Sibongile Kumalo (patient) and Community Care Giver Nqobile Zungu checking sugar levels during screening © Sanele Madela

Fostering the next generation of health workers

26th May 2017

During a 70th World Health Assembly event on access to diabetes medicines and care in underserved populations, health worker Dr Sanele Madela said "diabetes care depends on health workers able to empower patients with knowledge to participate in care." In this blog he illustrates this importance through his experiences as a health worker in South Africa.

“Every day when I show up for work, I think - I’m glad I get the privilege today to save lives. In life, it’s all about how you want to show up. For me, showing up means serving my community.” - Dr. Sanele Madela

Dr Sanele Madela gives NCDs Health Eduction During HealthRise campaign at Gcumisa Umgungundlovu, © Expectra Health Solutions

When I was just a boy, my best friend died of a completely treatable illness. One day we were playing outside, the next he was simply gone. His family hadn’t recognized his symptoms quickly enough and there was no healthcare worker for miles. I never wanted this to happen again. In that moment, I committed my life to providing outstanding healthcare services for all. And I’ve never looked back.

I write this as I’m heading to the 70th World Health Assembly, the annual convening of state delegations that advise the World Health Organization on important health policies- focusing on access to healthcare, the importance of quality healthcare for all and addressing critical healthcare infrastructure needs. I’m excited to attend such a proceeding and even more excited to serve as a voice of frontline health workers amidst the policy discussions. Let me share why this matters to me.

Frontline health workers are the glue for healthcare systems to function effectively. We’re the people who sacrifice our lives to deliver difficult care, who build trusted relationships with patients to improve their quality of life and who develop innovative healthcare solutions out of necessity. We take this responsibility very seriously and need our health systems to do the same by addressing critical priorities:

Priority 1: Invest in safety and training for frontline health workers.

Young people today are witnessing their family members dying in the line of healthcare duty from exposure to infectious disease and deadly outbreaks e.g. Ebola in Congo etc. Because there are limited frontline health worker safety standards and training opportunities, many young people are not interested in pursuing a healthcare career in underserved communities. Achieving universal health coverage will not be an easy task if this continues.


Expectra Health Solution: Household visit by nurse (Phumalani Dlangalala) and Mr D Sithole at his house.

Priority 2: Adequately compensate frontline health workers.

As the global burden of chronic diseases continues to rise and healthcare becomes more about the management of diseases, frontline health workers play an increasingly important role in building effective healthcare systems. We work hard to build trusted relationships with families and communities to lead cost-effective prevention efforts and to provide outstanding follow-up care when needed. We believe in the work that we do, but we also need to earn enough to take care of our families too. Without adequate compensation, frontline health worker morale is reduced which negatively affects their quality and commitment to care. Ultimately this results in top talent leaving to pursue other sectors.

Priority 3: Adapt policies and regulations to allow frontline health workers to provide more care at the local level.

In many countries, we simply don’t have enough doctors or nurses to adequately treat a population. While it makes for a challenging healthcare environment, it also presents an opportunity for us to re-think healthcare delivery, to identify opportunities for frontline health workers to deliver increasingly important health services in their communities. In my work at Expectra 868 Health Solutions, we’re excited to provide frontline health workers with blood pressure machines and glucometers used at the community level. These simple devices provide incredible confidence and motivation to these health workers, knowing that when they visit a household they’re leaving it better than it was before. Research has also proven that post-surgery patients who recover in familiar surrounding with their loved ones, recover more quickly. Therefore, empowering frontline health workers with post-surgery care skills and appropriate hospital referral linkages go a long way in patient recovery.


HealthRise project home visit: Dr M Sibeko,  Lungile Madela and Mrs G Makhanya

As a primary healthcare physician in South Africa, working at the Pomeroy Community Health Centre, I share these statements on behalf of frontline health workers everywhere. Frontline health workers who don’t have time to complain about their working conditions and in-service training required because they are busy taking care of their patients. Frontline health workers who provide patient coaching at the community level and who educate community caregivers on how to promote and prevent disease including care for their loved ones at home. Frontline health workers who are directly saving lives every day, but so often don’t have a voice in key policy conversations.

Frontline health workers - a special breed whose stories need to be shared & considered

Those working on the frontline are a special breed, their stories need to be elevated for policy makers to understand the true plight of the critical role these frontline health workers play to the overall picture of the community health status. Linkage to care of patients, meeting of health targets, giving dignity to the sick and frail and ultimate improving the overall health status of the community, country and the world would not be possible if those in the frontline are not given the platform to influence the decisions in the sector they committed their lives to.


About the Author

Dr Sanele Mandela was born in the dusty streets of Dundee Sibongile Township and now holds a medical degree from Instituto Superior de Ciencias Médicas de Villa Clara (Cuba) and Stellenbosch University (South Africa). Sanele is the MD/founder of  Expectra 868 Health Solutions, a non-government organization (NGO) in South Africa focused on community health work. Expectra 868 aims to address the health disparities faced by the South African communities especially previously disadvantaged, uninsured population living in rural areas. Dr Sanele was awarded the 2013 MEC Annual Excellence Award for his contribution to the community based-medical education and advocacy of primary health care. He is currently implementing HealthRise project on NCDs in Umngungundlovu District focusing on Diabetes Mellitus and Hypertension, creating opportunities and skills for the local youth.