April and early May are bookended by World Health Worker Week (April 7-11) and International Day of the Midwife (May 5) -- two opportunities to recognize the invaluable contributions of health workers in saving and bettering the lives of our communities. The women and men who have been on my mind are the innumerable hard-working, selfless, often heroic frontline health workers I've worked alongside while training nurses and midwives in the last 15 years.
I think of Beatrice -- a midwife posted in rural Tanzania, far from her family -- working alone in a small health facility, always on call, always the one. I think of the nurse-midwives I've met in Nepal who work 18-plus hour shifts without basic necessities like electricity. I hear stories of the women they've lost: women who arrived at the facility too late, who had obstructed labor, or a baby stuck in their pelvis, or who were convulsing from unmanaged high blood pressure in pregnancy. The losses are painful, but they press on, determined to save another mother, another baby.
Young women graduating from the Community Health Officer program in Ghana have shared their fears with me. They're afraid of being posted in remote health clinics far from everything and everyone they know. Blushing, looking down, they confess they'd rather stay in the city to meet someone and get married. But when they're posted, many go.
Frontline health workers make profound sacrifices to do what they do.
But there are simply not enough of them. The 2011 State of the World's Midwifery report surveyed 58 countries where 91% of the world's maternal deaths and 82% of newborn deaths occur. The report found that the majority of these countries suffer from a severe lack of frontline health workers: a human resources for health crisis.
Among the 38 countries with the most severe shortages, 112,000 more midwives are needed to meet the Millennium Development Goals target of 95% of deliveries seen by a skilled birth attendant. Because of this severe lack of midwives, pregnant mothers have paid the price. Approximately 800 women and girls die every day in pregnancy and childbirth due to complications like infection and bleeding; enough to fill four movie theatres.
When we at the Frontline Health Workers Coalition say "health workers count," we mean it. Every report, case study and anecdote affirms that health workers are vital to the health and well-being of a country.
I am reminded of Jhpiego's work in Kenya, which is supported by the U.S. Agency for International Development. Mary Johnson, a community health worker (CHW) in Kitui County, goes door-to-door advocating for hospital deliveries in the Matinyani area.
"It was challenging [initially]," said Johnson. "Doors were closed on our faces most of the time. However, we did not give up. We talked to expectant mothers and emphasized the importance of delivering with a skilled birth attendant."
Fourteen year-old Kalekye was one of the young mothers Mary discovered during a home visit.
"Kalekye was in denial of her pregnancy and ran away each time I brought up the topic," said Johnson. "But I never gave up. After several visits to her home, the results were significant! She agreed to attend her antenatal clinics as long as I accompanied her. She delivered in a hospital a few weeks later."
"Mary is a lifesaver," Kalekye explained. "If she had not intervened I would have delivered at home. I could not have had the courage to go to the hospital as I was too embarrassed to be pregnant at my age. After Mary talked to me, I was able to deliver in a hospital with a nurse, exclusively breastfeed my baby and ensure she gets all her immunizations."
Health workers inspire courage, spur action and save lives.
As we honor frontline health workers this month, let us together advocate for nurses, midwives and other health workers serving to keep a mother alive, a community healthy and a country strong.
Nurses and midwives comprise 87% of the health workforce but lack a strong voice in ministry-level positions globally. Community health workers are similarly underrepresented.
Stand with the Frontline Health Workers Coalition - an alliance of 37 United States-based organizations including Johnson & Johnson and the organization I work for, Jhpiego - to educate our policymakers about the massive impact of investments in health workforce strengthening, and to advocate for continued strategic investment by the United States and our partners in human resources for health on the frontlines of care in developing countries.