As COVID-19 spread across the globe, we at the Johnson & Johnson Center for Health Worker Innovation began strategizing how to support frontline health workers in low- and mid-income settings. One early result was the formation of a new collective partnership with funding from the Johnson & Johnson Foundation among three of our partners, The World Continuing Education Alliance (WCEA), The Aga Khan University School of Nursing and Midwifery East Africa (AKU) and the International Council of Nurses (ICN). Together, we set out to design a mechanism to deliver vital training and education opportunities to frontline health workers managing dual imperatives: to prevent and treat COVID-19 while also providing primary health care amidst a potentially devastating interruption of health services, particularly in already fragile health systems.

Bearing this in mind, the partners developed together a focused training program delivered via mobile app that aims to reach 600,000 nurses and midwives across Sub Saharan Africa and the Middle East. Since its launch in April, nearly 175,000 nurses have been reached and more than 1.1 million continuing professional development (CPD) training courses have been completed[i]. Each partner has truly brought their expertise to bear in this collective effort:

·       AKU has established a certifiable COVID-19 Curriculum for nurses with six modules adapted from World Health Organization (WHO) training.

·       ICN has brought tremendous reach to engage nurses through their collaboration with national Nurses Associations, Nursing Councils and Ministries of Health.

·       WCEA’s virtual learning platform and mobile phone-based training capacity has enabled us to scale this program rapidly.

Knowledge is everything – especially on the frontlines of care where lives are in the balance. The content developed by AKU and other organisations covers COVID-19 training modules but also more general training for instance on maternal and newborn child health, mental health and resilience. Trainings are open source in the app and currently available in English, Arabic and French. The app also encourages information sharing that creates effective feedback channels to quickly provide greater insight into the training needs and experiences of those on the frontline. This agile feedback loop provided strong learnings during the Ebola crisis and provides opportunity to better address the COVID-19 pandemic by giving voice to those on the frontline. Our hope is that this data will help broker critical conversations between health workers and their national public health representatives to help further advance training for community-based care as systems recover from the pandemic.

At the heart of the Johnson & Johnson Center for Health Worker Innovation is the intersection between community health and primary care. In this regard, we believe that well-functioning health systemsmust be anchored in strong community-based primary care, a focus this collective partnership so clearly represents. Frontline health workers, especially nurses, midwives, and community health workers (CHW), play a critical role in all resource settings, but especially within low and mid income-resource systems. The world is facing a critical health worker shortage – estimated by the WHO to reach a gap of 18 million by 2030. While frontline health workers are lacking in numbers, it is paramount to adequately equip those who are on the frontlines today with knowledge and tools to render their work and care as efficient and effective as possible.

Digital health and knowledge tools are spreading across Africa – so what’s different about this work? The WCEA mobile based training are accessible on low bandwidth and endorsed by National Nurses Councils, Ministries of Health and Nurses Associations as continued professional development (CPD) credits. In short, it is recognized as part of a national certification curriculum. It enables nurses to access locally developed training and life-long education, growing their knowledge and developing agility to respond to health needs of their communities. In times of pandemic, it also equips them with the latest information and opportunities to upgrade their skills to face the spread of any virus.

All of us have had to act with agility in responding to the emergence of the pandemic as well as the emerging evidence and knowledge on how best to address it. The way we collaborate must embody the complexity of the situation; partnerships need to be systemic, acknowledging that the whole is more than the sum of its parts. As we start building back better, we realize the importance of boosting the recruitment, development, training and retention of the health workforce in low-income countries to foster stronger primary care health systems, which also implies that collectively we need to be bolder and more ambitious to achieve transformational change. Often this means working across stakeholder groups, processes, and siloes embracing the interconnectedness and complexities of the challenges in front of us.  It means convening and leveraging our networks and willingness to partner towards a collective action and impact principle that renders more chances to achieve systemic change. In the COVID-19 era this way of thinking and acting is paramount.

[i]  Countries in scope: Kenya, Ethiopia, Uganda, Rwanda, Tanzania, Nigeria, South Africa, Ghana) A roll out to other countries including in the Middle East is also underway.

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