Primary Care & Systems Strengthening

Today on World Children’s Day, I am reflecting on my role as a mother and how I want to reimagine a different world for my children. I want a world where all children, regardless of where they are born, have the opportunity to live a happy and healthy life and reach their full potential.

John Lazame Tindanbil, Executive Director of MABIA-Ghana, is a recipient of the 2020 Aspen Nurse Innovator Grant in collaboration with Johnson & Johnson Foundation. The grant recognizes nurse/midwife innovators for their innovative practices to provide healthcare access to marginalized communities.

As the COVID-19 pandemic continues to rage throughout Africa and essential health services like immunization campaigns are interrupted, community health workers (CHWs) continue to play a key role in protecting their communities by providing vital and often life-saving care. The demand for personal protective equipment (PPE) has grown substantially and, in many countries, CHWs are not included in the forecasting for PPE. This lack of recognition puts the front line of primary healthcare “last in line” for this essential equipment.

A 2018 study in The Lancet showed that 5 million people in low- to middle-income countries died in 2016 from poor quality healthcare, and an additional 1.5 million people from not having access to care itself.

A few years ago, I met Wang Linyun, a nurse/midwife from Taiyuan Maternity Hospital in Shanxi, China. The photo below is a screenshot from an interview—she is expressing the utter desperation and helplessness she felt when she did not know how to help a baby experiencing childbirth complications. If a baby died or suffered a long-term disability, she blamed herself!But one may ask, how could a nurse/midwife in a maternity ward not know what to do? To answer that, let’s look at Wang Linyun’s pathway to becoming a midwife. Like many nurses/midwives in China and elsewhere, Wang completed her 3-year general nursing education, which included few midwifery specific courses. After attending 20 supervised births at a local hospital where she was expected to “learn on the job,” she was licensed to work as an obstetric nurse (Chinese title for midwife). In short, Wang became a midwife with little midwifery education or training.

As COVID-19 spread across the globe, we at the Johnson & Johnson Center for Health Worker Innovation began strategizing how to support frontline health workers in low- and mid-income settings. One early result was the formation of a new collective partnership with funding from the Johnson & Johnson Foundation among three of our partners, The World Continuing Education Alliance (WCEA), The Aga Khan University School of Nursing and Midwifery East Africa (AKU) and the International Council of Nurses (ICN). Together, we set out to design a mechanism to deliver vital training and education opportunities to frontline health workers managing dual imperatives: to prevent and treat COVID-19 while also providing primary health care amidst a potentially devastating interruption of health services, particularly in already fragile health systems.

A disproportionate number of women die from preventable pregnancy-related causes in rural Indonesia. Most of them deliver at home with traditional birth attendants who are not equipped to handle complications during labor and childbirth, contributing to Indonesia’s high maternal mortality rate—one of the highest in Southeast Asia.

By WHO estimates we need 18 million more frontline health workers (FLHWs) by 2030 to achieve SDG targets and other global health aspirations. An article authored by the Center for Health Worker Innovation's Joanne Peter, published on the ICTworks™ website, discusses how task shifting to virtual services is an opportunity for health systems to do more with the FLHWs they currently have.

Though the United States and the world have been galvanized to action by visceral images of acute police brutality, we know that systemic racism can be far more subtle, insidious, and deep-seated. Racism within health care is no exception.