The AAAH Plenary Series: Addressing Health Care Workers’ Challenges in Response to COVID-19

The AAAH Plenary Series: Addressing Health Care Workers’ Challenges in Response to COVID-19

When the 11th Asian Action Alliance for Human Resources for Health (AAAH) plenary sessions open on November 18, speakers will build on a series of discussions about how governments, donors, and policymakers are supporting health care workers during the COVID-19 pandemic. AAAH’s webinar series, Addressing Health Care Workers’ Challenges in Response to COVID-19: Sharing experiences and drawing countries’ lessons, which took place over the past two months, drew speakers from across 16 countries who highlighted how governments, partners, and other stakeholders mobilized the health workforce surge capacity; addressed occupational risks; and continued training and education.

The health workforce needed to combat the pandemic – to provide early detection, contact tracing, and management of mild to complex cases – requires a sufficient number of skilled health workers. Yet, frontline health workers are at greater risk of contracting the disease, and their resulting deaths, illnesses, and required isolation result in a diminished capacity to respond to outbreaks. The fear of the disease, its associated stigma, and the increase in workload also result in fatigue and mental stress among health workers, which also limits health systems from responding effectively. In the face of all of this, what have countries learned about mobilizing surge capacity?

Countries such as Singapore, Iran, and Sri Lanka are relying on their primary health care systems, well in place, to serve as “gatekeepers” for managing the crisis. Their primary care systems are treating asymptomatic and mild cases through home quarantine, dedicated isolation facilities, or private-sector hospitals, ensuring that tertiary hospitals and their health staff have greater bandwidth for higher risk or severe cases. In other countries, decision-makers deployed (or are still deploying) health workers from low-burden areas to higher ones—like China did when it mobilized thousands of its health workers from low burden areas to buttress the existing workforce in Wuhan and Hubei provinces. Or, like Indonesia, which is using the data from its HRH information system to make decisions on how to redistribute its workforce where cases are significantly increasing.

Yet even when there are sufficient numbers of health workers to manage patient care, they still face occupational risks. Health care workers’ risk of infection and mental health stressors are inherent when serving on the frontline, but COVID-19 has exponentially magnified them. A few lessons highlighted in AAAH’s second part of the webinar series, on occupational risk protection of health workers, stand out.

First, identifying the causes of infection has an implication on the prevention and control measures that are being implemented in healthcare facilities. While the natural assumption is that health workers are at a higher risk of getting COVID-19 because of their direct contact with confirmed cases, this is only sometimes true. While evidence from Thailand indicates that more than half (54%) of its 118 cases of health worker infections occurred due to patient contact, this wasn’t the case in Egypt. There, just over one quarter (27%) of health worker infections were attributed to their contact with COVID-19 patients, with the majority of cases, 37%, attributed to exposure from their fellow health workers. The data also showed that community exposure was another top cause of infection in both countries. Therefore, reiterating adherence to infection control measures at all times—even when health workers were not at patients’ bedsides—was necessary, especially as health workers were shown to be more lenient in following protocols when with their colleagues.

Second, while mental health programs (not well-funded even prior to the pandemic) suffered further budget cuts as resources were prioritized elsewhere, some countries did move quickly to ease health workers’ mental health burden. In Qatar, 6,000 people were given psychosocial training to provide psychological support to health workers. In Pakistan, the government’s We-Care initiative is aiming to provide 100,000 healthcare workers with mental health training. Technology is also helping to fill the gap. In the World Health Organization’s Southeast Asia Region, an online platform is reaching health workers in 11 countries, serving as a self-help screening tool to users’ needs for further mental health support. Qatar is also leveraging digital technology, sending messages on infection prevention and health promotion to tens of thousands of health workers, and organizing “virtual drop-in clinics” where patients can seek information and advice.

While attention to the needs of the current health workforce is paramount, there is still a need to consider the health workers of the future. The sudden disruption in professional education has jeopardized the cycle of new nurses, midwives, physicians, lab technicians, and all cadres who join the health system every year. Training and education in the COVID-19 context is still evolving, but some lessons have emerged. The AAAH’s third webinar shared the training and education experiences of Malaysia, Sri Lanka, and the United Arab Emirates (UAE).

Most of the teachers in healthcare professions education are more accustomed to the traditional face-to-face learning. The need to shift to virtual learning caught most educators off-guard, and they tried to recreate the physical classroom experience in the online platforms. Most of the course materials, however, are designed for classroom learning, and are less engaging if used online, raising the issues of quality and effectiveness of virtual education. Most teachers were not skilled in using the technology, and so consequently they needed to be trained quickly so that learning could progress. A final challenge was that many educators in the healthcare professions are also clinicians themselves, and most were pulled away from teaching duties to provide clinical services, due to surge in demand for healthcare workers.

Despite these challenges, institutional and policy responses helped to facilitate the sudden shift to virtual delivery. In Malaysia, health workforce education goes beyond the clinical cadres to include all cadres that are part of the One Health workforce—such as veterinarians. Health workforce education is governed not only by the education sector but also by the country’s professional associations, and the Malaysian Blueprint 2015-2025—which requires online platforms for educators and students—made the universities better positioned to make the shift to online classes. In the UAE, regulatory bodies played a role in enforcing educators to shift to online or blended modalities in teaching. Sri Lanka’s 10 medical colleges joined forces to develop a framework on how to continue the training of future healthcare professionals.

The challenges brought by the pandemic paid some surprising dividends to students, with new innovations emerging with the use of technology and online tools. In the UAE, for example, a high-fidelity simulator was used to create a virtual patient to support the problem-based learning approach used for medical and clinical students. Still, students yearned for real-life experiences, and those in their clinical years volunteered in non-COVID and COVID-19 treatment areas in the UAE, while graduating students were brought into facilities to gain clinical skills.

With outbreaks again on the rise in many regions across the world, the strategies and approaches above merit further review and adaptation. The countries highlighted here already had most of the critical factors for mobilizing surge capacity and ensuring occupational safety, even before the pandemic. Virtual training and education, however, have a way to go. An accelerated response to bring this pandemic to a faster end will require quick decision making and the ability to mobilize resources and implement strategies without too much bureaucracy. This is where the AAAH plenary sessions will pick up the conversation on November 18 and continue through November 20. To see what’s on the full agenda, see the plenary overview. To join the discussion, register here.