional day-to-day primary health care delivery, the infrastructure to implement essential public health functions, sufficient health care workforce capacities, and a reliable supply chain.1 In addition to delivering best-quality care to populations, many participants suggested that a strong everyday health system should be resilient and flexible enough to respond quickly to disease outbreaks or other public health emergencies -- and be able to receive assistance effectively from regional or international support systems as needed -- without compromising or terminating its ability to continue delivering primary care. López-Acuña remarked that these capacities should meet the core commitments of the International Health Regulations (IHR)
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From page 35... ...
, Jim Campbell, Director, Health Workforce, World Health Organization (WHO) Executive Director, Global Health Workforce Alliance, expressed concern over whether countries who struggle to provide even the most basic health services to their populations can realistically be expected to take part in the unbroken line of defense, constituted by strong national public health systems, on which global public health security depends.
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From page 36... ...
Ideally, these strategies would lead to lower, more sustainable costs. BUILDING PUBLIC HEALTH CAPACITIES IN EVERYDAY HEALTH SYSTEMS Multiple participants highlighted the need to strengthen basic public health capacities and functions during interoutbreak periods and to integrate those capacities within health care delivery.
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From page 37... ...
Campbell described how in countries most affected by recent outbreaks, basic information about their respective national health workforces was very often lacking: records were not available in terms of the clinical capacity of the health workforce or its managerial support, its public health capacity, the location of health care workers, where they were deployed, and so on. To accurately gauge national health workforce capacity, Campbell reported that participants suggested using a census of national capacity to evaluate the workforce in its broader sense, followed by assessing the specialized areas of laboratories, surveillance, and public health management.
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From page 38... ...
Noting that the data captures the number of skilled health professionals specifically, he called for better understanding of the respective roles and contributions of advanced clinical practitioners, midlevel health workers, and community-based practitioners in devising better ways to build health workforce capacities. Bolstering the "White Economy" Campbell remarked that multiple World Health Reports over the past 10 years have highlighted the role of health care workers as a fundamental component of health care systems.
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From page 39... ...
FIGURE 3-1 Distribution of skilled health professional by level of health expenditure and burden of diseases (WHO Regions) , 2004-2005 versus 2013-2014.
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From page 40... ...
IHR Core Capacity 7 is its human resource capacity; Campbell called for its integration within the health labor market to move toward the objective of universal health coverage, and advised against global health security becoming the next vertical agenda. Campbell suggested that incorporating universal health coverage efforts with the Open Working Group Proposal for Sustainable Development Goals (UN Sustainable Development, 2014)
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From page 41... ...
SOURCE: Campbell presentation, August 6, 2015. Engaging Community Health Workers in the Primary Health Care System To address the previously mentioned gap in remote health care delivery, Panjabi called for creating a new workforce to save lives of people living in extremely remote areas by professionalizing community and frontline health workers to extend the reach of the primary care system.
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From page 42... ...
and 23 percent of children under 5 years of age had never sought health care for fever-related illnesses at a health facility. Prior to the EVD outbreak in 2014, the community health care workers had increased antenatal coverage to 97 percent and facility deliveries to 82 percent; 100 percent of children were covered by services for malaria, pneumonia, and diarrhea treatment.
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From page 43... ...
Furthermore, community health workers could be linked into national sources of supply by utilizing multiple communication channels to ensure comprehensive data sharing. Building a Strong Workforce: Education, Training, and Retention Participants, including Perl and Fowler, recognized the need to better educate clinicians and health care workers regarding the essential concepts of public health and emerging infectious diseases, which are not generally covered in medical school or other training programs.
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A participant mentioned that the need to improve training is intensified by fact that the most undertrained health care workers tend to work in the facilities that have the most needs. Further, she suggested that training programs should include traditional health practitioners and those from the private sector.
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. Aceng described how Uganda has been training health care workers on the management of viral hemorrhagic fever and other epidemics for years, directed by continually updated training guidance.
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Campbell similarly commented on the challenge of recruiting and retaining workers in the health care sector. He noted that not enough health care workers are being produced to meet the need, there is not an adequate labor pool, and health care workers who are trained are very often lost due to lack of compensation or other factors.
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From page 47... ...
Campbell cited the scale of labor mobility as a huge concern for health systems resilience, one which will need to be addressed by training as well as properly supporting workers through provision of adequate PPE as well as compensation and insurance policies. He added that economic costs arose during the Ebola outbreak because many health care workers refused to work under subpar conditions during the outbreak.
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From page 48... ...
Thus, they highlighted providing access to safe environments (such as having available personal protective equipment or proper hospital isolation and ventilation measures) , and appropriate safety training to ensure that workers were empowered to go back to work and to care for other frontline health care workers.
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From page 49... ...
STRENGTHENING SUPPLY CHAINS Matowe of PharmaSyst Africa explained that in the Southern African Development Community member states, there are relatively few in-country pharmacists relative to the population, with many pharmacist responsibilities falling to other types of health care workers such as nurses. As a consequence, the supply chain for medicines was overwhelmed by the EVD crisis, with pharmacists ill-equipped to manage the disease and supply chain managers unable to determine what was needed.
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From page 50... ...
Both the national and district task forces have subcommittees responsible for over seeing and implementing the task force decisions and different components of epidemic response: coordination, resource mobilization, surveillance and labora tory systems, case management, social mobilization, logistics, and psychosocial support. Community Level All have community health workers called village health teams (VHTs)
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From page 51... ...
Focusing on the element of country ownership, Matowe recommended that issues in the health supply chain system should be managed at the local or country level to ensure • Engaged stakeholders and supply chain leaders are present in both policy and technical areas related to national health supply chains, • Policies and plans are in place to support planning and sustainable approaches to system developments,
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From page 52... ...
He suggested turning to people trained in supply chain management of vaccines and other commodities as a resource with the view to creating a new cadre of dedicated supply chain specialists. Another workshop participant noted the difficulty health care workers have in managing PPE supply chains and suggested that health administrators put a stronger focus on PPE supply chain management.
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From page 53... ...
Collaborating to this end would involve the public sector to manage and procure contracts, pharmacy chains, quality medicine vendors, and local, quality providers from NGOs, civil societies, local agencies, and the private sector. As Sarley presented, resources for implementation could include • Operational funding for transportation, supervision, and warehousing • Trained supply chain professionals, pharmacy assistants, and technicians • Quality business supply chain education and processes • Solar energy and long-holdover off-grid cold chain equipment for vaccines Sarley noted that while having a central medical store is an important part of the supply channel for public safety and security purposes, a country should not have all of its commodities in a single channel.
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From page 54... ...
Thus, improving clinical guidance was suggested as a priority during interoutbreak periods, supported by collaboration with international partners and continually updated as new research- and fieldbased information becomes available. From the perspective of a clinician on the ground during an outbreak, Rubinson of the University of Maryland remarked that while some disease features are predictable, such as sepsis/septic shock, the particular organs involved and its impact on disease course can be more difficult to determine.
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From page 55... ...
Fowler described the efforts of the International Severe Acute Respiratory and Emerging Infection Consortium,7 a global federation launched in 2011 of more than 40 existing clinical research networks. Its aim is to change the approach to global collaborative patient-oriented research about rapidly emerging health threats between and during epidemics, in order to generate new knowledge and maximize the availability of clinical information.
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