Blog: Will health systems be ready to meet the post-MDG realities?

تم النشر: 8 أبريل 2014 12:51 CET

How often do seismic shifts happen under our feet, and before we realize it we are toppled by a changed landscape that we have not prepared to navigate? Countries are facing such seismic shifts as they ponder their post-2015 national health strategies. Beyond the drive to reach the Millennium Development Goals, how will we re-engineer our systems to achieve Universal Health Coverage and meet the growing needs of long-term care and chronic conditions care?

Community volunteers have become a key service delivery mechanism for expanding access to care, disseminating health information, and providing essential prevention and follow-up services. For maternal and child health, volunteers – many of whom are now paid through various programmes – are the right hand of the facility in enrolling pregnant women into care at the facility and supporting new mothers to provide the necessary care and nutrition to their newborns so they will thrive. For HIV clients, expert patients have been the ‘saving grace’ for many a stigmatized patient in their desperate search for emotional solidarity and home care support.

Donors and public-private partnerships have equipped this growing cadre of diverse community providers with mHealth and eHealth technologies to allow them to more effectively counsel and gather real-time information that can be used to inform responsive strategies. Using these technologies, community health workers become more informed, empowered, and independent. They learn to track their own supplies and submit orders; they learn to use their inter-connectedness not only to contact supervisors for guidance but also to connect with each other and wider social networks for information and assistance. The community health worker can leverage the mHealth technologies to better link the community to the public system and to strengthen bonds within communities themselves.

The IFRC World Disaster Report 2013 indicated that there are now more than 6 billion mobile phone subscriptions and over 2 billion mobile broadband internet subscriptions. Between 2008 and 2013, developing countries doubled the number of mobile phone subscriptions, adding 2.5 billion. There are almost twice as many mobile broadband as fixed broadband subscriptions.

One example of the power of these linkages is the use of mHealth by volunteers of the national membership societies of the International Federation of Red Cross and Red Crescent Societies (IFRC).

Technology for collaboration

With advancing technologies, Red Cross Red Crescent  staff and volunteers can learn to track health emergencies and disasters, disseminate information, connect with colleague volunteers from neighboring communities, and direct families and villages with instructions on how to protect themselves and where to go for health services. Further, volunteers can collaborate with the communities they serve to recruit needed supplies and commodities, solicit funds, and connect missing family members with loved ones.

For example, in Haiti, Red Cross staff and volunteers used technologies to get information to their communities through a local community radio station that was up and running after the 2010 earthquake.  Rose Marie is just one of the many listeners who still tunes into the on-going Red Cross radio show, Radyo KwaWouj.  In Sierra Leone, the local Red Cross Society uses the Trilogy Emergency Relief Application (TERA) in collaboration with local telecom providers to connect instantly with communities during floods, wildfires and disease outbreaks. Right now in Guinea, Red Cross volunteers are being trained to usea system called Rapid Mobile Phone-based survey (RAMP) to respond to the Ebola epidemic outbreak. RAMP enables volunteers from the community to upload information with their phone to the internet immediately so managers can analyze it and respond to needs.  

Not only are community volunteers and frontline health providers stronger in responding and managing disasters, but they are managing their own economic growth through better linked micro-financing mechanisms and mobile banking, managing their education through access to open-source education and supporting each other in health responses.

As national health authorities craft policies that will better incorporate community health workers and volunteers into national care delivery strategies, and work with districts to be more responsive to the health needs of the communities they serve, they need to lift their eyes from the individual trees, to see the wider – changing – forest.

Involving individuals and communities

The mHealth Systems Framework, developed by the USAID Applying Systems to Strengthen and Improve Systems (ASSIST) Project, looks beyond the immediate benefits of mHealth and eHealth applications to exploring how the incorporation of those technologies does or does not enable the system to deliver higher quality services. The incorporation of information and communication technologies into low-resource settings will shift the role of the individual workers, the capacities of the community providers and the influence of the communities.

Are we ready to meet the needs of evolving landscape? How do country decision makers look beyond immediate needs to better integrate community providers into the human resources for health support system? How do national and sub-national decision makers partner with communities themselves to design new service delivery models that will adequately engage and incorporate the community in decision-making, planning, and delivering care and services?

The rumblings under their feet alert us that if we don’t embrace and prepare for a new landscape we may be catapulted into the new reality with much less grace than we would like.

Allison Annette Foster
Senior Advisor, Quality Improvement and Health Workforce Development


Ombretta Baggio
Senior Officer, Communications
International Federation of Red Cross and Red Crescent Societies


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