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Making Community Health Workers the Cornerstone of Pandemic Preparedness

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The global death toll from the coronavirus outbreak in China has risen to more than 1,870, surpassing the SARS epidemic in 2003. From Ebola in West Africa to Zika in South America to MERS in the Middle East, dangerous outbreaks are on the rise around the world. Over the past 60 years, the number of new diseases cropping up in a decade has almost quadrupled. The number of outbreaks each year has more than tripled since 1980. And when epidemics or pandemics hit, they usually hit the poor first and worst.

Yet the World Health Organization (WHO) warns that we are chronically unprepared against the attack of a virus. Its recently released list of urgent, global health challenges serves as a compelling reminder that pandemics, health emergencies and weak health systems not only cost lives but pose some of the greatest risks to the global economy and security. The WHO’s list brings attention to the role access to healthcare and strong health systems play in pandemic preparedness—universal health coverage and global health security are two sides of the same coin.

It is not enough to start thinking of pandemics when we are in the throes of a global health crisis.

The health system that is in place to detect malnutrition and malaria and to provide a pregnant woman the information she needs to stay healthy during pregnancy is the same health system that can detect and contain the next pandemic.

In 2014, Johnson & Johnson played an early, catalytic role by providing seed funding and content support for a South African National Department of Health-led mHealth initiative called MomConnect. The program aimed to improve maternal health outcomes by registering every pregnant woman through their mobile phone and providing stage-based health information via text during pregnancy and in the year after birth. In 2016, the program expanded to launch NurseConnect, a platform for nurses and midwives to exchange learning and build skills to improve patient outcomes and experience.

Fast forward to 2017, when South Africa suffered the world's worst ever listeriosis outbreak, which mostly affected newborn babies. With MomConnect in place, the Ministry of Health had a ready system to blast out information to protect newborns that went straight into the hands of pregnant women and new mothers. Additionally, NurseConnect gave the government a direct channel to educate health workers on what to look out for and how to keep their patients informed.

Today, MomConnect has reached more than three million subscribers and has scaled nationally to 95% of South Africa’s health facilities. Johnson & Johnson has partnered with UNICEF to launch similar programs in Mexico, Uganda and China, and with ARMMAN to launch mMitra in India.

Systems such as MomConnect provide a megaphone to reach massive numbers of people during an emergency with official information. But for half the world that lacks access to essential health services, these approaches need to be coupled with health workers on the ground.

Digitally empowered community health workers and rapid sharing of data are critical in detection and response to outbreaks.

The Ebola crisis in 2014 revealed how lack of access to healthcare in remote communities can have devastating consequences. The outbreak that originated in a small village in Guinea claimed more than 11,000 lives across six countries.

How can we be ready for that next outbreak that we know is coming, to prevent it from becoming a global epidemic? Digitally empowered community health workers (CHWs) connected to strong primary health systems going door-to-door making routine house calls are our first line of defense. They can detect early signs of an outbreak and rapidly relay the information back to health authorities allowing health systems to pull their resources together to urgently contain the spread of disease.

The Johnson & Johnson Center for Health Worker Innovation supports outstanding work by several partners in this area. Organizations such as Last Mile Health, Living Goods, and the International Rescue Committee hire, train and deploy CHWs empowered with digital technology tools. Other partners such as Medic Mobile and Ona develop the technology used by CHWs to do their jobs.

The Center imagines a widely-distributed network of people working in the farthest and smallest of villages who while remote from each other are connected to each other and to health systems through their devices. Well-supported CHWs with continuous training to grow in their field become critical in pandemic response but even more valuable as trusted everyday providers of lifesaving essential health services and interventions in their communities.

As the deadline for the 2030 Sustainable Development Goals is quickly approaching, Johnson & Johnson has committed $250 million to the Center for Health Worker Innovation to make the next 10 years the decade of action to recruit, train and empower frontline health workers and strengthen primary healthcare systems to achieve health for everyone, everywhere.

Using an approach that advances a government’s own commitment to universal health coverage, the Center will work to bring together Ministries of Health with health workers and other implementers to co-create solutions that address specific challenges of selected countries. The Center pioneered this approach in Kenya last year with the Community Health Units for Universal Health Coverage (CHU4UHC) platform to integrate CHWs formally into the health system to deliver preventative and promotive healthcare.

China can build a hospital in six days to quarantine and treat coronavirus patients, but almost anywhere else in the world such an extraordinary feat would be impossible to accomplish. What we can do is help build the largest army of CHWs—health heroes from everyday citizens—who can serve as the nerve center for our health systems doing surveillance in our communities every day to detect and stop the next virus in its tracks.