ICTworks

A ten-year countdown has begun to the deadline for achieving the Sustainable Development Goals (SDGs), including a pledge for universal health coverage. However, half the world’s population still lack access to essential healthcare.

Much progress has been made globally in recent decades. Between 2000 to 2017, maternal deaths dropped 35%, per-capita government health expenditure more than doubled, and life expectancy increased by 5 years. However, with most investment ploughed into maternal health and infectious diseases, burdens are now shifting to non-communicable diseases and age-related diseases.

As these burdens shift, we need a health workforce to meet this challenge. However, most low- and middle-income countries (LMICs) lag behind the World Health Organization (WHO) recommended 4.45 total clinicians and 1 physician per thousand population.

It is projected that Southeast Asia and Africa will account for 32% and 42% of the world’s shortage of health workers in 2030, respectively. This problem hits rural, lower-income areas hardest. Here, we explore how this issue affects progress towards Universal Health Coverage (UHC) and SDGs, and how to respond.

Consider that being a frontline health worker is hard, often with long hours for low pay, in harsh environments. Average government spending on health services in LMICs is 1/5 of the global average. The inadequacy of public sector wages often drives providers to dual practice, with practices such as serving private clients when they should be attending to public patients. Those with the ability tend to migrate to cities or abroad, draining talent from rural areas, where half of people in LMICs live.

Not being equipped to support your community is emotionally draining. Frontline health care provider burnout in LMICs and high-income countries alike is found to be associated with long work hours, higher workload and lower organizational support.

When I examine the impact of this, from our work across the Philippines, Cambodia, and India, I see three main effects:

• Low trust in the public health system, reinforcing the use of private sector services. The lack of resources and essential commodities mean that engaging with the public sector is tedious. This increases out-of-pocket (OOP) health costs, often without a measurable improvement in outcomes.
• Reliance on unsafe practices, such as quack doctors or herbal healers, unlicensed midwives and birthing attendants; and widespread availability of potentially dangerous medicines available without a prescription from pharmacies.
• Barriers to new services, even when funding is available. For example, we find it can be challenging to run basic screening campaigns for certain conditions in some rural areas of Cambodia as there simply aren’t enough medical technologists.

This prohibitive tripartite exists in addition to a multitude of other systemic issues, such as a lack of universal IDs, inadequate internet connectivity, lower literacy and limited ability to pay for essential health services (where Out-of-pocket spending still makes up 56% of all health costs in LMICs).

Universal Health Coverage cannot be achieved unless we properly address these major shortages in frontline health workers. We need more rapid action now in key areas.

1. Fully harnessing digital and mobile technology

Clinical decision support and telehealth is not new, but we must focus much more on training frontliners with digital approaches and using “offline-first” apps to help them make better decisions in the field. eDigitally enabled task shifting is key, with telehealth to doctors in cities providing a referral pathway.

We partnered with public and private sector partners to equip thousands of frontline community health workers in Southeast Asia with the knowledge and skills to combat COVID-19 during the pandemic. This was predominantly achieved through digital channels alone with courses and resources on our mobile e-learning platform, available ‘at the point’ of need on community health workers’ mobile phones.

The faster adoption of low bandwidth, digital platforms to support frontline health workers during the pandemic must now been accelerated and expanded further.

2. Giving health workers the pay they deserve

We need to incentivize frontliners properly, with funds pooled from both public and private sectors as they all depend on them to deliver their services and objectives. Programmes that utilize minimal economic incentives to part-time Community Health Workers tend to limit their focus, with only the financially incentivized activities becoming central.

Better rewards need to be complemented by better recognition for Community Health Workers and their now proven impact on population health outcomes.

3. Mobilise roaming workforces

We need to accept that trained health professionals often don’t want to live in rural areas, so embracing mobile work and roaming teams and diagnostic labs will help deliver high-quality services to remote populations. For patients, the cost of travel is often higher than the cost of paying for the health service – thus, to drive the UHC agenda we need to take care to the community level.

Community Health Workers who used our mHealth tool captured and transmitted higher percentages of monthly cases without missing information; compared to those who used paper-based data collection tool. Moreover, the Community Health Workers who used our mHealth tool were found to be more satisfied in terms of their performance.

We Need to Invest in UHC Now

Investing and acting now in these areas is essential. They must be integral to every country’s health policy – supported by all stakeholders – centred around respect and value for those on the frontline. But equally we must move beyond commitments and policy to make this happen on the ground now. The case for investment is there – prevention and public health reduces downstream care costs.

And if we don’t invest and innovate now, the vision of UHC 2030 simply won’t be achieved.

By Edward Booty, CEO reach52