In February, I had an amazing opportunity to join with colleagues from the Community Health Impact Coalition and meet with some brilliant minds in the Bay Area to discuss — and, hopefully, shape — the future of primary healthcare. Entrepreneurial thinkers, influencers, innovators, tech leaders, funders, and global health colleagues convened by the Mulago Foundation participated in several days of presentations, conversations, and working meetings. I was honored to be present, and even more, honored to present the closing remarks. The opportunity to step back and take a 50,000-foot view of the global health field was of great value. I have documented some of those thoughts on the future of primary health care here to help further this conversation.
The Future is Female.
I’m not going to lie, it felt good to make this statement. But more importantly, I truly believe this. On the front lines of primary healthcare delivery, the people I see driving change are women — female Community Health Workers, nurses, midwives and mothers, who make the lifesaving decision to seek care for their children. Few statements are an aspirational rallying cry, combining decree, demand, and dream in one — I believe the future of primary healthcare will be female.
When I think of this statement, I think of Kassan, Rebecca, Veronique, and the dozens of female staff recruited since 2015, when we first began prioritizing women to be hired as Community Health Workers as part of an integrated primary healthcare delivery program. At the time, despite criticism and backlash, we held to the belief there was tremendous untapped potential in the women of rural, remote communities in places like Togo. While many had never received formal education, these women were highly intelligent, motivated, and hard-working.
The results of this endeavor exceeded expectations. As I wrote in this column, #MeToo meets #HealthforAll, we underestimated the social benefits that would result from such action. A virtuous cycle transpired. Not only did the source of employment reinforce the women’s sense of self-worth, but the women also self-organized savings groups, pooled their incomes, granted loans, and invested in other income-generating activities. By actively working to change aspects of the culture of health, we saw a cascading transformation that influenced gender equity, economics, equality, and violence prevention.
The Future is Radically Collaborative.
Shout-out to my colleague, Madeline Ballard, Executive Director of the Community Health Impact Coalition (of which Integrate Health plays a role) for breaking down what is sure to be the buzzword to watch, with such eloquence.
Radical Collaboration is one of those “easy in theory, difficult in practice” concepts that seems straightforward on the surface but represents a fundamental shift in the way we do things. As Madeline explains in the video above, we have to shake off the practices inherited from the private sector — the norms of the business world that NGOs adopt unquestioningly — to make progress achieving health for all.
We have to stop looking at similar organizations as competitors vying for a market share or limited donor dollars. Instead, we should be openly discussing not only the results achieved, but the process of how. Our closely guarded IPs should become open sourced and collectively reviewed. To move the field forward we need to stop emphasizing our own brand and focusing on our own expansion but consider what shared success looks like and work together to accomplish our common mission. Put frankly, its time to set our egos aside.
It was in this spirit of radical collaboration that we joined with Last Mile Health, Living Goods, Muso, Partners in Health, and Possible to publish insights from our collective practitioner expertise (the report can be found here).
The Future is Integrated.
A Community Health Worker is recruited from her local community, equipped with skills, and charged with providing services to her fellow community members. Working full-time, she goes door to door to find and treat sick children and pregnant women. In areas throughout the world where distance is a significant barrier to care, Community Health Workers are the great equalizers.
However, Community Health Workers do not work in a vacuum. At some point, even the best Community Health Worker will encounter a diagnosis she cannot treat, she will then make a referral to a local clinic for more advanced care. If that clinic is not equipped to provide quality care, if the patient is treated poorly, the trust a Community Health Worker has worked so hard to earn will be eroded. The role of a Community Health Worker can only be fully realized if it is balanced with a strong primary healthcare clinic and integrated into a functioning healthcare system.
A large part of our work, in partnership with the Togolese Ministry of Health, involves improving infrastructure and the quality of care provided in clinics. Deploying Clinical Mentors to provide peer-based coaching to improve how providers treat and communicate with their patients. Making sure shelves are fully stocked, the staff is fully trained, and the buildings are fully functioning.
Historically, primary healthcare has been delivered in silos, fragmented by disease, delivery channel and donor. This can no longer stand. We must break down the silos and stop building new ones in order to ensure primary healthcare delivery is integrated. This is the only way that we can achieve our goal of universal health coverage, or put simply, health for all.
Achieving Universal Health Coverage: Health For All
There are 1 billion people throughout the world that go their entire lives without ever seeing a health worker. Entire communities have been forgotten. Easily preventable deaths occur with tragic frequency because the treatments that exist are simply inaccessible to the poor. We are working, collectively, with CHIC and others to remove these barriers, to create access, to ensure quality and to close these gaps for everyone, everywhere.