Where are the health workers? New data efforts aim to answer big coronavirus questions

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Health workers take a COVID-19 patient’s blood sample in Surabaya, East Java province, Indonesia. Photo by: Antara Foto / Didik Suhartono / via Reuters

NEW YORK — New data initiatives are offering a clearer picture of COVID-19, including what factors determine a country’s preparedness and how governments can better understand where to send their frontline health workers.

Two data dashboards released by the U.N. Development Programme last week highlight the connection between countries’ level of development and the increased risks associated with coronavirus preparedness and financial losses.

The idea of COVID-19 vulnerability and preparedness goes beyond immediate questions of health care system capacity, according to Milorad Kovacevic, chief statistician at UNDP.

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Countries with higher human development — a composite of life expectancy, quality of life, and education — are more likely to have higher levels of trust in the government and more widespread internet access. This can influence how well governments communicate public health messages and how accurately people can receive them during a health pandemic, Kovacevic said.

The average country with low human development has limited capacity to accommodate a surge of COVID-19 patients in hospitals, with an average of 7 hospital beds, 2.5 physicians, and 6 nurses per 10,000 people, the digital data dashboard shows. That stands in contrast to the 55 hospital beds, over 30 physicians, and 81 nurses per 10,000 people available in an average country with more development.

“The important thing is to see how well countries are prepared to face virus cases of this nature and magnitude. This prompted us to look at the indicators that tell us something about society. We are not looking at income data. We are rather looking at classification of countries according to the Human Development index averages,” Kovacevic explained. “And today, we realize that income inequality is very important.”

There is also a correlation between countries with lower human development and reliance on tourism and remittances — indicating that while the virus has spread most severely across western Europe and the United States, countries in the global south will likely experience longer-term economic impacts of government shutdowns and travel restrictions, Kovacevic explained.

“But because of this globalization in place, because of this chain of dependencies, the impression coming from looking at these tables is that less developed countries will be hit hard, harder than developed countries as a consequence of economic fallout. And probably as a consequence of their underdeveloped health systems,” Kovacevic said.

The World Bank has identified “increasing demands for information and data” as one of the biggest challenges during the global COVID-19 response. And lack of testing and data collection in low-income and fragile countries has revealed only a partial picture of the virus’ spread, U.N. Emergency Coordinator Mark Lowcock said recently.

Chemonics is an example of a development organization that is working to improve COVID-19 data collection at the national level. It has supported the Indonesian government in creating a new data dashboard on national and regional health care worker demographics over the last few weeks.

“It is sometimes the thing that's most overlooked [in a pandemic] — understanding what your health workforce is, who they are, and where they are.”

— Leah McManus, Indonesia project lead, HRH2030 program

Indonesia has more than 1 million community health workers across 17,000 islands. Better data collection can help the government make more informed, strategic decisions, such as redistributing health care workers to hospitals in need, according to Leah McManus, the project lead in Indonesia for Chemonics’ HRH2030 program.

“The health workforce is the most important thing for an epidemic, a pandemic, just an outbreak of any kind of to help with anything related to family planning or TB or anything like that,” McManus said. “But it is sometimes the thing that's most overlooked — understanding what your health workforce is, who they are, and where they are.”

The dashboard, which is in the official language of Indonesia, provides information on the types of health facilities and available health workers.

“It's not always perfect. You know, it takes time. There's issues with data quality. But that doesn't mean it's improbable to use this data — it just means that if we know where our gaps and our weaknesses are, we can address it versus having nothing, which is what unfortunately we find in some countries,” McManus explained.

The Congo, Mali, Liberia, Guinea, and Sierra Leone all conducted similar kinds of data collection on health worker location and other information, such as when they last received specific kinds of training, during the 2014-2015 Ebola outbreak.

“It is to help governments and private sector stakeholders, everybody, understand where and how they're going to have a quality health workforce to provide quality services,” McManus said.

One mobile platform first created during the 2014-2015 Ebola outbreak has also been relaunched after the COVID-19 pandemic reached Liberia, according to Emily Nicholson, a technical adviser at IntraHealth International. The government is using the two-way, mobile phone-based communication system to engage with health workers and use the information to guide their public health response.  

“In light of the fact it is such a flexible tool, we have had multiple other partner organizations approach us with requests to use it in other countries,” Nicholson said.

“Health workers are so paramount to everything. Not just now, but always. They need to know the signs and symptoms of COVID, they need to know how to protect themselves, but there is a need for data the other way, too. Ministries really need to hear from them to make the best decisions they can.”

Update, May 5, 2020: This article has been updated to clarify that the Congo, Mali, Liberia, Guinea, and Sierra Leone conducted data collection on health worker location during the 2014-2015 Ebola outbreak.

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About the author

  • Amy Lieberman

    Amy Lieberman is the U.N. Correspondent for Devex. She covers the United Nations and reports on global development and politics. Amy previously worked as a freelance reporter, covering the environment, human rights, immigration, and health across the U.S. and in more than 10 countries, including Colombia, Mexico, Nepal, and Cambodia. Her coverage has appeared in the Guardian, the Atlantic, Slate, and the Los Angeles Times. A native New Yorker, Amy received her master’s degree in politics and government from Columbia’s School of Journalism.