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Why an open-source manifesto for investment in global health workers?
The global immunization community is now focused on “the big catch-up”, dealing with recovery of immunization services from the consequences of the COVID-19 pandemic, as countries – and immunization staff on the frontlines – work toward the goals of Immunization Agenda 2030 (IA2030).
- At the Seventy-Fourth World Health Assembly, the Director General of the World Health Organization had called for “a broad social movement for immunization that will ensure that immunization remains high on global and regional health agendas and help to generate a groundswell of support or social movement for immunization”;
- A Movement is larger than any one individual or organization. The Geneva Learning Foundation is one of many working to support this Movement. In March 2022, we launched a call for immunization staff at all levels of the health system to connect across boundaries of geography and to commit to working together to achieve the goals of Immunization Agenda 2030 (IA2030). In 2022, over 10,000 health professionals, primarily government workers from districts and facilities, joined this Movement and shared ideas and practices, analyzed root causes of their local immunization challenges, and developed and implemented corrective actions to tackle them, together.
How is version 2.0 different from 1.0?
Today, we share a second draft of an open-source Manifesto for investment in global health workers which draws on experiences and opinions shared voluntarily by more than 1000 health workers.
- By ‘open source’ we mean that this draft of the manifesto summarises key recurring themes and opinions shared by health workers;
- Because this involves multiple perspectives from diverse countries, the draft manifesto at times reflects multiple positions, reflecting the diversity of the health workforce and its experiences.
The purpose of the Manifesto is to give a snapshot of how a subset of health workers see the health systems in which they work, and the recurring challenges and opportunities they perceive at this potential turning point in how health systems are structured and financed following the pandemic.
The Manifesto is built on voluntary responses to the following questions shared alongside at the first draft of the manifesto in the run-up to Teach to Reach: Connect 8, on 16th June 2023:
- Why do you work for health?
- How has your work been affected by the COVID-19 pandemic?
- How have digital technologies become embedded in your daily work?
- What will help you to build and maintain trust with the communities that you serve?
- How has sharing experience with colleagues helped you in your daily work?
- How do you see the future of health work where you work?
- If you work in a humanitarian setting, what is the biggest challenge that you face to ensure every child and family is protected from vaccine-preventable diseases?
Following collation, responses were grouped by theme, and common themes identified and summarised. This version of the Manifesto will be shared back to self-selecting health workers in the run-up to Teach to Reach 9 (October 2023) to 1) elicit more specific recommendations as to what they see as next steps for inclusion in the Manifesto, and 2) gather feedback on missing areas / areas that could be strengthened.
Watch the 15 September 2023 Consultation on the draft Manifesto version 2.0
This consultation, held on 15 September 2023, was held with 390 health leaders to discuss a new Manifesto for global health developed by more than 1,200 community-based health leaders from Asia, Africa, and Latin America.
On 15 September 2023, 390 health leaders, primarily from districts and facilities in over 80 countries of Asia, Africa, and Latin America, came together to review and discuss the draft version 2.0 of a new Manifesto for Global Health being developed ahead of Teach to Reach 9.
No international consultants, global health agencies, or donors were present. Most of the participants work for their country’s Ministry of Health (MoH). Watch this session to learn more about the Manifesto and, if you work for the health of your community and country, how you too can become a Contributor.
What are Manifesto 2.0 Contributors saying?
Why are you involved in drawing up this Manifesto? How can this Manifesto help you? Who should read it? How should your Ministry of Health respond to this Manifesto? What do you expect from international partners such as Gavi, WHO or UNICEF in response to the Manifesto?
Pharm Okechi Nzedibe, a public health specialist (MPH) at a Health Facility in Akwa-Ibom State, Nigeria is involved in the Manifesto because of the lives of millions of children that will be secured by our collective strategic plans, deliberations and contributions:
“I am involved because the lives of millions of children that will be secured by our collective strategic plans, deliberations and contributions. This manifesto will help me to air my opinions on what needs to be done to reach more zero-dose children across the world. This manifesto should be read by state and non-state actors- the government, ministries of health, policy makers, international partners and organisations, NGOs, CSOs, MNCs and members of the public. My ministry of health should respond by carefully considering the issues raised and build systems to accommodate them. I expect GAVI, WHO, UNICEF to support the manifesto and throw their weight behind it in amplifying the concerns and recommendations.”
“I’m involved in drawing up this Manifesto to help me raise my voice to the relevant authorities for action to take place for changes”, writes Zuhura Gakii Ahmed, a Community health worker working in a Health Facility for the Ministry of Health in Meru County Municipality Ward, Kenya
“I’m involved in drawing up this Manifesto to give guideline to my government for it to see where there’s defaults so that it can do proper implementation of whatever the problem is. The manifesto can help me raise my voice to the relevant authorities for action to take place for changes.
Manifesto version 2.0
Who are we and where do we work?
While many of us have trained as health workers, we also come from other professional backgrounds: teachers, social workers, scentists, academics and technicians. Some of us are volunteers: we receive little or no payment for carrying out health work in our communities.
We come from all levels of health systems, and are aware of the strengths and limitations of these large and complex organisations, and the critical role of political direction and leadership in making these systems work. Some of us lead big teams at national or regional level; others are responsible for specific areas of work within a local facility or across several facilities.
Many of us work with poor communities: for some of the people we work with health care is not a priority above economic activity to survive. The communities we work with may be geographically hard to reach, suspicious of government and by extension us, or hold religious or cultural beliefs that do not easily adopt the science we base our work on. Some of us highlight how decisions about housing, sanitation and education affect the health of the communities we serve – but decisions on these things are made without reference to populations’ health needs.
COVID-19 has for many of us highlighted the fragility of the systems we work in and our relationships with communities. For some of us it has meant more investment, and renewed political focus on healthcare; for others it has meant cuts in key budgets and the rise of new threats to our work, such as rumours spread by social media. Many of us remember the fear of the early days of the pandemic and losing colleagues and friends. We often carried out our work without adequate protective equipment. For some of us this period confirmed why we signed up to work in health – for other this period was a source of mental stress and anxiety.
Each of us is working in a unique context. The nuances of community structures, culture and religion interact with the structures, image and resourcing of our own health systems. To be successful, we must make this interface work.
Those of who work in humanitarian contexts report further complexity in our work: our security is often not guaranteed, the facilities and equipment that we rely on may be targeted and destroyed, and our target populations may be inaccessible or displaced.
What motivates us to work in global health?
Many of us describe growing up in communities with limited access to health workers, and experiencing the avoidable deaths of family members and friends at young ages as a factor that motivated us to become health workers. The sense of serving our communities is strong, as is the sense of the importance of our roles and the respect that they can engender among community members.
For some of us, health work is seen as a stable career that allows us to support families. And a few of us are being recruited to fil gaps in European health systems. Yet for others, pay is irregular and promises of payment are broken. Fortunately money is not our only motivation – we speak of the feeling of success when a child is reached and cured, or immunised against a life-threatening disease. We describe being motivated through involvement in decisions that affect us, through the recognition of our leaders as well as community members, and through the ongoing support of partners who want to support our communities to be healthy.How can use of digital technologies in health systems be strengthened?
Contribute to the Manifesto: what will attract the next generation of health workers?
What would you say to a young person thinking about a career in health work?
Health systems, equity and investment
Many of us are concerned at the sustainability of the health systems we work in – citing missing human and medical resources to carry out our current roles, let alone expand services to reach hard to reach communities or communities in humanitarian settings. This affects our motivation – as do missing monthly payments, and lack of long-term planning for health system financing.
Many of us mention equity as something to strive for in our health systems: it hurts us when individuals cannot prioritise health care for economic reasons, and relatively minor issues escalate through lack of care.
The need for more investment in structures, supplies, equipment and staffing appears universal if global targets are to be met. At the same time, some of us see greater focus on preventative medicine as critical to reducing pressures on existing systems. Multidisciplinary teams and greater integration to care coordination are seen as ways in which we can work more efficiently.
Several of us see national insurance systems as a possible basis for inclusive and sustainable healthcare in the future, while others wonder whether healthcare will inevitably become too expensive for the poorest people in our societies. The need for intelligent investment across health systems is a recurring requirement of the future.
Contribute to the Manifesto: How can health systems become stronger and more equitable?
What do you do to make your place of work more equitable? What do you do to strengthen preventive medicine where you work? What three things should political leaders of your country to do to improve health services for the community you serve?
An anonymous reader responds to the question: “What do you do to make your place of work more equitable?” in the Manifesto draft:
“Continued communication and participatory decision-making processes are very important in any organization to ensure an equitable working environment. There should be a shared and reasonable distribution of duties and responsibilities at the different levels.”
Edwin Simple responds to the question: “What do you do to strengthen preventive medicine where you work?” in the Manifesto draft:
“Using health promotion to reform preventive medicine. Increase communication to strengthen the linkage between public health and clinical medicine, and also the use of innovative strategies to increase adherence and access”
An anonymous reader responds to the question: “What should political leaders of your country to do to improve health services for the community you serve?” in the Manifesto draft:
“Increase budgetary allocation for health care services, provide infrastructure, pay salaries and provide adequate personnel.”
Knowledge and learning
We recognise the power of learning as something that can transform the way we work. The diversity of our contexts mean that we work with both scientific knowledge of the right way to do things, and the knowledge that comes from knowing a particular context, and the social, political and economic factors that shape people’s lives in a given community. Success is based on us combining these factors effectively.
Some of us are concerned that inadequate investment is being made to train up new entrants into our industry: they are not equipped with the knowledge and skills to take on these complex tasks.
Many of us point to the inequities in global health knowledge, which prioritises global knowledge over context-based expertise. We respect and enjoy hearing from global experts, but many of us suggest that talking to peers with day-to-day field experience is often of more relevance to us.
Contribute to the Manifesto: How can knowledge and learning in health systems be strengthened?
Describe a time when you did something different in your workplace, and what you learned from that. What made it easy or difficult to innovate and learn? Describe how a leader in your workplace has supported you or a colleague to learn. What skills do you need to be a learning leader in your workplace?
María Monzón suggests the addition of:
“We do believe that investing time and participating in trainings and various learning opportunities, like the ones offered by TGLF, are cornerstones of our knowledge.”
Trust and Transparency
We recognise the need for trust and transparency, both within our organisations and between our organisations, us, and the communities we serve. A small minority of us note corruption and poor decision-making within our organisations; many more of us are preoccupied with how to build acceptance with communities, and occasionally with different and conflicted factions.
Contribute to the Manifesto: How can trust and transparency in health systems be strengthened?
What do you do to improve trust with communities? What do you do to strengthen transparency within your workplace?
Kingsley Nignere responds in the Manifesto draft::
“Trust and transparency are paramount within the organization as well as the project communities. Transparency always brings about trust. Hard working and commitment hence leads to a successful and effective implementation of a project as well as measurable output.”
Digital Technologies
The pandemic pushed change in the ways with which we wrk with digital technologies. We experienced opportunities to connect with peers in other regions and countries, and build on their experiences.
Digital tools are allowing us to digitalise patient information, collect and analyse new data and engage with communities through new media. However, many of us do not have the equipment or consistent internet access to build on this potential. Some of us pay from our own pocket in order to participate in peer learning opportunities, such as offered by the Movement for IA 2030. And similarly, many of the communities that could benefit from these technologies risk further exclusion through poverty and lack of access.
Contribute to the Manifesto: How can use of digital technologies in health systems be strengthened?
What digital technologies do you use in your work place? What is their impact? What is the next step to strengthen digital capabilities in your workplace? How do you use digital technologies in your workplace to support communities to be healthy?
Souleymane Traore responds:
“We have to admit that this international platform has helped us a lot to manage our vaccination programs after Covid. And that’s thanks to technology.”
Partnership and coordination
Some of us have experienced how effective partnerships make a difference in delivering healthcare, whether with international actors, or with local private sectors. But it is frustrating when government departments do not work together, or when international actors do not share data that would allow for more effective collective responses during humanitarian operations.
Contribute to the Manifesto: How can health systems develop new partnerships and coordinate better with other actors?
What do you do to develop new partnerships for health? How do you coordinate with other actors, particularly in conflict areas?
Caroline Akosile highlighted the challenge of partners who do not share data at the Manifesto consultation event
“Yes, we are really experiencing a lot of effective partnerships, learning from one another, mentoring each other and so on, but then have international actors, actors who do not want to actually share their data.
I had such an experience at a time we were writing our action report to be submitted for a particular program on TGLF.
I tried to get data from a particular organization in my country, they didn’t give it to me.”
Contribute to the Manifesto: What is missing in the Manifesto? What needs to be added, or changed?
You’ve read the Manifesto version 2.0. It is based on insights from over 1000 health workers. What important themes are missing in your opinion ? What do you agree strongly with? What do you disagree with? Why?
“I want the Manifesto to include that it’s time for us to do health inclusion. We say inclusion, we say diversity, we say equity, but when it comes to people who cannot speak, and here I’m talking about a deaf community, we hardly show that interest,” said Gifty Akusi-Ajibe at the Manifesto consultation event
“What is motivating some of us to do what we are doing in our communities is first of all our own biological sister who has become deaf having been a normal child, all because of missing a measles jab. Her now being deaf should tell you how important immunization is.
And that is why where I’m working for the past nine years, I’ve also been doing my best to contribute in the same way for parents with disabilities, speech and hearing impairments, to be able to access quality and also equal healthcare at any time.”
“I want to highlight that the health system is like a seven-legged stool. Without one or the other part,” it’s bound to fail said Victoria at the Manifesto consultation event.
“So one of the things that we need to emphasize in the Manifesto is, that as we are working on integration, we really need to have checks and balances or a checklist of things that must be incorporated and mechanisms where we have continuous accountability about this integration process because when everyone talks about integration, it’s very easy, but actualising it and being accountable and ensuring that we actually get what we want from it is always a challenge.”
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