Eschewing the ‘Arrive-Teach-Leave’ Approach, Seed Invests in Long-Term Healthworker Training in Africa
A group of trainee midwives receiving training from a Seed Global Health educator at the School of Midwifery Makeni Lab in Sierra Leone.

Africa’s health worker shortage is projected to reach more than six million by 2030 – and the weaker the system, the more likely health workers are to leave as poor working conditions erode their morale. 

The non-profit organisation, Seed Global Health works to address this shortage by investing in long-term training and support for health workers in four countries – Malawi, Sierra Leone, Uganda, and Zambia – via partnerships with health ministries.

For Seed, long-term means “for as long as our partners will have us”, says CEO Dr Vanessa Kerry, who is also the World Health Organization’s (WHO) Climate Envoy.

Seed launched its 2030 strategic plan last week, an ambitious programme that requires the organisation to raise at least $100 million.

“The 2030 strategy is a reflection of what we see as a deep need in the world today, which is to build the health workforce of the future and to position the workforce as a global priority,” says Kerry in an interview with Health Policy Watch.

“The workforce is the frontline of any response, whether it is managing existing disease burdens, pandemic preparedness, or our response to climate change.”

She stresses that Seed is not “pivoting to any new flashy moment” but rather “doubling down on what we’ve done always, which is focusing on education, practice and policy, to ensure that we have a skilled workforce that can provide definitive care for those in need.”

“The mission is simple. It’s a just equitable and healthy world. The mission is to expand access to quality care and improve health outcomes for all. We do this by training health workers and we really believe that can be transformative across any number of sectors.”

Not a ‘fly-in, fly-out’ model 

Vanessa Kerry, CEO of Seed Global Health.

Seed “embeds” its educators with partners for at least a year to build trust, understand the context, learn from colleagues, and apply their skill set to support the problem.

“A lot of folks will create a curriculum, or they’ll teach through Zoom or they’ll feel like they can just come, teach, leave,” says Kerry.

“We’re not a fly-in, fly-out model. We are about integrating into communities and being in service to the priorities of our partners.”

The challenges are immense. All four partner countries are on the World Health Organization’s (WHO) list of countries with critical health worker shortages.

A woman giving birth in Malawi is 28 times more likely to die than a woman in the UK; a Zambian newborn is 24 times more likely to die than a Norwegian newborn and Uganda has four doctors per 100,000 people while Switzerland has 440.

Sierra Leone has one of the world’s highest maternal mortality rates (MMR). Malawi’s MMR is also high, Uganda struggles with high rates of injuries, mostly from traffic crashes, and Zambia has been trying to move to universal health coverage but it does not have staff trained in family medicine.

All four countries are affected by rapidly changing climates, including floods, droughts and migration.

Seed has found that the best way to support health workers is by day-in, day-out mentoring at patients’ bed sides.

“I’m a physician. Medicine, nursing and midwifery require apprenticeship and learning. You cannot memorise an algorithm on hypertension and think you’re going to walk into a patient’s room and know how to care for that patient in the right way,” says Kerry.

“Every patient brings a different background, a different pattern to their diseases, a different combination of diseases.”

Country selection

Kerry founded Seed in 2011, and its flagship programme, the Global Health Service Partnership (GHSP) with  Peace Corps sent US health professionals abroad to train others, including to Malawi and Uganda. 

But when the GHSP wrapped up after more than a decade, “we weren’t done”, says Kerry.

Both Malawi and Uganda wanted Seed to continue helping to train health workers to tackle their health challenges.

Malawi has a maternal mortality rate (MMR) of 349 deaths per 100,000 live births. It aims to reduce this to 70 per 100,0000 by 2030.

Uganda’s leading causes of death and illness are acute childhood illnesses, injuries (driven by road traffic injuries), and maternal health conditions. Non-communicable diseases account for 40% of the disease burden.

Then in 2018, Zambia asked for help to launch a Family Medicine programme to provide the core of its primary healthcare system.

A Seed Global Health midwife educator assessing a pregnant woman at Makeni Hospital in Sierra Leone.

In 2019, the government of Sierra Leone called Kerry, asking for help to address its MMR, one of the highest in the world with 717 women dying per 100,000 live births.

Seed supports health ministries’ training goals rather than developing their own separate agendas, says COO Andrew Musoke. 

Some of its achievements are astonishing. Since it started working in Sierra Leone in 2020, for example, there has been a 60% reduction in maternal mortality in the districts where it has been working.

Human rights challenges

Post-partum haemorrhaging is the leading cause of maternal mortality in Uganda and Malawi, sometimes caused by backstreet abortion as  abortion is illegal in both countries.

Before becoming Seed’s COO, Musoke was country director for Clinton Health Access Initiative (CHAI) in Uganda, and acknowledges that “especially during COVID, we saw a lot of teenage pregnancies and rising abortion mortalities”. 

Seed COO Andrew Musoke

These were often difficult for health workers to deal with as women and girls came to health facilities very late in the process with heavy bleeding. 

“While trying to improve emergency medical services, we have recognised that some of the gaps relate to the referral pathways, as well as health workers’ ability to address the issues,” says Musoke.

Ensuring speedier referrals and more skilled health workers has helped to reduce deaths from haemorrhaging. 

A year ago, Uganda passed its draconian Anti-Homosexuality Act, which introduces harsh punishment for same-sex sexual activities. In reaction, many civil society organisations called on international programmes to stop channelling money through the country’s health ministry.

Kerry acknowledges that human rights issues pose challenges for Seed in “a really complicated world with very complex politics”.

“I can look to my own country, the US, and I can look to Uganda. Every country is struggling to figure out our values and how we are going to move forward in this world, politically. When you see human rights issues in countries, it’s very difficult. 

“But the end of the day, we are a health organisation. I’m a physician. We are driven to care for patients with dignity, with respect, and to ensure that they have access to services.”

She adds that Seed’s partners all acknowledge the need for patient care to be driven by science.

“We stay focused on trying to raise awareness about how, for example, anti-homosexuality policies can actually be detrimental to the progress we’ve made in HIV and the progress we’ve made in primary care, and to raise awareness on that and to really help provide education.”

Climate resilience

Another component of Seed’s training is to assist health workers to address daily impacts of climate change, says Kerry. 

“Pick an aspect of disease, people are being impacted by climate change,” she adds. 

Zambia is in the midst of a drought which has caused a massive cholera outbreak. Malawi has had cholera from the effects of Cyclone Freddy. Sierra Leone, a coastal country, has seen the salinisation of its water sources and it is worried about rising sea levels. Changes in Uganda’s weather patterns have negatively affected livelihoods, particularly in agriculture and fisheries.

Recent research shows that, for 1° Celsius increase in temperature over 23.9°C, there’s a 22% increase in infant mortality. If midwives understand this, they can counsel women with high-risk pregnancies on how to stay cooler in extreme heat to prevent infant mortality. 

Indirect effects of climate include migration, projected to effect up to 1.2 billion in the next decade. And in some countries, women who have to walk farther for water are more prone to sexual assault. 

“Focusing on building strong resilient health workforce is our primary ability to respond,” says Kerry.

The REACT team from Katakwi District Hospital in Uganda

Rich countries’ poaching of health workers

One of the hazards facing partner countries is wealthier countries recruiting their skilled health workers.

While Kerry says it is a human right for health workers to be able to move, Seed tries to address the “push” factors related to job satisfaction.

“Health workers may want to stay in their country, their communities, their contexts, their families, but also don’t want to be demoralised every day because they’re watching someone die because there isn’t blood available for transfusions, for example,” she says.

“So the degree that we can help shift the system by building advocates and changing health outcomes can go a long way to promoting retention. And we’ve seen that places that were working, such as the emergency medicine graduates we have trained staying in Uganda. When there’s a change in morale, retention can be promoted.”

South Africa is leading an initiative, through the African Union COVID-19 Commission headed by President Cyril Ramaphosa, to develop a health workers’ compact that would enable health workers to work abroad on training exchange programmes.

“What the compact will do is create the economic case and roadmap for countries to be able to understand their health workforce needs and training, and also think about how to train enough health workers to be in service to the world as well as their home country. 

“What that allows is job creation and remittances. It builds an economy around healthcare workers, and it solves multiple problems at once. The population of Africa is growing so there is a workforce that can be in service for the world. So we’re trying to be very ambitious in thinking about how to solve these problems.”

Image Credits: Seed Global Health.

Combat the infodemic in health information and support health policy reporting from the global South. Our growing network of journalists in Africa, Asia, Geneva and New York connect the dots between regional realities and the big global debates, with evidence-based, open access news and analysis. To make a personal or organisational contribution click here on PayPal.