Mabinteh Koroma, nurse at Makump Bana health post in Sierra Leone, says healthy mothers and babies make her smile. © Rachel Deussom/FHI 360.

In Krio, I was called “belly woman.” Rural Sierra Leonean communities had not seen many foreign pregnant “belly women.” Sierra Leone had been recovering from years of conflict that had broken its health system and forced health workers to flee. The 2014-2015 Ebola epidemic only served to demonstrate how this weak health system and inadequate health workforce had prevented an effective response to the epidemic, and left communities without any other basic health services.

I had been working with Advancing Partners & Communities in Sierra Leone since early 2016, with the post-Ebola project goal of improving reproductive, maternal and child health services. During last month’s trip, we traveled to remote villages to talk with stakeholders in community health. I was in my second trimester, but despite bumpy roads I was feeling good. We met with district health managers, nurses, midwives, traditional birth attendants, community health workers, youth, pregnant mothers, and Ebola survivors. At the sight of my pregnant figure, many would congratulate me or call out “belly woman, very nice!”

But many went further, enthusiastically encouraging my unborn child to study very hard in school, so that he or she could become a health worker, and return to Sierra Leone to save lives.

I was heartened by their sense to recruit future generations to the health workforce. Sierra Leoneans know well the value of such an investment. The country has among the fewest doctors, nurses and midwives per capita: only 3 doctors per 100,000 people, and fewer than 4 nurses and midwives per 10,000 people, respectively. Globally, it’s estimated we’ll have a shortage of 18 million health workers by 2030. The world needs more health workers.

However, in the global development community, this health workforce investment logic can somehow seem complex, maybe because the solutions are intersectoral. Producing and sustaining a successful health worker requires an integrated approach, as I discussed with FHI 360’s Nadra Franklin and Otto Chabikuli earlier this month.

First, a child must grow up strong and healthy to excel through primary and secondary school. Then her family must be able to afford tuition for nursing school. She must be well-supported during her studies by a competent faculty who teach relevant curricula in well-equipped classrooms, with hands-on practice to prepare her for a job.

When she graduates, her future employers attract her to a well-paid position, ideally one where she helps underserved populations. She will be more likely to succeed and stay on the job if she can apply her skills: this requires running water, electricity, adequate equipment and drugs, and sleeping quarters so she can be available to the community she serves, especially if a mother in labor knocks on her door in the middle of the night.

She needs supportive mentors, supervisors and career opportunities to help her grow. She needs to feel safe in her working environment from hazard, harassment, and violence. When she starts a family, this nurse needs the flexibility to return after her maternity leave. She needs these elements and continued support over the course of several decades, so that she can join the nursing school faculty and mentor new health workers before she retires.

Many governments, employers, and partners in developing and developed contexts alike are challenged to promote this successful health worker life cycle illustrated above. Here are a few of the issues:
• How do we know if health professional education institutions are training health workers in the right skills?
• If it takes almost a decade to train a doctor, and nearly half as long to train a nurse, how can we scale up the health workforce to get results sooner than later?
• If country governments cannot sustain the existing health worker payroll, how can they expand it? What can other actors do?

What can be done?

Broadly, health, education, youth, gender, and workforce experts need to come together to transform the health workforce.

Pre-service training programs should prepare graduates to address the health issues faced in their country. Training programs should produce graduates to be competitive for jobs now and in the future. Programs also should attract and support youth from the rural and marginalized communities that need most to be served. They must integrate team-based approaches, management skills, public health values, and new technologies.

Policymakers need to recognize innovative ways to distribute health worker more equitably. First, they need to know their existing workforce with greater precision: How many? Who are they? Where are they? What skills do they have? Efforts to build health worker capacity should be better coordinated and better tracked. Too often, health workers are trained and re-trained on the same topics, which pulls them unnecessarily away from serving patients. For example, establishing nationally standardizing reporting approaches and building a national health workforce database (or human resources for health information system) and is a first step.

Professionalizing the community health workforce is also important. These lower-level health workers can be trained under a year to promote health, prevent and treat diseases at the community level, and drive demand for services. When appropriate, they can take up some of the tasks that doctors and nurses perform under their supervision; this is referred to as “task shifting” or “task sharing”. Community health workers can promote health system resilience by being rapidly trained to address emerging problems, whether it is Ebola, gender-based violence, opioid addiction, or diabetes.

Health is the largest growing sector for jobs. The public sector cannot support it alone. Private sector investors should recognize this emerging market, and consider how social impact investments, or partnerships for public purpose, align with their values. They can also help the efficiency of the existing health workforce by providing innovative technologies and services, such as helping a pharmacist manage stocks or provide clinical decision support on a tablet, or help a patient manager hypertension through a smartphone app.

I don’t know what my children will grow up to become, but my hope is that by they will have high-quality education, good health, and ample job opportunities. Our efforts now to invest in the health workforce should reap such dividends into the future. In the meantime, I shall be grateful for my midwives’ support at each prenatal appointment, that they may help deliver more prosperous futures.

How can we sustainably strengthen the global health workforce? Please help us continue this conversation in the forum:

Many governments, employers, and partners in developing and developed contexts alike are challenged to promote this successful health worker life cycle illustrated above. Here are a few of the issues:
• How do we know if health professional education institutions are training health workers in the right skills?
• If it takes almost a decade to train a doctor, and nearly half as long to train a nurse, how can we scale up the health workforce to get results sooner than later?
• If country governments cannot sustain the existing health worker payroll, how can they expand it? What can other actors do?