Event information
Remarks by U.S. Global Malaria Coordinator Dr. Raj Panjabi
In a few months a new virus spread like wildfire to nearly every corner of our world. Over 140 million people have fallen sick from COVID-19 and over 3 million people have died. COVID-19 has cast a dark shadow over our healthcare systems. There could be hundreds of thousands to millions of additional deaths from untreated HIV, tuberculosis, malaria, and because mothers and children have gone without routine prenatal care and immunizations. And every time a new life saving test, treatment or vaccine has been developed wealthy nations and the privileged have gained access while the poor and marginalized have been excluded.
This is not just the story of COVID-19. It is the story of pandemics humanity has faced from COVID-19 to malaria. It is a story of despair.
But out of stories of despair can come new chapters of hope. As COVID-19 threatened to bring us to our knees, we have seen courage. Like doctors and nurses, community health workers have not surrendered to fear. They’ve done what they’ve always done: they’ve answered the call to serve their neighbors.
From Afghanistan to Zambia, you have supported hundreds of thousands of community health workers team up with nurses and doctors to go door-to-door to find the sick and get them into care. They’ve carried out case finding, contact tracing and helped hunt down the virus in an attempt to stop it in its tracks. They’ve helped people learn to wear masks. And now they’re helping them get the COVID-19 vaccine. All along, they’ve tried to sustain treatment in the homes of those with HIV, tuberculosis and malaria and to keep primary health care like immunization and prenatal care services going.
From them, from your investments in primary care at the community level, we’ve learned a few things. We’ve learned outbreaks start and stop in communities. We’ve learned its smarter to bring care to people than waiting for people to come to care. We’ve learned that the best emergency system is actually an everyday system that can surge during a crisis and leaves no one out of reach.
COVID-19 is the newest pandemic. But it will not be our last. Our future depends on community and other frontline health workers. Our future depends on your investing in systems to strengthen primary care in communities.
That’s why we are here at ICHC 2021. Since we first came together in 2017 you have made progress. This is evident in the pre-conference scorecards you worked on. You’ve built community clinics. You’ve trained community health workers, nurses and midwives. You’ve equipped them with point-of-care tests, medicines and smartphones. And you’ve invested in systems to strengthen the quality of data and the quality of care.
Thanks in part to your work and building on the 2018 Astana Global Primary Health Care conference, Health Ministers from over 190 governments came together at the 2019 World Health Assembly to adopt a historic resolution on community health workers. This resolution called for greater investments not just in community health services, but in community health systems – including systems to strengthen skills, supervision, supplies, and salaries. Later that year, Heads of State committed to community-based healthcare through the first UN High Level Declaration on universal health coverage.
But today we recognize resolutions are not enough. Declarations are not enough. The progress we’ve made is not enough.
Today, at ICHC 2021, we dream of health systems that achieve equity and quality through optimizing primary health care in communities.
Today, in the Year of the Health and Care Workers, we dream of a future when millions of people can gain dignified jobs as community health workers to serve their neighbors – from the forest communities of West Africa to the coasts of the Caribbean, from the deserts of the Sahel to the mountains of Central Asia.
But to realize our dreams we have to overcome three challenges.
First, we have to protect health workers in communities.
Last summer, I came home after testing patients in a COVID clinic where I was forced to reuse the same gown all day. When I got home, I didn’t want to risk infecting my family. So I took off all my clothes before entering the front door. My children were amused. But I was worried.
The anxiety of being unprotected while caring for patients with this virus is unlike any other I have felt. It’s a fear that I know every health worker feels. And then things changed. I got vaccinated. And last Sunday, while volunteering to vaccinate others at a community center, I felt relief. I wasn’t worried about becoming infected. I wasn’t worried about making my family sick. Free from fear, I could focus completely on caring for the person in front of me.
Freedom from fear is something every single health worker in every community deserves to feel.
We applaud health workers as heroes. But applause is not enough. Over 17,000 unprotected health workers have died from COVID-19. Without masks, community health workers have knocked on doors in the poorest neighborhoods to find COVID patients. Without being vaccinated, midwives and nurses have delivered babies in community clinics. If we respect them, we must protect them.
Procuring COVID-19 vaccines will not be a ‘silver bullet’ – because vaccines don’t deliver themselves, health workers do. When epidemics like smallpox and polio threatened humanity community health workers went door-to-door to vaccinate billions around the world. Now, we are asking them to help vaccinate billions against COVID-19 to protect us. The question is are we prepared to go as far as it takes to protect them?
That brings me to the second challenge. We must confront structural urbanism.
Your scorecards highlighted inequity in the way community health workers are distributed – disproportionately leaving rural areas behind even before the pandemic.
Illness is universal, health care is not. Over half of the world’s 7.3 billion people, including 1 billion in remote rural communities, lack access to health care. While we’ve made great advances in modern medicine and technology, our innovations have not reached those at the last mile. We have seen these communities left behind because they have been thought too hard-to-reach and too expensive to serve.
Approximately 13 million children still go without a single dose of any vaccine. Nearly 9 million newborns, children and mothers still die each year from preventable or treatable conditions.
All of this is compounded by the fact that we have the worst shortage of healthcare providers in history. If we do nothing differently, the world will face an 18 million health worker shortfall by the end of this decade. No one should die because they live out of reach of care.
But investments in rural community health systems don’t just save lives – they keep us all safer. In rural areas, blind spots in health care can become hot spots of zoonotic disease. Ebola, Zika, HIV, malaria and other pathogens first emerged in rural areas. Science shows the next spill-over of a new pathogen from animal to human is most likely to emerge in these areas. Our investments in community health systems in the world’s most remote communities help us better prevent, detect and respond to the next pandemic.
Now the third challenge we have to take on is to abolish the pay gap for women on the frontlines.
Your scorecards reveal that gender inequity persists in community health.
Most community health workers are women. Most community health workers are poor. And most community health workers are not paid. Many midwives and nurses also remain underpaid. I was surprised to learn that women on the frontlines subsidize health care globally to the tune of over $1 trillion dollars with their unpaid labor. $1 trillion – that’s a figure larger than the economies of over 150 countries.
Power is never given; it must be demanded. We must demand our Finance Ministers and Heads of State go as far as it takes to abolish this pay gap. We should ask them: if you are paid for your work, why aren’t community and frontline health workers paid fairly for theirs?
We should demand our leaders abolish the pay gap for women on the frontlines not only because it’s the right thing to do – but because it’s the smart thing to do. The pandemic has led to massive unemployment and women have been most affected. Leaders are desperate to create jobs quickly to recover. We should remind our leaders that investing in a community health worker isn’t just one of the fastest ways to create a job, it’s a job that creates the fastest way out of the pandemic.
At ICHC 2021, let us commit to protect health workers in communities. To confront structural urbanism. And to abolish the pay gap for women on the frontlines.
Over the years, we have learned we are not defined by the conditions we face – no matter how hopeless they seem. We are defined by how we respond. The pandemic is a story of suffering. But how we choose to partner with communities to respond is our chance to write a new chapter of healing – the beginning perhaps of an entirely new story of how we come together to build back health systems that leave no one out of reach.