Generating over 200 unique Tweets in just over an hour, the recent Twitter chat on health systems in fragile and conflict affected states was a roaring success. The hashtag #HSRFCAS enabled Twitter users to follow the conversation and add their points to a discussion focussed on: why health workforce strengthening is important in these settings; the role of close-to-community providers of health care; windows of opportunity in post-conflict settings; and ensuring adequate staffing during conflict.
The Tweet chat was chaired by the journal Conflict and Health. Liverpool School of Tropical Medicine was represented by Tim Martineau who contributed views and opinions based on many years of work on human resources for health and with theReBUILD Consortium. Esther Richards and the RinGs team was also on hand to bring a much needed gender focus to discussions. While Beth Hollihead, Olivia Tulloch and Rosalind McCollum represented REACHOUT on community health workers.
The discussion ranged over many topics. There was broad agreement that health care workers are only as effective as the system that supports them and that these workers are an integral part of the system. Management Sciences for Health pointed out that medicines, supplies, and technology alone are insufficient without trained health workers to use them. While Advancing Partners and Communities made the argument that health systems strengthening helps identify the structure and support systems required for community-based services in fragile and conflict affected settings.
Jhpiego pointed out than in fragile and conflict affected settings health workers do more than deliver basic services they deal with issues like sexual and gender based violence and mental health. Others mentioned their role in suicide prevention and psycho-social support more broadly. Participants felt that research on workforce supply and distribution is needed to inform the rebuilding of health workforces post-conflict. With the Frontline Health Care Workers Coalition pointing out that we need a global strategy to guide investments and address knowledge gaps. Kim West reminded us all that strengthening human resources for health requires national leadership and policies.
Ensuring health worker safety was a dominant theme. With IntraHealth International tweeting, “Everyone deserves access to high-quality care, that means access to a health worker who can safely do their job - save lives!” Capacity Plus drew attention to the disruption to the Syrian polio vaccination programme caused by attacks on health care workers. Others pointed out that attacks on health care workers were probably under-reported and better data monitoring is needed. This led to discussions about how workers might best be protected. Sarah L. Dwyer directed us to the recent UN resolution that recognizes for the first time the severity of attacks on health workers and demands that states respond.
There was lively discussion about the role of close-to-community providers. Joy Marini of Johnson and Johnson explained that for some women, community health workers are the only health workers that they will ever see. The Maternal and Child Survival Program (MCSP) pointed out that empowered and trained community health workers can have expanded roles, providing the local community with important services. The 1 Million Community Health Care Workers Campaign argued that they have the potential to support more stable societies. Suzanne Fustukian, however, cautioned that expectations of CHWs in post conflict health systems can be unrealistic where support and referral systems are lacking. Nicholas Teodoro summed up quite neatly the high regard that participants had for close-to-community providers, “Stakeholders. Cultural understanding. Local. Should be included in management and policy decisions. Heroes.”
Tim Martineau reflected on the event,
“I’ve never done a Tweet chat before, but this was really exciting and fun. More importantly it has helped to confirm the level of interest in ReBUILD’s area of research and enabled us to make more links and to have deeper conversations with policy makers, practitioners and other researchers about this research area. We’ve started many conversations which we will be taking forward over the coming months.”