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Tackling NCDs Effectively Will Require More Health Workers

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This post is co-authored by Louis Galambos and Tina Flores

Imagine having a stroke in a place where the nearest health facility is a two-hour walk away. And should you manage to find your way there, a trained provider isn't available to assist you. Consider what would happen if the pharmacy ran out of the insulin you needed to manage your diabetes -- and all of the other pharmacies within 50 miles of your home were also out of supplies. This would be unusual for those of us who live in the U.S. or Europe, but it is all too often a reality for those in the developing world, where the burden of noncommunicable diseases (NCDs) -- cancers, cardiovascular disease, chronic lung disease and diabetes -- is the greatest. Health workers are crucial to preventing and treating chronic disease. In recognition of World Health Worker Week, we call on everyone to support efforts to strengthen the human resource capacity needed to tackle chronic disease effectively and efficiently around the globe. Access to well-trained health workers when you need them should not be an accident of geography.

Approximately 80 percent of non-communicable diseases occur in low- and middle-income countries, which lack sufficient means to address them. Chief among these challenges are the depleted numbers of the health workforce. According to the World Health Organization, there is a shortage of 7.2 million health workers around the world, resulting in about 1 billion people without access to the health services they need. The challenge is greatest in sub-Saharan Africa: with 25 percent of the global burden of disease, it has only 3 percent of the world's health workers.

Health care workers are the heart of the health system. The roles of doctors and nurses are universally understood, but there are also important roles for community health workers, clinical officers and other cadres of workers at every level of the health system, from community clinics to tertiary hospitals. Community health workers identify risk factors and offer counseling on behavioral changes to prevent chronic illness, improving population health while leaving doctors and nurses to focus on patients with more acute or complex health conditions. With appropriate training, these providers can screen for and diagnose disease so that it can be treated early, leading to better health outcomes, an important aspect of what has come to be known as "task shifting." But more needs to be done to improve the number of health workers who are equipped to prevent, screen, diagnose and treat NCDs. In low- and middle- income countries, efforts are being made to integrate NCD screening, prevention and treatment into existing health services, such as those for maternal and child health and HIV/AIDS. To address the increasing burden of chronic disease, many health systems are adapting existing models of care or implementing innovative approaches to screening and prevention using mobile clinics and mobile technology.

But there is another human resources issue to consider across the health sector. Health systems are complex ecosystems, with hundreds of moving parts, ranging from small rural community clinics to large, urban tertiary care hospitals. Doctors and nurses who have traditionally held leadership positions in these organizations have rarely been trained in how to manage finances, or motivate and mobilize staff, or handle the operational details of supplying and running large public facilities. Capacity building initiatives should include management and leadership development in addition to the provision of new technical and clinical skills. BRITE, a Zambian-based NGO, does just that. Recognizing that there are gaps in the health system, BRITE works with teams to identify and develop the tools to address the barriers to delivering care in their clinical settings. The organization works with the Ministry of Health and other partners to train multi-disciplinary teams across the health system to maximize available resources and develop pragmatic solutions to real problems.

However, none of these efforts will close the gap if there isn't a concerted movement to increase the number of health workers in resource-poor settings and build local capacity to meet the health needs of people in even the most remote communities. Existing health workers are too often over-burdened and under-resourced. Moreover, there quite simply aren't enough of them. In fact, the World Health Organization estimates that 83 countries fall below the minimum threshold of 23 skilled health professionals for every 10,000 people (compared to 122 doctors, nurses and midwives per 10,000 people in the United States). These statistics are even more dramatic in poor and rural communities. Unless something is done to address this issue, the health worker shortage is predicted to increase to 12.9 million by 2035.

The Global Health Workforce Alliance is leading the global charge to increase the number and strengthen the quality of the health workforce. Some of the foremost U.S.- based organizations and corporations working in global health have formed the Frontline Health Workers Coalition, which collectively mobilizes support around greater investments in health workers.

Weak public infrastructure in low-resource settings demand greater investments from donors, multilateral agencies and national governments alike to develop more efficient mechanisms for managing supplies and medicines as well as building local capacity to provide care. It will be impossible to make adequate gains toward reducing the burden of NCDs, much less achieve universal health coverage, without the right numbers of well-trained and well-resourced health workers where they are most needed. It is time to do more.

Louis Galambos and Jeffrey L. Sturchio are the co-editors of the recently-published Noncommunicable Diseases in the Developing World: Addressing Gaps in Global Policy and Research (Johns Hopkins University Press).

Louis Galambos, PhD, MA is a Professor of History, Johns Hopkins University; Editor, The Papers of Dwight David Eisenhower; and Co-Director of the Institute for Applied Economics, Global Health, and the Study of Business Enterprise. A former editor of The Journal of Economic History, he has written extensively on modern institutional development in America, the rise of the bureaucratic state, and the evolution of the professions.

Tina Flores, MS is a Director at Rabin Martin. She has more than a dozen years of experience in global health communications, policy, research and stakeholder engagement, working with NGOs, donors, multilateral organizations and the private sector. Prior to joining Rabin Martin, she had served as Director of Strategic Communications at the Global Health Council and Editor-in-Chief of Global Health Magazine.