Q&A: Kerry says community health worker model 'cannot be done in isolation'

LILONGWE, Malawi — Community health workers are seen by many, including donors, as a cost-effective solution to the problem of the global shortage of health care professionals. But depending so heavily on community health workers, without prioritizing investments toward training doctors, nurses, and midwives, will ultimately result in substandard care for patients, Dr. Vanessa Kerry, chief executive officer of Seed Global Health, told Devex during a recent trip to Malawi. There is a shortage of millions of skilled health care professionals globally, with the most severe scarcities present in Southeast Asia and Africa. The World Health Organization estimates that there is a shortage of some 17.4 million health professionals across the world. Seed Global Health, a United States-based nonprofit, is one of the organizations aiming to address this shortage. The organization brings American health professionals to Malawi, Liberia, Swaziland, Tanzania, and Uganda to train doctors, nurses, and midwives in-country. Its Global Health Service Partnership, a public-private collaboration with the Peace Corps and the U.S. President’s Emergency Plan for AIDS Relief, places health professionals “alongside local medical and nursing faculty counterparts to meet the teaching needs identified at each partner institution.” Our conversation with Kerry has been edited for length and clarity. Can you talk about some of the issues surrounding standards of care? I find that people are always looking for short-term solutions, or some kind of way around the big problem. And they come up with solutions, which may be very effective, but to me, they are sort of allowing a substandard way of practicing care. What I worry about is, for example, the community health worker model. I think the community health worker model is actually incredibly powerful. You increase access to care, you engage the community, you can see incredible health improvements. “While [the community health worker model] is an incredibly important part of the health care system, it cannot be done in isolation.” --— Dr. Vanessa Kerry, CEO at Seed Global Health But if you don’t invest, at the same time, in health professionals — doctors, nurses, midwives — who can help train those community health workers from a local perspective, who can be the backstop for referral for those community health workers, who can help serve as an important infrastructure backbone to the health system, you will never actually achieve a full standard of care in that country. Community health workers cannot perform C-sections. Malaria becomes cerebral, women rupture in childbirth, you have patients that get septic, people get incredibly sick. [Health workers] need to be able to go beyond. While [the community health worker model] is an incredibly important part of the health care system, it cannot be done in isolation. I find that a lot of people are putting investments and efforts into just that, as though it is going to be the panacea. That, to me, is investing in substandard care. What are some strategies for changing mindsets around this? That is a really difficult and thorny question. But for me, it is two-fold. For one, it is showing what is possible. Once people started to see that you could treat people in resource-limited settings with antiretroviral treatments, for example, suddenly we had [U.S. President George W. Bush] willing to sign billions of dollars into law to treat millions of people. But it took that example. It took that evidence to show people what was possible and for people to say that it does make sense. The other thing that I think is really important is generational change. I believe that if you can invest in a younger generation when they are still nimble, inquisitive and curious, and not yet entrenched, and help them to think differently and to understand what is possible, they will rise to become leaders. Then they will help to institute the change. We realize that is going to take time. We can’t keep looking to short-term solutions, or these ‘silver bullets,’ as we say in the United States, to fix things. These are big problems, and they have developed over time. The solutions are going to take time to fix. How do you talk to donors about the need to train doctors, nurses and midwives? We struggle. There are not a lot of donors interested in training health professionals. Donors like the community health worker model. It’s a lot sexier. It takes shorter training. It has a very direct impact, that you can see in a very measurable way. Training health professionals is a lot more amorphous in terms of how you can measure it. Donors are savvy now. They want to tie their investments to metrics. I think very few donors are in the health professional space. The last three years there has been a rise of donors [funding] community health workers. It’s been growing. In fact, I know a number of conferences that are going to talk only about community health workers. Changing the mindset to me is incredibly difficult. But to me, you just need to keep telling the same message, keep reinforcing and showing examples. Editor’s note: Seed Global Health facilitated Devex's travel and logistics for this reporting. However, Devex maintains full editorial control of the content. Read more Devex coverage on global health.