On Thursday, 25 February, I joined the WHO PMNCH Partnership for Maternal Newborn and Child Health and United Nations Women’s Fund in welcoming, and rendering commitments to the Gender Equal Health and Care Workforce Initiative of the Government of France, WHO, and Women In Global Health – to increase visibility, advocacy, dialogue, technical output, and commitment to action on improving gender equity in the health and care workforce alongside the UN Women Generation Equality Campaign to accelerate gender equality actions.
As a worthy precursor to International Women’s Day 2021, in this Year of the of the Health and Care Worker, I have endorsed the clarion call for a Gender Equal Health and Care Workforce, to further recognise and reinforce the capacities and impact of nurses, midwives and community health and care workers at the frontline of providing essential services around the world.
As leaders and policymakers gather throughout our Women’s Month of March to identify, celebrate and increase the visibility of women’s achievements, they help forge equality through strategic collaborations based on shared purpose, trust and the appreciation of impacting positive change for women. We are boldly choosing to challenge gender bias and discrimination in order to accelerate gender parity in the health and care workforce throughout the Year of the Health and Care Worker, marching on towards a decade of delivery for the sustainable development goals, and a gender equal world by 2030.
Long before the first COVID-19 case was reported, a spotlight was shone on the heroes and heroines who mustered and mastered managing many of the ‘medical waves’ that preceded it.
It is indeed far from new news, that a host of countries have, and do continue to face inadequacies and challenges in their workforce, particularly regarding staffing levels and the maintenance of their morale and momentum. In 2016 it was estimated that an additional 18 million healthcare workers would be required in order to actualise Universal Health Coverage. Now COVID-19 is creating an additional burden in the form of health worker deaths, infection, exhaustion, mental trauma, long-COVID, and attrition.
As we progress through the International Year of the Health and Care Worker, we have an unprecedented opportunity to powerfully recognise, re-position, and reverberate our policies as a clarion call to a much needed global revival of their empowerment through autonomy within the health and care worker professions, and by way of assuring a patient’s continuum of (health) care.
When we look at the progress made through upskilling Nigeria’s healthcare professionals in previous years, the importance of accredited and assessed evidence-based practice and care facilitation has been a central and vital component. It has not only strengthened the promise of career progression, but affords and assures the safety and provision of an uncompromised work environment for the health and care giver, and for their family when it comes time for ‘clocking off.’
Taking a deep-dive into case studies such as the successful eradication of the wild polio virus in Nigeria, we have seen that females on the frontline have been instrumental in building trust within communities, and thus, successfully facilitating uptake of vaccinations and immunisations.
The national polio eradication programme led through the Emergency Operations Centre (EOC) and in partnership with the WHO and Global Polio Eradication Initiative (GPEI), successfully leveraged a gender strategy that addressed the challenges of gender inequalities in immunisation and vaccination. The approach ensured that all house-to-house vaccination team members for the polio campaign were females in order to guarantee access to children both inside and outside of the house.
The multidisciplinary team sent out to women and children in hard-to-reach settlement areas also comprised at least one nurse or midwife and a host of community health extension workers. The female polio workers in particular, provided vital information about immunisation and other health related interventions available at the health facilities during their interactions with caregivers in the household. Pregnant women received antenatal care, malaria preventive therapy, iron folate, tetanus toxoid vaccine and treatment of illnesses (e.g. malaria and respiratory infections) or referral for care. Children aged 0–59 months received a full complement of routine immunizations (including oral polio vaccine), vitamin A supplements, deworming, diagnosis and referral for malnutrition, treatment of diarrhoea, pneumonia and malaria and additional referrals as required. In addition, all women attending outreach sessions were provided with health education on key household practices; hand washing, personal hygiene and infant feeding including exclusive breastfeeding.
Ultimately the responsibility was not just to eradicate the polio virus, but to ensure a healthier life after the virus itself. Even in the weakest of healthcare infrastructures, female health workers demonstrated an ability to deliver quality healthcare for all.
My WBFA has remained committed to administering care and informed accurate counsel to women and families even at the height of the pandemic, and their success in delivering a quality continuum of maternity, newborn and child health care serves as proof and support for increased investments in the direction of upskilling and responsibilities.
This is what the frontline requires, and desires to have access to. The determined community health-worker even in the most rural parts of sub-saharan Africa dreams of inner-city impact beyond leveraging locality. This will only be made possible by way of up-skilling, adequate remuneration and qualifying him or her as a vibrant and accredited professional healthcare practitioner. Increasing investments from the start of a CHW’s journey, and dream in the direction of impact, is therefore vital.
Midwives, nurses and the community health workers who aspire to follow in their footsteps are majorly women, and have proven to be effective in facilitating better maternal and child health outcomes, essential newborn care, SRH education and the promotion of breastfeeding and immunisation, and we must ensure that our healthcare policies reflect that of equal remuneration and equal access to facilities – truly personifying the front in frontline.
Growing studies such as the ICM, UNFPA, WHO ‘Impact of Midwives‘ published in Lancet Global Health estimate that, relative to current coverage, universal coverage of midwife-delivered interventions would avert 67% of maternal deaths, 64% of neonatal deaths, and 65% of stillbirths, allowing 4·3 million lives to be saved annually by 2035.
Lives saved can only be accomplished through realising the unabridged potential of midwives, through augmented skills and competencies, conducive teams and enabling work environments by way of increased investments. If increased coverage and efficacy of midwife-delivered interventions can be achieved, national and subnational health systems will provide more effective coverage of essential sexual, reproductive, maternal, newborn, and adolescent health interventions.
In the 2020 Year of the Nurse and Midwife, I was pleased to crown the conclusion of my second term and 6 years of service as the Inaugural Global Goodwill Ambassador to the International Confederation of Midwives in leading my Wellbeing Foundation Africa to join Member States and Non-State Actors at the 73rd WHO World Health Assembly, in unison, speaking to the critical role of health and care workers in ensuring our health and prosperity. We emphasized the urgency and imperative to address persistent health worker challenges.
Ahead of the 74th World Health Assembly, recognising the need to advocate for a gender equal health and care workforce, the Wellbeing Foundation Africa which had launched its own Women Girls and Gender Development Targets in November 2020 wholeheartedly endorses and supports actions in the health and care sectors in the 4 identified areas:
Increasing the number of women health workers in leadership roles, recognising the value of unpaid health care work and the importance of equal pay in the health and social sectors, protecting women health workers from harassment and violence in the workplace, ensuring safe and decent working conditions for all health workers.
From the community healthcare worker aspiring to facilitate life’s first cry, to the autonomous and multi-skilled practitioner working to ensure the promise of optimal care, the priority must remain; to welcome, protect and preserve life from cradle to age.
For my native Nigeria, the last six years in particular have demonstrated that fervency and commitment towards tackling outbreaks of deadly disease lies in repeated and robust methods of prevention, namely vaccination and medical equity, ensuring dissemination of information is evidence-based, culturally-sensitive and digestible, all while building a societal trust that averts a culture of hesitancy to any treatment of any kind.
The Wellbeing Foundation Africa is committed to tackling health, gender and global development together, as we prioritise equity, facilitate decent work conditions and increase investments in the direction of upskilling in a bid to position the midwife, the nurse, and all female healthcare workers, towards a gender equal health workforce, truly leading at the front of the frontline.
Making our commitments to the ethical principles and practices of the WHO Global Code of Practice on the International Recruitment of Health Personnel (Code), we continue to urge prioritization of support and safeguards for the countries with the greatest vulnerability, including greater investment, and endorsed the call to action for WHO and development partners to strengthen its financing, implementation and monitoring and moving purposefully beyond applauding the contributions of the frontline health workforce, to deliberate and intentional investments in health, health systems and in health and care workers.
To quote Her Royal Highness Princess Muna of Jordan, at the 73rd World Health Assembly, “applause without action is no longer acceptable. Recognition without rights and proper remuneration is not sufficient. A resolution without implementation is not governance. We must invest in health workers.”
I endorse Her Royal Highness’ sentiments to further urge all Member States, International Financing Institutions, Global Health Initiatives and partners to invest in health workforce readiness, education and learning, to manage the pandemic, maintain health services and roll out the COVID-19 Vaccine, the WHO has given clear direction on consensus and the necessary actions on the health and care workforce.
We must now, at our global, national and subnational frontlines, ensure that this key consensus necessarily unites, includes and integrates a gender equal approach to capitalise female leadership in the global health workforce.