In a situation where two thirds of the population needs humanitarian assistance, children and the poorest will be the worst hit. The threat of COVID-19 looms, and a severely damaged health system is teetering on the brink of total collapse.
At a time when hospitals and facilities are being targeted and large swathes of the population are displaced, traumatised, and homeless, health care needs to be immediate and accessible. In a situation such as the one faced in Yemen, community health workers suddenly become the most valued entity within a community even if they are often the least educated, the least paid and the least valued within a health system.
Save the Children's experience in Yemen has shown that community health workers (CHWs) save lives. They are the unsung heroes providing much needed care for communities living through 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 scarce resources, has not prioritised training, hiring, equipping, and supporting CHWs. They are not seen as part of the national health workforce and therefore their training is 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-based health programme needs the assistance of CHWs -- be it health awareness programmes, COVID-19 messaging, community-based disease surveillance, nutrition information, community health checks, interventions for basic health problems such as diarrhoea, malaria and pneumonia, and pre-post-natal care.
Most community-level health data is collected by CHWs, collated by health facilities, and goes on up the food chain to finally make up the District Health Information System, which informs planning and budgeting at the regional and central levels. These services are provided by CHWs in more than one location -- all of which add up to a very high 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 flare up at any given moment just outside their doorsteps, CHWs in Yemen face big risks in serving the communities they are committed to. Many CHWs we support and work with have faced direct dangers when skirmishes have broken out during their community visit, and they have been forced to take refuge, fearing for their lives. The isolation of certain communities and the lack of, or high cost of transport, also means that CHWs must often walk long distances unaccompanied, putting them at risk.
CHWs often get a family member to accompany them for their own safety, whose expenses then need to be covered out of their own "incentives". Often CHW incentives also stretch to cover medicines and commodities they buy for a community to cover stock-outs or a long break in the government supply chain.
SUPPORTING COMMUNITY HEALTH WORKERS
Save the Children has tried to address a few of these problems by considering some of the challenges faced by CHWs. We have
- worked with the Ministry of Health to support the hiring of CHWs to increase numbers in the areas we work in and ensure they can be in the community they serve without having to travel too far and exposing themselves to other dangers.
- ensured that CHWs are better trained, supported and informed about COVID-19 and its impact -- supporting them to remain reliable sources of information, accessible, and resilient, so that they can better serve their communities.
- worked with community and traditional leaders to increase the acceptance of CHWs, resulting in strengthening their links to the community.
TH WORLD HEALTH ASSEMBLY, 2021
Community health workers remain a critical link to impoverished and marginalised communities who need to access health care in Yemen, as well as in most parts of the world, including other conflict-affected and fragile states. We welcome the Year of the Health and Care Worker and hope CHWs and their critical importance will be reflected during relevant discussions at the 74th World Health Assembly and in the upcoming resolution on health workforce. We also hope that WHO's next health workforce action plan 2022--30, will propose ways forward for countries such as Yemen to build a strong health workforce, whose foundation will be the supported and empowered community health worker.
We urge Member States to:
- increase the number of community health workers in line with population density and needs and ensure their recruitment is fully costed and funded
- fully integrate community health workers into the national health workforce and pay them a just wage
- better support community health workers who are at the forefront of delivering essential services and supporting outbreak response at community level
- work with civil society in your countries to develop health workforce action plans, which will reflect your commitment to Universal Health Coverage, primary healthcare, and health security
- develop targeted financing plans to help fill national health worker gaps as this can result in a triple return of improved health outcomes, global health security, and inclusive economic growth
- improve data collection and availability at subnational and national levels for any information regarding the national health workforce, including for community health workers.