Background Information

In 2020, AAAH planned to organize the 11^th AAAH conference in the theme “Accelerate Progress towards Achievement of 2020 and actions for 2030 Milestones of Global Strategy on HRH” in Myanmar in August 2020. However, because of the COVID-19 pandemic globally and its impacts on public health and health care workers (HCWs) who are work frontline and are the high-risk group to expose COVID-19, AAAH needs to address this important global HRH issues timely. Therefore, the AAAH conference of this year will change the theme toward HCWS in response to COVID-19. The platform of AAAH conference also      will revise the format from an in-person conference as usual into a series of webinar to ensure safety of all attendees while AAAH members still widely share their experiences with HRH experts and international agencies. The series of webinar will be useful to open widely discussion and sharing experiences among HCWs globally that have faced with this health crisis. It will also help strengthen HCWs capacity to battle COVID-19 safely and to help AAAH members and other countries formulate evidence-based health policies in response to COVID-19 pandemic under their national contexts effectively.

COVID–19 situation

Based on WHO’s situation report^[1], on 31 December 2019, the WHO China Country Office was informed of pneumonia cases of unknown etiology detected in Wuhan City, Hubei Province of China. Less than a week the number of pneumonia cases of unknown etiology had increased in Wuhan City. In January 2020, a new type of coronavirus (novel coronavirus: 2019-nCoV) was identified as a causal agent of these pneumonia cases and the outbreak is associated with exposures in one seafood market in Wuhan City. Because of rapid confirmed cases and deaths from this novel virus in China and many countries, WHO declared the 2019nCoV outbreak a public health emergency of international concern^[2] and named this novel virus as “coronavirus disease 2019 (COVID-19)” on 11 February 2020.^[3]

Since January until currently, the number of total confirmed cases and total deaths are rapidly      increasing globally, especially in Americas and Europe. Although AAAH members’ countries have less number of COVID-19 cases and deaths, the trend of infected cases and deaths are rising in many countries, such as India, Indonesia, and Philippines while many countries can flat the curve of this virus transmission, such as China and Thailand. Although the number of the COVID-19 cases decrease in some countries, HRH resiliency for future outbreaks or resurgence is needed to focus.

Governments of all countries take this health crisis to be their priority to save lives of their people by reducing COVID-19 transmission. Many preventive and control measures are used, such as mandated quarantine, social distancing, and isolation of infected populations since COVID-19 is beginning to spread, stopping mass gatherings, closure of educational institutes or places of work where infection has been identified, etc. It is still difficult to prevent and control this disease. It also add negative impacts on health systems, economic, and physical, psychological, and social effects on people.

There are many challenges of this emerging disease that the countries have faced.  Medication to treat the disease and vaccines are under development but may take a year or more to be able to effective and safety use in human). The virus is easily and rapidly transmissed from infected person to other person before the onset of symptoms and there are a large number of asymptomatic cases of COVID-19.^[4] It is overwhelming for HCWs to provide cares for patients for a long period of time. Some cases have severe respiratory signs and symptoms that require patients to be admit in intensive care units, but health care facilities have a limited number of beds in ICU and HCWs who can provide care for critical ill patients.  To control the transmission, the number of health care facilities to quarantine the suspected cases and confirmed cases, medical devices, such as ventilators and personal protective equipment (PPE) are also limited. Health care services for non-communicable diseases (NCD) are also essential because there are evidence that NCD patients increase the susceptibility to COVID-19 and about 60-90 % of mortality COVID-19 cases had NCD comorbidities.^[5] Temporary closure of outpatient health facilities in some hospitals due to COVID-19 situation is also a challenge for NCD and other essential care.

Health Care Workers in Response to COVID–19

HCWs are recognized as the frontline workers to play an essential role in detecting the suspected cases and providing care for COVID-19 patients.^[6]  However, WHO reported that as of 8 April 2020, 22,073 cases of COVID-19 among HCWs from 52 countries had been infected.^[7] It is accounted for 1.63% of the total number of confirmed cases globally (1,353,361 cases). However, WHO illustrated that there is no systematic reporting of HCWs COVID-19 infection⁶, so that the number of reports tend to under-represent the number of COVID-19 HCW infections nationally and globally.

Evidence or studies on risk factors and impacts on HCWs in response to COVID-19 are also limited. The editorial of Lancet reported global shortage of PPE for HCWs is a key concern while the COVID-19 pandemic accelerates. WHO reported that HCWs are exposed to hazards that put them at risk of infection.^[8] Hazards include pathogen exposure, long working hours, psychological distress, fatigue, occupational burnout, stigma, and physical and psychological violence.⁵

WHO announced Health worker rights, roles and responsibilities⁵ and recommended a high level of infection prevention and control (IPC) and occupational health and safety to protect HCW from infection, all of which are urgently required. Principles of IPC strategies associated with health care for suspected COVID-19 ⁵ are:

1. Ensuring triage, early recognition, and source control (isolating patients with suspected COVID-19);
2. Applying standard precautions for all patients;
3. Implementing empiric additional precautions (droplet and contact and, whenever applicable, airborne precautions) for suspected cases of COVID-19;
4. Implementing administrative controls; and
5. Using environmental and engineering controls.

The Frontline Health Workers Coalition^[9] also provided policy recommendations to protect and support frontline health workers in low-and middle income countries during COVID-19 pandemic, including

1. National and regional health workforce planning;
2. Occupational safety—health, testing, treatment, wellbeing;
3. Surge capacity;
4. Better data on the number of health worker infections and deaths, medical supplies, and PPE availability;
5. Education, health workforce pipeline, e-learning for health care students and HCWs;
6. Addressing gender-related inequalities/barriers of HCWs;
7. Addressing stigma, attacks and harassment; and
8. Policy changes and investments on new, long-term funding for HCWs as part of COVID-19 response.

In addition to impacts on in-service HCWs, policies in response to COVID-19, including lockdown, social distancing, and school closure, affect to health professional training and education directly, especially teaching and learning modalities. Most of health profession educational institutes still provide teaching and learning activities in classrooms or laboratories than online approaches. The core essence of health professional education is also clinical practice with patients either in hospital and community settings. Therefore, the COVID-19 pandemic is a main obstacle for continuing pre-service HCWs’ education. To maintain competencies and on-time graduation of health professional students, teaching and evaluation methods need to adapt from in-person to online platforms though these are quite difficult to minimize clinical practices with patients in healthcare facilities. These challenges may require institution and instructional reforms. In addition to focused attention to modifying teaching and learning modalities to maintain in service training delivery (virtual, digital, etc.) to maintain current health workforce stay up to date.

[1] https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200121-sitrep-1-2019-ncov.pdf?sfvrsn=20a99c10_4

[2] https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200130-sitrep-10-ncov.pdf?sfvrsn=d0b2e480_2

[3] https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200211-sitrep-22-ncov.pdf?sfvrsn=fb6d49b1_2

[4] https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200402-sitrep-73-covid-19.pdf?sfvrsn=5ae25bc7_6

[5] https://ijme.in/wp-content/uploads/2020/04/Non-communicable-disease-management-in-vulnerable-pgs103-105.pdf

[6] https://apps.who.int/iris/bitstream/handle/10665/331510/WHO-2019-nCov-HCWadvice-2020.2-eng.pdf?sequence=1&isAllowed=y

[7] https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200411-sitrep-82-covid-19.pdf?sfvrsn=74a5d15_2

[8] https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2930644-9

[9] https://www.frontlinehealthworkers.org/sites/fhw/files/fhwc_covid-19_recommendations.pdf

Theme

Addressing Health Care Workers’ Challenges in Response to COVID–19: sharing experiences and drawing countries’ lessons

Objectives

As inputs for the 11^th AAAH conference, a series of webinar will be convened prior to the conference as follows:

1. To share national and global experiences in planning and implementing to mobilize the surge capacity of HCWs who are responsible for public health actions and clinical services in response to COVID-19 pandemic, identify challenges and recommend effective solutions;
2. To share national and global experiences on measures which reduce occupation hazards and violence from COVID-19 infection and mortality in HCWs; to discuss and promote approaches that ensure HCW’s mental health, well-being and resilience; to discuss data systems which capture morbidity and mortality from COVID-19 in HCWs; and to identify challenges and recommend effective solutions; and
3. To share national experiences on pre-service health professional training in the context of school closures due to COVID-19 pandemic and HCW in-service and graduate training for effective response to public health emergencies, identify challenges and recommend effective solutions.

Contents of Webinar Series 

Webinar 1: Mobilizing surge capacity of health care workers in response to COVID–19 pandemic

Episode 1: Mobilizing surge capacity for public health actions, which include field epidemiologists, public health workforce for case identification, contact tracing, quarantine, risk communication and community engagement, leverage of private sectors, identify innovation strategies (if any), challenges and recommend effective solutions;

Episode 2: Mobilizing surge capacity for diagnostic and clinical management which include physicians, nurses and midwifes, pharmacists, laboratory technicians. What additional measures are introduced such as package of financial, non-financial incentive including social recognition packages, identify challenges and recommend effective solutions;

Episode 3:  Sustaining non-COVID-19 essential health services and maintaining quality of care (such as non-communicable diseases, accident and emergencies, and other medical urgencies) by HCWs in the context of COVID-19 response.

Webinar 2: Occupational risk protection of health care workers 

Episode 1:  Country experiences from the WHO three Regions (EMR, SEAR and WPR) on measures to ensure occupational safety of HCWs against infection and mortality, financing for treatment cost of HCWs affected from COVID infection; COVID insurance coverage, additional hardship incentives and allowance, and adequacy of personal protective gears;

Episode 2: Country experiences from the WHO three Regions (EMR, SEAR and WPR)  on impact of COVID on health care workers’ mental health, stressful work environment, and government’s psychosocial support, including violence against health care workers (if any), and HCW resilience.

Webinar 3: National experiences on pre–service health professional training in the context of school closures due to COVID–19 pandemic and HCW in–service and graduate training for effective response to public health emergencies    

Episode 1:   Country experiences from the WHO three Regions (EMR, SEAR and WPR) on innovations and investment, challenges and effective solutions on pre-service HCW training such as online training and clinical practicum (a. medical and b. nursing and midwifery) in the context of school closures;  in-service and post-graduate training related to public health competencies. This lesson will guide future direction of skill mix essential for effective response to public health emergencies.