01 Aug Joining Forces to Strengthen the Health and Social Services Systems
HRH2030 Project Director Wanda Jaskiewicz has more than 20 years of experience in international health and development with a focus on human resources for health, HIV/AIDS, family planning, reproductive health, and maternal and child health. She has worked in more than 25 countries providing strategic leadership to advocate for global and national initiatives to strengthen the health workforce.
The numbers are staggering. One billion children under age 18 experience some form of physical, sexual, and/or emotional abuse. With more than two billion children in the world, that means one child in every two is exposed to harmful situations that negatively affect them now and long into their future.
There is no question the problem is complex and must be tackled from many sides. Of interest to HRH2030, of course, are the workforce implications; in particular, the health workforce and the social service workforce. Imagine how much more powerful of a force they would be if they intersected more regularly. And not only for direct intervention with children suffering some form of abuse or neglect but also for their family members, whose health and well-being are essential to prevent and mitigate abuse situations and provide children with the nurturing environment they need to grow.
However, for the most part, we in the global health community tend to talk about these two groups separately and take a siloed view of them, when we could all learn—and children and families could be better served—from an integrated, more inclusive approach. Personally, when talking about the health workforce, I prefer to use the fuller, more inclusive term of “health and social services workforce.” It’s well documented that the social determinants of health affect health risks and outcomes. The advocacy role that the social service workforce plays for its clients in its own domain is often lacking within health systems—because health workers must focus on other things. Too often, however, healthcare is impeded when patients can’t focus on getting well because they are worried about how their illness is causing housing issues, employment issues, or childcare issues or makes parenting more difficult. It’s the social service workforce—social workers, case managers, child protection agents, youth care officers, and others— that facilitate access to services in these areas.
In some countries, this kind of integration is better established or is trying to get there. In Colombia, the current government launched a cross-institutional social and health framework, called Ni Uno Mas, or Not One More, with the goal of providing better services in order to reduce the high child mortality rates associated with all types of violence. This initiative is led by the first lady, the Ministry of Health, and the Colombian Family Welfare Institute (ICBF); the latter is an HRH2030 partner in our Colombia activity. Ni Uno Mas also involves participation from the private sector (Fundación Éxito and Niñez Ya), the public sector (local and regional governments), international organizations such as USAID and UNICEF, and most importantly, local communities. This framework strives to improve the coordination between institutional stakeholders, clearly defining the roles of all those who are involved, qualifying the services with better tools in parenting and family care, improving social and health sector capacities with training in technical skills, and ensuring a link with vulnerable rural communities and indigenous populations.
I was fortunate to visit Colombia in May, where I met with leaders and providers of child welfare services from both the health and social service sectors. HRH2030 is supporting the cross-institutional social and health framework and is working with ICBF, the Ministry of Health, and the National Learning Service (SENA) to develop training for social workers, psychologists, lawyers, nutritionists, and health personnel in order to ensure better adherence to childcare protocols and better case management practices with children and families. In addition, we are supporting the process to improve the coordination between stakeholders with a clear referral process, as well as to establish better communication processes with the communities to ensure their direct involvement in the referral process.
Colombia is not alone in taking a more integrated approach to the health and social service workforces. Evidence from South Africa has shown that the child protection component contributes to supporting HIV prevention goals. The Global Social Service Workforce Alliance continues to document the role that the social service workforce plays in contributing to the fight against HIV and AIDS. Earlier this year, UNICEF published Guidelines to Strengthen the Social Service Workforce for Child Protection, which recognized the undue burden that violence against children places on the social service workforce and how it undermines investments in health.
As we’ve seen in the human resources for health domain, calls for more integrated and inclusive approaches can have results. After years of advocacy for scaling up and better integration of community health workers into health systems, for example, the WHO issued guidelines last year on optimizing community health worker programs into health systems, and soon thereafter, members at the World Health Assembly adopted the CHW resolution to invest in these types of programs.
We talk a lot about interprofessional care within health systems, and when we do, we are mostly thinking about integrating physicians, nurses, pharmacists, and nutritionists and the like. Wouldn’t it be great if we could more naturally and more frequently think about social workers when we think about health workers, too? Doing so will let us join forces for the benefit of children and families and help ensure quality health for all.
HRH2030 Communications Director Elizabeth Walsh contributed to this blog.
Photo: A mother and child engage in a joyful embrace in Bogota, Colombia. Credit: HRH2030, 2019.