From the frontline to systems change: Reflections from a nurse on World Health Day

I am Carolyn, and I have been a nurse for 26 years, working in the UK, India, Nepal, Nigeria, Saudi Arabia and Tanzania.  

One of the hardest days was when I worked frontline as an intensive care nurse in a busy London hospital. We were short-staffed, it was a night shift, and the patients were critically unwell on multiple drug infusions, ventilation and renal support.  

For 13 hours straight, we were working solidly without a break. We were firefighting, from one critical task to the next. 

At some point, when I was too tired to carry on, another alarm went off, and I had to find the energy to assist someone close to dying.  

As the shift finished and the morning team came on duty, I burst into tears.  

I had nothing left to give. The shocking thing is that this was standard practice. Not something out of the ordinary. All the staff knew what it felt like to be running on empty and drained.  

Strengthening health systems to support the workforce 

This experience can happen anywhere in the world, in any health setting, where front line health workers give beyond what they are able to give. We receive critical thinking and practical skills training, such as how to use specific machines or give medications.  

The vast majority among us do the job because we care and want to support people when they are sick, help to prevent people from getting sick in the first place and promote wellbeing. Now I work at Unlimit Health, where I have a chance to support health systems around neglected tropical diseases (NTDs). My day-to-day work couldn’t be more different, but the intention is still very much the same: making people’s lives healthier and helping redress the imbalance that ill-health brings.  

But doing this at a structural level, addressing the systems required to optimise healthcare, so the impact is felt beyond delivering treatment. One of the fundamental elements of health systems strengthening is supporting the health workforce, enabling systems to work better, easier and smarter so staff are able to do their job with care and pride. 

This has become even more significant with the recent changes in global funding for NTDs and international development as a whole. With more pressure on health systems to deliver more with less funding, it means even more pressure for health care staff on the frontline. 

The ways we’ve previously thought about health systems strengthening have had to adapt, as has the way that treatments are delivered; for example, integrating treatments alongside existing activities and care packages is becoming a priority.  

A holistic approach to health and wellbeing 

Recently, Unlimit Health has been looking at integration beyond just human health systems and utilising the One Health approach, which recognises that human, animal and environmental health are deeply interconnected, in our One Health Systems Strengthening work.  

This approach uses the 4C’s model – communication, coordination, collaboration and capacity strengthening.  

We are working alongside our endemic country partners to explore where integration can be successful across a wider range of programmes and services, opening huge opportunities. The scope is not only for being more efficient with the funds available but ensuring that the community remain at the centre of health care.  

Imagine a community member visiting a health post for a vaccination. At that same visit, they could also receive water purification tablets, guidance on protecting livestock from disease, or access information about safe sanitation. This saves time and travel costs, increases the impact of every interaction, and places the community’s needs at the forefront.  

We know that health is beyond being disease-free, so we must look at human health holistically, and its interactions with the environment, to ensure sustainability.  

As a health care worker, I believe this approach optimises the overall health and wellbeing of a family as opposed to a structured and siloed approach. Thinking back to my work in intensive care in a high-income country, I feel proud of the care I managed to offer. However, my work on One Health Systems Strengthening now makes me hopeful for the future, one where interconnected priorities have equal space.  

On this World Health Day, I’m reminded that when we strengthen systems, we get to the root of the problem, lift health workers’ capacity, and transform care for the communities they serve.