Frontline health workers (FHWs) are at the heart of strong, well-functioning and resilient health systems, yet often overlooked are the daily stressors and accompanying psychosocial distress that can inhibit their ability to provide optimal care.
“We expect FHWs to provide quality care, without providing the same for them,” says Professor Amina Abubakar, Director of the Institute for Human Development at Aga Khan University (IHD). FHWs need skills, resources and support to thrive and be mentally, physically and spiritually well, she adds. “We must not only support FHWs in caring for others, but we must also empower them to take ownership of their personal well-being.”
In line with that vision, the IHD and the School of Nursing and Midwifery at Aga Khan University, with support from Johnson & Johnson Foundation, launched a project to strengthen the well-being and resilience of FHWs. The project aimed at generating an evidence-driven understanding of psychosocial well-being and resilience of FHWs through primary research and collation of existing data relevant to low-resourced settings in East Africa.
Phase 1 of the project, launched in 2021, focused on three specific areas:
1. Building an evidence base on the current psychosocial well-being and resilience of FHWs. Around 4,000 nurses and CHWs across Kenya’s 47 counties participated in a quantitative and qualitative survey to build a better understanding of the burden of mental health challenges— including burnout, depression, anxiety, post-traumatic stress disorder and stress—and predictive and protective factors that impact well-being and resilience.
2. Synthesizing evidence from the policy environment on provisions made to improve psychosocial well-being and resilience of FHWs. The project identified 18 existing policy documents with guidance on providing support for healthcare workers in distress.
3. Increasing immediate support to improve psychosocial well-being and resilience. Through the Johnson & Johnson Resilience Collaborative, a pilot SMS-based psychosocial support program was introduced with contextually relevant messages on self-care, counseling tips and advice on where and how to access psychosocial support. Messages were well-received, with more than 97% of participating FHWs calling them relevant and helpful.
The results of the project have informed next steps to test and implement a set of multifaceted interventions, including the SMS-based services, to provide practical information and skills for FHWs to manage their health.
“We have used the study outcomes to produce a rich evidence base that will support contextually relevant strategies to better understand, describe and address challenges facing FHWs and determine the socio-ecological factors at play,” says Sabina Odero, Research Officer at IHD who served as the resilience study coordinator. “The study has helped us identify knowledge gaps—gaps in the current training and curriculum for FHWs and gaps within health systems—that may contribute to sub-optimal support. It will also help lay the foundation for a longer-term, multi-country and multi-stakeholder approach.”
Combining forces to drive policy, scale, and sustainability
This resilience work is steeped in strong collaboration and aims to create a robust community of practice in East Africa, forming an alliance that advocates for strengthened resilience among FHWs, says Abubakar. “We will work to convene like-minded stakeholders that support each other to scale up the interventions, tools, and program learnings—not just for this project, but other projects focused on FHWs’ mental well-being and resilience.”
The alliance will also advocate to raise awareness and drive policy change at regional level, identifying and working with key players in civil society, government and the private sector in East Africa to ensure these groups invest in and help formalize and institutionalize mental health programs for FHWs.
“We will take steps to ensure this remains at the forefront of policymakers’ discussions and thought processes. This is an ongoing effort; we will continue pushing it forward to ensure it has a place on policy agendas, and to secure the long-term sustainability of these initiatives,” adds Abubakar. “We will not only recommend to policy and advise on what works, but also bring health economics into the equation in the hope that this builds momentum for broader scale.”