Yemen has been in turmoil for six years and more than 8 million children are at serious risk. According to Unicef “No place is safe for children in Yemen “.
In a situation where two-thirds of the population is in need of humanitarian assistance, children and the poorest will be the most affected. The threat of COVID-19 is looming and a severely damaged health system is on the brink of total collapse.
At a time when hospitals and institutions are targeted and a large part of the population is displaced, traumatized and homeless, health care must be immediate and accessible. In a situation like Yemen, community health workers suddenly become the most valued entity in a community, even though they are often the least educated, the least paid and the least valued within a community. health system.
Save the Children’s experience in Yemen has shown that community health workers (CHWs) save lives. They are unsung heroes who provide much needed care to communities experiencing political turmoil.
CHALLENGES OF BEING A COMMUNITY HEALTH WORKER
Despite their critical role – often as the only link to the national health system for the most vulnerable and isolated communities – there are not enough trained and well-equipped CHWs in Yemen. The government, struggling with limited resources, has not prioritized training, hiring, equipping and supporting CHWs. They are not considered to be part of the national health workforce and their training is therefore kept to a minimum. This “difference” is used as an excuse to pay them very little – so little that it is not classified as a salary but rather called an “incentive”.
Every community health program needs the assistance of CHWs – whether it is health awareness programs, COVID-19 messaging, community disease surveillance, nutrition information, community health checks , interventions for basic health problems such as diarrhea, malaria and pneumonia, and antenatal care.
Most health data at the community level is collected by CHWs, collated by health facilities and moves up the food chain to ultimately constitute the district health information system, which informs planning and budgeting at regional levels and central. These services are provided by CHWs in more than one location – all of which add to a very heavy workload.
MORE THAN A JOB FOR COMMUNITY HEALTH WORKERS
With health facilities in ruins, public transport almost non-existent, and the ongoing conflict, which can erupt at any time right outside their doors, CHWs in Yemen face great risk serving the communities in which they are engaged. Many CHWs we support and work with faced direct dangers when skirmishes broke out during their community visit, and they were forced to take refuge, fearing for their lives. The isolation of some communities and the lack or high cost of transport also mean that CHWs often have to travel long distances unaccompanied, putting them at risk.
CHWs often use a family member to accompany them for their own safety, whose expenses must then be covered by their own “incentives”. Often times, incentives for CHWs also extend to cover drugs and products they purchase for a community to cover stockouts or a long disruption in the government supply chain.
SUPPORT COMMUNITY HEALTH WORKERS
Save the Children has attempted to address some of these issues by considering some of the challenges CHWs face. We have
- worked with the Department of Health to support the hiring of community health workers to increase the number of people in the areas where we work and ensure they can be in the community they serve without having to travel too far and expose yourself to other dangers.
- ensured that CHWs are better trained, supported and informed about COVID-19 and its impact – helping them to remain reliable, accessible and resilient sources of information, in order to better serve their communities.
- worked with community and traditional leaders to increase acceptance of CHWs, which helped strengthen their links with the community.
TH WORLD HEALTH ASSEMBLY, 2021
Community health workers remain a vital link with poor and marginalized communities in need of access to health care in Yemen, as well as in most parts of the world, including other fragile and affected states. Conflicts. We salute the Year of the Health and Care Worker and hope that CHWs and their critical importance will be reflected in relevant discussions at the 74th World Health Assembly and in the upcoming resolution on the health workforce. We also hope that the next WHO 2022-30 action plan on the health workforce will provide ways for countries like Yemen to build a strong health workforce, the foundation of which will be the agent of sustained and empowered community health.
We urge member states to:
- increase the number of community health workers according to population density and needs and ensure that their recruitment is fully costed and funded
- fully integrate community health workers into the national health workforce and pay them a fair salary
- better support community health workers who are at the forefront of providing essential services and supporting outbreak response at the community level
- work with civil society in your countries to develop health workforce action plans that will reflect your commitment to universal health coverage, primary health care and health security
- develop targeted financing plans to help fill the gaps of national health workers, as this can lead to a triple return of improved health outcomes, global health security and inclusive economic growth
- improve the collection and availability of data at subnational and national levels for all information regarding national health workers, including community health workers.