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Nurturing Health Worker Resilience in Latin America

The Center is working with partners across Latin America to support the well-being and resilience of frontline health workers and also to build the capacity of health systems to provide that support.
Paulo Fabre Paulo Fabre
Lucas Albuquerque, at home with his mother and grandmother, works as a community health agent in São Paulo, Brazil.

In Latin America, already overburdened health systems across the region have been facing severe personnel challenges in the wake of COVID-19, worsened by a growing burnout epidemic among frontline health workers. According to a recent study by the Pan American Health Organization, health workers in 11 Latin American countries show elevated rates of depressive symptoms, suicidal thinking, and psychological distress. What’s more, in some countries only about a third of those who said they needed psychological care received it.

Johnson & Johnson Center for Health Worker Innovation (the Center) has been working with partners across Latin America to understand health workers’ challenges, address their resiliency needs and empower them to deliver high-quality healthcare while maintaining their own well-being.

The Center’s resilience work in Latin America is catalyzing collaborations with institutions on the ground, such as hospitals, professional associations and national councils, and supporting individual health workers to build their capacity and nurture their mental health with resources including training and e-learning initiatives.

ReConecTAR: Collaborating to boost well-being at work

Collaboration is vital to any system-shifting work, and it is at the heart of ReConecTAR, a Brazilian initiative bringing together institutions with a shared commitment to increasing joy at work and building resilience. With support from Johnson & Johnson Foundation, the Center collaborated with the Institute for Healthcare Improvement (IHI) and Hospital Sírio-Libanês (HSL) to launch ReConecTAR in 2021 to help boost well-being, satisfaction and engagement in health workers’ day-to-day working environment.

Over the first phase of the initiative, teams from 18 Brazilian public hospitals worked to identify the main obstacles healthcare professionals face—both in their institutions and systemically—and then to address those obstacles via multidisciplinary and collaborative working groups. Appling IHI’s Framework for Improving Joy in Work and practical improvement science and method, each hospital’s team proposed solutions, tested them and implemented the most effective changes. The teams have suggested more than 350 changes over the past eight months, and most of them have already been put into practice.

To date, ReConecTAR has reached over 2330 frontline health workers, among them 782 nurses, giving them autonomy to improve their working lives for the long term and reaching more than 25,690 lives directly. In 2022, the program will be scaling up to 100 sites in Brazil, as well as plans to expand into 20 institutions in Mexico.

Rosangela Santos, an Assistant Nurse and participant in the ReConecTAR program: “ReConecTAR has improved our work processes, including communication channels, and our physical and psychological safety. The best part was the feeling of recognition and the implementation of the 12x36 scale (working for 12 hours, followed by 36 hours off) to reduce our workload. We are very happy!”.

Using technology for assessment and support

Technology is bringing transformational improvements across the healthcare sector, helping to address fundamental challenges in new and creative ways.

One such example is Vitalk, a Brazilian digital health startup that aims to bridge the gap in primary care by putting a ‘virtual health assistant’ in the pockets of millions of patients around the world. Using artificial intelligence (AI), Vitalk alleviates some of the pressure on frontline health workers, allowing them to focus their energy and skills on urgent, high-risk or complex patients. It has also played an important role in tackling COVID-19 in Brazil, with the company working with the Ministry of Health to identify potential cases, particularly in low-income populations.

Since March 2020, the Johnson & Johnson Foundation has been supporting Vitalk to adapt and scale their technology to boost resilience amongst health workers. Via Vitalk’s free app, users can access expert-created content, advice and information around mental health, all personalized to users, as well as practical exercises to reduce stress and anxiety. Since launching in Brazil in 2020, the initiative has already made a remarkable difference; groups considered to be at high or very high risk of mental health difficulties saw a drop in anxiety levels from 71% to 39% after they had used the app. The Center is working with Vitalk to launch the app in Mexico later this year.

Lucas Albuquerque works as a community health agent (CHA) in Bairro Vila Itaberaba, one of São Paulo’s northern neighborhoods. Since becoming a CHA, he has had to abandon his mental health treatment with a psychotherapist because of the demands of his job. Vitalk has provided a much-needed source of solace and guidance. Speaking to the Financial Times, Albuquerque said: “I used to feel that I had to solve every problem, but I changed with time and discovered that I have a limit, otherwise I wouldn’t be able to handle it.” Vitalk has reminded Albuquerque to nurture his mental health rather than waiting until a serious problem emerges before seeking support.

In 2021, Vitalk raised a $24 million Series A funding round to continue their work destigmatizing mental health in the region, as well as to expand into other countries for testing, such as Malawi.

Building capacity with e-learning initiatives

With support from Johnson & Johnson Foundation, the Center has partnered with a number of organizations across Latin America to develop and promote e-learning initiatives for nurses, midwives and community health workers, focused on building technical skills and resilience, and implementing regular, genuinely helpful self-care practices.

For example, in the middle of the pandemic, the Center collaborated with UNICEF Brazil to provide mental health training and support to over 5,000 health workers, mainly CHWs, to help them better care for their communities across the country. “This ‘mental health in times of pandemic’ course for healthcare professionals was a wonderful opportunity to have health workers speak up about our difficulties and create awareness on the importance of self-care,” says Carmen Lúcia Guimarães, Doctor and Chief of Pediatric and Newborn Unit at Hospital das Clínicas UFPE in Pernambuco, Brazil.

Similarly, the Center partnered with Doctor Payaso to offer emotional support to over 10,000 nurses and frontline health workers in Argentina, Mexico, Peru, Chile and Colombia. The program helped health workers with strategies to build resilience and boost their self-care via virtual workshops, interactive online content and individual video calls with wellness coaches and trained volunteers from Johnson & Johnson companies. More than 90% of those who participated found that they were able to apply the lessons learned in their daily working lives to positive effect. After participating in the program, Gilma Rico Gonzalez, a nurse in Colombia, spoke of how the emotional support calls and e-learning content had helped to change her mindset during stressful situations: “Resilience can transform us. Anything that is bad, it turns into good.”

“In order to create truly sustainable health systems, we not only need to support the well-being and resilience of frontline health workers but also to build the capacity of health systems to provide that support,” says Regiane Polizer Soccol, Latin America Leader for Global Community Impact, Johnson & Johnson. “Only by working at both an institutional and individual level will we achieve real, long-term change.”