Maureen Kanyiginya is a young midwife with a gentle, confident presence. Sitting on a bench in a grassy area outside the rural health center where she works, in western Uganda, she says she loves helping mothers and delivering their babies. "I make mothers comfortable," she states firmly. "I'm a health worker."
Maureen provides vital care for women in a remote area of a country that has a critical shortage of health workers, according to the World Health Organization. Uganda is one of 57 countries with fewer than 2.3 doctors, nurses, and midwives per thousand people.
Similar Constraints, Different Outcomes
In the global health community, we tend to lump these "health workforce crisis" countries together and assume that they have similarly poor health outcomes, such as high rates of maternal and child mortality.
But there is surprising variation. Countries with similar levels of doctors, nurses, and midwives have radically different health outcomes.
For example, some of these countries have a maternal mortality ratio as low as 50 (per 100,000 live births), while others go as high as 1,100. Why?
What Some Countries Are Doing Differently
Some "health workforce crisis" countries are making the best use of scarce resources. Countries that achieve better health outcomes tend to ensure more equitable access to the doctors, nurses, and midwives they do have. They also deploy them more effectively.
But what really tips the balance toward better health outcomes, we're finding, is what these countries do with other types of health workers.
Successful countries are making smart use of community health workers, health educators, clinical officers, and others that provide essential services but don't have the full qualifications of a doctor, nurse, or midwife.
When these additional health workers help bring essential care to communities far and wide, it makes a difference.
Not every woman has ready access to a doctor, a nurse, or a midwife like Maureen. But if a woman can easily access a community health worker, health educator, or clinical officer, there is a lot they can do to help her.
More Health Workers (of all kinds), Better Health
The Health Workers Reach Index is a recently-developed measure of access to health workers. It includes availability of doctors, nurses, and midwives as well as other types of health workers, and factors in equity of access.
Applying this index, we see that as access to health workers goes up, maternal mortality goes down. Child mortality goes down. Life expectancy increases. This is true in "health workforce crisis" countries as well as other countries.
In short, successful countries are deploying health professionals more effectively and making better use of other kinds of health workers as a way of making essential services widely available.
Making smart choices
This is good news. There are creative opportunities to advance access to health workers. Even "health workforce crisis" countries can make progress. Countries have a lot of power to make smart choices in dealing with the shortage of doctors, nurses, and midwives and improving health outcomes.
Of course, every country is unique and must chart its own path to ensuring access to health workers. But there is abundant evidence to guide policy and planning, which can be adapted to the realities of every individual country.
Finally, on September 24th I'm pleased to partake in the Innovative Solutions on the Frontline panel which will consist of members from the American Academy of Pediatrics, Johnson & Johnson, AMREF, Freedom from Hunger, mothers2mothers, Pro Mujer and Save the Children whom will all showcase how health workers like Maureen are saving the lives of women and children around the globe. The health workforce crisis is a problem we can solve.
Follow Maurice Middleberg on Twitter: www.twitter.com/IntraHealth