Stories

Tag: health workforce

  • Strengthening primary health care in a changing climate

    Strengthening primary health care in a changing climate

    A new article by Andy Haines, Elizabeth Wambui Kimani-Murage, and Anya Gopfert, “Strengthening primary health care in a changing climate,” outlines how climate change is already impacting health systems worldwide, with primary health care (PHC) workers bearing the immediate burden of response.

    Haines and colleagues make a compelling case for strengthening primary health care (PHC) as a cornerstone of climate-resilient health systems.

    First, they note that approximately 90% of essential universal health coverage interventions are delivered through PHC settings, making these facilities and workers the backbone of healthcare delivery.

    This is particularly significant because PHC systems address many of the health outcomes most affected by climate change, including non-communicable diseases, childhood undernutrition, and common infectious diseases like malaria, diarrheal diseases, and respiratory infections.

    Furthermore, PHC workers are often the first responders to extreme weather events such as floods, droughts, and heatwaves.

    They must manage both the immediate health impacts and the longer-term consequences of these events.

    This comprehensive view of PHC’s role in climate resilience represents a significant shift from viewing primary care merely as a service delivery mechanism to recognizing it as a crucial component of climate adaptation and health system strengthening.

    The authors argue that investing in PHC is not only essential for addressing immediate health needs but also for building long-term resilience to climate-related health threats.

    In examining workforce issues, Haines et al. specifically emphasize that “building the capacity of the PHC and public health workforce in emergency preparedness and response to climate-induced risks is crucial for enhancing the resilience of health systems.”

    They argue that “the health-care workforce, including multidisciplinary PHC teams, should be provided with training and education on the impacts of climate change on health and the implications for health-care delivery.”

    The article specifies that this training should focus on three key areas: “strengthening integrated disease surveillance and response systems,” “diagnosis and management of changing disease patterns (eg, outbreaks of vector-borne diseases in new locations),” and “interpretation and use of available climate, weather, and health data to support planning and management of adaptation and mitigation interventions.”

    They mention resources like those proposed by the “WONCA Global Family Doctor Planetary Health Working Party” as instructive for such training.

    Although the article emphasizes the role of PHC workers as being “often on the front line of responses to extreme events such as floods, droughts, and heatwaves,” it does not discuss mechanisms for capturing or leveraging their experiential knowledge.

    This is what they know because they are there every day.

    Recommendations follow a traditional institutional approach: strengthen health information systems, build workforce capacity, develop integrated service delivery models, increase funding, and enhance governance.

    While these recommendations are well-founded, they primarily envision a top-down flow of knowledge and resources, with health workers positioned as recipients of training and implementers of policies.

    The epistemological framework underlying their recommendations reflects what educational theorists would recognize as a transmission model of learning, where knowledge is conceived as flowing primarily from experts to practitioners in a hierarchical manner.

    This approach, while valuable for disseminating standardized protocols and evidence-based practices, implicitly positions health workers as passive recipients rather than active knowledge creators and agents of climate-health resilience.

    Such a framework potentially undervalues the situated knowledge and practical wisdom (what Aristotle called phronesis) that practitioners develop through direct experience with climate-health challenges in their communities.

    It also overlooks the potential for what complexity theorists describe as emergent learning – where new knowledge and practices arise from the dynamic interactions between practitioners facing similar challenges in different contexts.

    Our research has documented how health workers are already responding to climate-related health challenges.

    For example, observations from more than 1,200 health workers in 68 countries reveal a rich tapestry of local knowledge and insights that often go unrecognized in formal academic and policy discussions

    Health workers are already intimate witnesses to the impacts of climate change on the health of the communities they serve, possessing valuable knowledge that should inform both science and policy.

    Where Haines sees health workers primarily as implementers of climate-resilient healthcare strategies, we view them as leaders and innovators in climate adaptation.

    However, these perspectives need not be mutually exclusive.

    TGLF’s model offers a bridge between formal institutional approaches and ground-level experiential knowledge.

    New peer learning platforms like Teach to Reach enable rapid sharing of solutions across geographical and institutional boundaries.

    This platform enables health workers to be both learners and teachers, sharing successful adaptations while learning from colleagues facing similar challenges in different contexts.

    Such participatory approaches also help local knowledge inform global understanding – if global research institutions and funders are willing to listen and learn.

    When TGLF gathered observations about climate change impacts on health, we received detailed accounts of everything from disease transmission to healthcare access.

    A health worker from Cameroon described how flooding from Mount Cameroon led to deaths in their community.

    Another from Kenya shared how changing agricultural patterns forced them to develop new strategies for ensuring safe food access.

    Jones, I., Mbuh, C., Sadki, R., Eller, K., Rhoda, D., 2023. On the frontline of climate change and health: A health worker eyewitness report. The Geneva Learning Foundation. https://doi.org/10.5281/zenodo.10204660

    These granular insights complement the broader statistical evidence presented in academic literature, providing crucial context for how climate changes manifest in specific communities.

    TGLF’s model demonstrates how digital technologies can democratize knowledge sharing to strengthen scientific evidence and drive locally-led action.

    This creates a dynamic knowledge ecosystem that can respond more quickly to emerging challenges than traditional top-down approaches.

    Importantly, this model addresses a key gap in Haines’ recommendations: the need for rapid, scalable knowledge sharing among frontline workers.

    While formal research and policy development necessarily take time, climate impacts are already affecting communities.

    TGLF’s approach enables immediate peer learning while building an evidence base for longer-term policy development.

    The model also addresses the issue of trust.

    Health workers, as trusted community members, play a crucial role in helping communities make sense of and navigate the changes they are facing.

    Their understanding of local contexts and constraints are critical to develop strategies that can actually be implemented.

    By combining institutional support with health worker-led local action, we can strengthen health systems to be both technically robust and locally responsive.

    Our experience at the Geneva Learning Foundation suggests that new learning and leadership are needed to bridge these approaches, enabling the rapid sharing of both formal and experiential knowledge while building the collective capacity needed to survive the impacts of climate change on our health.

    References

    Haines, A., Kimani-Murage, E.W., Gopfert, A., 2024. Strengthening primary health care in a changing climate. The Lancet 404, 1620–1622. https://doi.org/10.1016/S0140-6736(24)02193-7

    Image: The Geneva Learning Foundation Collection © 2024

  • Protect, invest, together: strengthening health workforce through new learning models

    Protect, invest, together: strengthening health workforce through new learning models

    In “Prioritising the health and care workforce shortage: protect, invest, together,” Agyeman-Manu et al. assert that the COVID-19 pandemic aggravated longstanding health workforce deficiencies globally, especially in under-resourced nations. 

    With projected shortages of 10 million health workers concentrated in Africa and the Middle East by 2030, the authors urgently call for policymakers to commit to retaining and expanding national health workforces. 

    They propose common-sense solutions: increased, coordinated financing and collaboration across government agencies managing health, finance, economic development, education and labor portfolios.

    But how can such interconnected, long-term investments be designed for maximum sustainable impact?

    And what is the role of education?

    Rethinking health worker learning

    In a 2021 WHO survey across 159 countries, most health workers reported lacking adequate training to respond effectively to pandemic demands. This exposed systemic weaknesses in how health workforces develop skills at scale. Long before the COVID-19 pandemic, limitations of traditional learning approaches were already obvious.

    Prevailing modalities overly rely on passive knowledge transfer rather than active learner empowerment and engagement with real-world complexities. While assessment and credentialing are important, ultimately learning must be judged by its relevance, application and impact on people’s lives and health systems.

    Between April and June 2020, I had the privilege of working with a group of 600 of Scholars of The Geneva Learning Foundation (TGLF) from 86 countries. Together, we designed an immersive learning cycle integrating skill-building and peer exchange for those on the frontlines of the epidemic. We called it the “COVID-19 Peer Hub”. 

    It grew into an ecosystem that connected over 6,000 health professionals across 86 countries to share unfiltered insights, give voice to on-the-ground needs, and turn shared experience into action.

    Within three months, a third of participants had already implemented COVID-19 recovery plans, citing peer support as the main driver for turning their commitment into results.

    By the end of 2020, TGLF’s immunization platform, network, and community had tripled in size.

    In 2022, this network transformed into a Movement for Immunization Agenda 2030 (IA2030).

    Informing health workforce decisions

    What insights can health workforce policymakers draw from the Geneva Learning Foundation’s unique work to achieve the ambitious growth and support targets outlined by Agyeman-Manu et al.?

    First, expert-driven, top-down  approaches alone cannot handle emergent real-world complexities. In TGLF’s learning cycles, the most significant learning often occurs in lateral, one-to-one networking meetings between peers. These defy boundaries of geography, gender, ethnicity, religion, and job roles.

    Second, thoughtfully-applied technology can exponentially accelerate learning’s reach, access and connections following learner needs. New digital modalities opened by pandemic disruptions must be sustained and optimized post-crisis, despite the tendency to revert back to previous norms of learning through high-cost, low-volume formal trainings and workshop.

    Third, relevance heightens learning and application. Learning and teaching should not just be centered on learners’ needs and problems to boost motivation and effectiveness. Learning cannot be detached from its context.

    Finally, nurturing cultures that support effective learning matters for performance and human achievement. Systems enabling peer reward and accountability build resilience.

    Protect, invest, together in a learning workforce

    Health policymakers are manifesting intent to act on the health workforce crisis.

    Alongside urgent investments, applying systemic perspectives from learning innovations like those The Geneva Learning Foundation has pioneered presents a path to growing motivated, capable workforces ready for the challenges ahead.

    Rethinking assumptions opens eyes – when we commit to support health workers holistically, the rewards radiate across health ecosystems.

    Reference: Agyeman-Manu et al. Prioritising the health and care workforce shortage: protect, invest, together. The Lancet Global Health (2023). https://doi.org/10.1016/S2214-109X(23)00224-3

  • Climate change is a threat to the health of the communities we serve: health workers speak out at COP28

    Climate change is a threat to the health of the communities we serve: health workers speak out at COP28

    The Geneva Learning Foundation’s Charlotte Mbuh spoke today at the COP28 Health Pavilion in Dubai, United Arab Emirates (UAE). Watch the speech at COP28…

    Good afternoon. I am Charlotte Mbuh. I have worked for the health of children and families in Cameroon for over 15 years.

    I am one of more than 5,500 health workers from 68 countries who have connected to share our observations of how climate is affecting the health of those we serve. 

    “Going back home to the community where I grew up as a child, I was shocked to see that most of the rivers we used to swim and fish in have all dried up, and those that are still there have become very shallow so that you can easily walk through a river you required a boat to cross in years past.”

    These are the words of Samuel Chukwuemeka Obasi, a health worker from Nigeria.

    Dr Kumbha Gopi, a health worker from India said: “The use of motor vehicles has led to an increase in air pollution and we see respiratory problems and skin diseases”.

    Climate change is hurting the health of those we serve. And it is getting worse.

    Few here would deny that health workers are an essential voice to listen to in order to understand climate impacts on health.

    Yet, a man named Jacob on social media snapped: “Since when are health workers the authority on air pollution?”

    Here are the words of Bie Lilian Mbando, a health worker from my country: “Where I live in Buea, the flood from Mount Cameroon took away all belongings of people in my neighborhood and killed a secondary school student who was playing football with his friends.”

    Climate change is killing communities.

    Cecilia Nabwirwa, a nurse in Nairobi, Kenya: “I remember my grand-son getting sick after eating vegetables grown along areas flooded by sewage. Since then I resolved to growing my own vegetables to ensure healthy eating.”

    And yet, another man on social media, Robert, found this “ridiculous. As if my friend who sells fish at his fish stall comes as an expert on water quality.”

    I wondered: why such brutal responses?

    Well, unlike scientists or global agencies, we cannot be dismissed as “experts from on-high”.

    What we know, we know because we are here every day.

    We are part of the community.

    And we know that climate change is a threat to the health of the communities we serve.

    We are already having to manage the impacts of climate change on health.

    We are doing the best that we can.

    But we need your support.

    The global community is investing in building a new scientific field around climate and health.

    Massive investments are also being made in policy.

    Are we making a commensurate investment in people and communities?

    That should mean investing in health workers.

    What will happen if this investment is neglected?

    What if big global donors say: “it’s important, but it’s not part of our strategy?”

    Well, in 5, 10, or 15 years, we will certainly have much improved science and, hopefully, policy.

    Yet, some communities might reject better science and policy.

    Will the global community then wonder: “Why don’t they know what’s good for them?” 

    I am an immunization worker. For over 15 years, I have worked for my country’s ministry of health.

    Like my colleagues from all over the world, I know more than a little about what it takes to establish and maintain trust.

    Trust in vaccination, trust in public health.

    Trust that by standing together in the face of critical threats to our societies, we all stand to do better.

    Local communities in the poorest countries are already bearing the brunt of climate change effects on health.

    Local solutions are needed.

    Health workers are trusted advisors to the communities we serve.

    With every challenge, there is an opportunity.

    On 28 July 2023, 4,700 health workers began learning from each other through the Geneva Learning Foundation’s platform, community, and network.

    Thousands more are connecting with each other, because they choose to.

    And because they want to take action.

    It is our duty to support them.

    In March 2024, we will hold the tenth Teach to Reach conference.

    The last edition reached over 17,000 health workers from more than 80 countries.

    This time, our focus will be on climate and health.

    We invite global partners to join, to listen and to learn.

    We invite you to consider how you, your organization, your government might support action by health workers on the frontline.

    Because we will rise.

    As health workers, with or without your support, we will continue to stand up with courage, compassion and commitment, working to lift up our communities.

    Our perseverance calls us all to press forward towards climate justice and health equity.

    I wish to challenge us, as a global community, to rise together, so that  the voices of those on the frontline of climate change will be at the next Conference of Parties.

    By standing together, we all stand to do better.

    Thank you.

  • Investing in the health workforce is vital to tackle climate change: A new report shares insights from over 1,200 on the frontline

    Investing in the health workforce is vital to tackle climate change: A new report shares insights from over 1,200 on the frontline

    Geneva, Switzerland (1 December 2023) – The Geneva Learning Foundation has published a new report titled “On the frontline of climate change and health: A health worker eyewitness report.” The report shares first-hand experiences from over 1,200 health workers in 68 countries who are first responders already battling climate consequences on health.

    As climate change intensifies health threats, local health professionals may offer one of the most high-impact solutions.

    Charlotte Mbuh of The Geneva Learning Foundation, said: “Local health workers are trusted advisers to communities. They are first to observe health consequences of climate change, before the global community is able to respond. They can also be first to respond to limit damage to health.”

    Listen to Charlotte Mbuh’s speech at the COP28 Healthcare Pavilion on 11 December 2023. Read the full speech…

    “Health workers are already taking action with communities to mitigate and respond to the health effects of climate change, often with little or no recognition,” said Reda Sadki, President of The Geneva Learning Foundation (TGLF). “If we want to build and maintain trust in climate science, policy, and action, we need to invest in the workforce, as they are the ones that communities rely on to make sense of what is changing.” 

    The report vividly illustrates the profound impacts climate change is already having on health, as shared by health workers themselves.

    The wide-ranging health consequences directly observed by health workers include malnutrition due to crop failures, increasing incidence of infectious diseases, widespread mental health impacts, and reduced access to health services. Here are three examples.

    • Bie Lilian Mbando, a health worker in Cameroon: “Where I live in Buea, the flood from Mount Cameroon took away all belongings of people in my neighbourhood and killed a secondary school student who was playing football with his friends.”
    • Cecilia Nabwirwa, a nurse in Nairobi, Kenya: “I remember my grand-child getting sick after eating vegetables grown along sewage areas. Since then I resolved to growing my own vegetables to ensure healthy eating.”
    • Alhassan Kenneth Mohammed, health facility worker in Ghana: “During the rainy season, it is very difficult for people to seek care for their health needs. They wait for the condition to get worse before coming to the facility.”

    Surprising insights from these experiences include:

    • Climate change worsens menstrual hygiene: Scarce water access brought by droughts can severely affect women’s ability to maintain proper menstrual hygiene. “Women and girls have challenges during menstruation as there is limited water,” noted one community health worker.
    • Respiratory disease spikes with prolonged dust storms: Multiple health workers traced a rise in chronic coughs and other respiratory illness directly back to longer dry seasons and dust storms in areas turned to desert by climate shifts.
    • Crop failure drives up alcohol abuse among men: In farming regions struggling with drought, women health practitioners connected livelihood loss to a stark rise in substance abuse, specifically alcoholism among men. “There has been job loss, low income, and depression. Also, men became alcoholics, which is now a national menace,” described one district-level worker.

    Reda Sadki explains: “The experiences shared provide vivid illustrations of the human impacts of climate change. By giving a voice to health workers on the front lines, the report highlights the urgent need to support local action with communities to build resilience. This report is only a first step that needs to lead to action.”

    Beyond the report, an opportunity to scale locally-led action using innovative approaches 

    As John Wabwire Shikuku, a community health worker from Port Victoria Sun County Hospital in Kenya, explains: “What gives me hope and keeps me going in my work is witnessing the growing awareness and mobilization of young people to address climate change, the development of sustainable solutions, and the potential for global collaboration to safeguard their future.”

    We need new approaches to supporting climate and health action. We need to go directly to those on climate change’s frontlines – connecting local health workers globally not just to share struggles but lead action.

    • Rather than siloed programs, we need radically participatory solutions that distill and share hyperlocal innovations across massive peer groups in real-time.
    • Through new approaches, we can rapidly distill hyperlocal insights and multiplier solutions no top-down program matches.

    The Geneva Learning Foundation’s proven peer learning model provides one such solution to connect and amplify local action across boundaries, offering those on the frontline tailored support and capabilities to lead context-specific solutions.

    How to access the report

    The report “On the frontline of climate change and health: A health worker eyewitness report” is available here: https://www.learning.foundation/cop28. An abridged Summary report and an At a glance executive summary are also available, together with a compendium of 50 health worker experiences.

    Watch the Special Event: From community to planet: Health professionals on the frontlines of climate change

    What happens next?

    • Register here to receive email updates from The Geneva Learning Foundation about climate and health.
    • During COP28, health workers are answering this question: “If you could ask the leaders at COP28 to do one thing right now to keep your community healthy, what would it be?”. You can find their responses on LinkedIn, Twitter/X, Facebook, and Instagram.

    About The Geneva Learning Foundation

    Learn more about The Geneva Learning Foundation: https://doi.org/10.5281/zenodo.7316466

    Created by a group of learning innovators and scientists with the mission to discover new ways to lead change, TGLF’s team combines over 70 years of experience with both country-based (field) work and country, region, and global partners.

    • Our small, fully remote agile team already supports over 60,000 health practitioners leading change in 137 countries.
    • We reach the front lines: 21% face armed conflict; 25% work with refugees or internally-displaced populations; 62% work in remote rural areas; 47% with the urban poor; 36% support the needs of nomadic/migrant populations.

    TGLF’s unique package:

    1. Helps local actors take action with communities to tackle local challenges, and
    2. provides the tools to build a global network, platform, and community of health workers that can scale up local impact for global health.

    In 2019, research showed that TGLF’s approach can accelerate locally-led implementation of innovative strategies by 7X, and works especially well in fragile contexts.