Our attention has been drawn to a press release by the Ghana Registered Nurses and Midwives’ Association (GRNMA) dated 6th August, 2021. The Press Release, co-signed by the President and General Secretary of GRMNA, is in response to a Memorandum of Understanding signed by the Ghana Health Service (GHS) and the Youth Employment Agency (YEA).
We believe the issues raised by the GRMNA in their Press Release are based on a misunderstanding of the Community Health Worker (CHW) Programme. The GRMNA’s concerns are centered around the perception that CHWs are a type of nurses (zoom Nurses) that are being introduced:
1. From the outset we would want to state emphatically that Community Health Workers (CHWs) are not “Nurses” and thus should be referred to as whom they are (CHWs). Indeed, the conflicting reference of CHWs by various typologies is not unique to Ghana, but this confusion has been settled by the International Labour Organisation (ILO) through its International Standard Classification of Occupation (ISCO) in 2012 .
The ILO refers to community health workers as a distinct occupational group (ISCO 3253) within the associate health professionals category who provide health education and referrals for a wide range of services, and provide support and assistance to communities, families and individuals with preventive health measures and gaining access to appropriate curative health and social services. They create a bridge between providers of health, social and community services and communities that may have difficulty in accessing these services.
2. It is clearly not the mandate of the Youth Employment Agency to recruit professional nurses but we acknowledge the challenge of service delivery in various fields arising from capacity and go ahead to augment the sector through a support system of our beneficiaries who are not equated to the professionals but only provides support service as interns.
This is approved by parliament as captured by the Agency’s Act, 2015 (Act 887) This is exactly the case for other modules including Community Protection Assistants, CPAs (popularly referred to as Community Police).
It is important to note that the African Union, at its 29th Summit in July 2017 adopted resolution Assembly/AU/Dec.649 (XXIX) in which the Heads of State and Governments recognized the challenges in health workforce in the continent and urged the African Union Commission (AUC), together with UNAIDS, WHO and other partners to rapidly recruit, train and deploy two million Community Health Workers across the continent when and where needed. The AU noted that CHWs programmes have substantial potential, not only in healthcare, but also in harnessing the demographic dividend and reducing gender inequality. Additionally, the World Health Organisation (WHO) in 2018 issued Guideline on Health Policy and System Support to Optimize Community Health Worker Programmes .
• It is also important to underscore that with the onset of COVID-19, the Africa Centres for Disease Control and Prevention (Africa CDC) has issued a CHW Curriculum and Training on COVID-19.
Therefore, Ghana’s attempts at deploying a CHW programme need not be viewed as conflicting, competing or “adulterating” the nursing profession as the GRMNA opined. In fact, the MoU between YEA and GHS is very clear on this distinction and would want the CHWs to be referred to as who they are and never referred to as “nurse” in any form --- for that is not what they are or what the programme seeks to achieve.
3.Other important provisions for CHWs can be found in the United Nations political declaration on universal health coverage (UHC) . See paragraphs 23 (on need to train, build and retain nurses, midwives, CHWs etc), paragraph 61 (on need for evidence-based training and promotion of continued education and life-long learning for midwives, CHWs etc) and paragraph 63 (on need to scale-up, inter alia, CHWs and mental health professionals).
This also settles the argument that since there are unemployed nurses and midwives in the system, they should be employed and not CHWs. It is important to underscore that they are different professions and thus they play different roles and are engaged with different conditions of service.
Lessons from the most recent CHW programme, which was ran between 2016 and 2018 by YEA closely with the GHS; as well as global evidence from WHO, African Union, Africa CDC etc have informed the design of the current programme.
As part of the operational arrangements, GRMNA will actually be engaged prior to the rollout of the CHW programme to ensure smooth collegial working arrangements.
We urge the GRMNA to eschew any fears of displacement, competition or ‘adulteration’ as they are of a higher professional level and have a totally different focus from that of the CHWs. We will also urge the media to kindly do due diligence and the necessary crosschecks before reportage of technical areas of this sort.
We by this extend our deepest congratulations to the GRMNA on your frontline role in the fight against COVID-19.
Signed
Kwasi Afriyie
Director, Corporate Affairs
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