Section 1: Issue Identification

1.     What health inequity does your initiative aim to address? Which specific regions, populations, health disparities, etc.? Please be as specific as possible.

Africa bears 24% of the global burden of disease, and has just 3% of its health workforce. To put that in perspective, while Switzerland has about 440 physicians per 100,000 people, Malawi has just five physicians for the same sized community. Without a sufficient number of well trained and supported health care workers, morbidity and mortality rates remain stubbornly high in many countries across Africa and making progress against the Sustainable Development Goals can be incredibly challenging.

Seed Global Health envisions a world in which — instead — every country is strengthened by a robust health workforce to best meet the health needs of its population. Seed educates a rising generation of health professionals to strengthen access to quality care to improve health and save lives.

Over the last decade, Seed has forged deep partnerships and co-designed impactful programs to address the unacceptable health equity gaps that impact Africa. Hand-in-hand with national governments, local academic and clinical institutions, fellow civil society organizations, and philanthropic partners, Seed has established and transformed health workforce training programs, training over 34,000 nurses, midwives, and physicians. Through our partners, Seed serves a community of over 73M people in Malawi, Sierra Leone, Uganda, and Zambia - all countries with major health workforce shortages, but ambitious plans for how to strengthen their health systems to save lives.

2.     Why did your organization choose to prioritize this specific inequity/initiative for action?

Building a stronger health workforce is a critical, but deeply under-resourced opportunity for impact. Less than 7% of global health aid between 2000-2020 was invested in the health workforce despite a global health worker shortage that was severely exacerbated during the COVID-19 pandemic, and has persisted even today.

However, we know that investing in the health workforce pays for itself — academic studies show that the return on investment for the health workforce can be as high as 10:1, and that there is a ripple effect that occurs. Focused, long-term investment in a country’s health workforce has been shown to drive better health outcomes, and hence better governance, build stronger and more inclusive economies, promote national and global security, and most importantly, to improve and save lives.

Section 2: Initiative Overview

1.     Please provide an overview of your initiative / approach and which department owns it. (200-300 words)

At Seed, we take a unique approach working closely with public sector partners in health facilities that experience some of the most acute health worker shortages in the world. Seed partners deeply with the national government to ensure that there is buy-in to the programs that we design and advance. Our work begins by asking how we can best align with and advance existing Ministry of Health strategic plans and goals. Seed also identifies where we can uniquely add the most value, ensuring we are coordinating, not competing, with existing partners already working in the health system.

We then develop close partnerships with government, academic, and health leaders to strengthen education, training, and support that addresses their greatest health challenges, such as reducing maternal mortality, improving primary health care, or better preparing for the next disease outbreak or epidemic, made more probable by our rapidly changing climate.

We work at a unique, and often overlooked intervention point: applying classroom learning to patient care through bedside clinical mentorship. By training students in a clinical setting, Seed not only directly and immediately improves the quality of care provided to patients, but also ensures that learners can provide high quality comprehensive care and continue to improve clinical outcomes for years to come, impacting the broader health system, building resilience to the growing challenges. This leveraging approach also ensures that the health workforce remains highly versatile and adaptive, improving readiness for the impacts of climate change, future pandemics, and disasters.

2.     Which of the four domains of health equity action (organization, offerings, community, ecosystem) does the initiative target? For additional context, please visit the GHEN website.

Seed’s initiatives operate at the community and ecosystem level. Section 3: Impact & Accountability

1.     What impact has the initiative achieved? Please be as specific as possible, focusing on outcomes rather than outputs.

As one example of the power of Seed’s model to transform care outcomes in disease, Seed’s work in Sierra Leone has been critical to reducing maternal mortality. In Sierra Leone, Seed and its partners have observed a 60% reduction in maternal deaths year-over-year from 2021 to 2022 at Makeni Regional Hospital, where we implement our model to train new midwives to better manage the early signs of postpartum hemorrhage and other labor complications. In 2023, our team continues to track this promising program carefully, and has recorded zero deaths over the first half of the year. We are closely tracking and observing positive impact on similar programs in Uganda (emergency medicine, maternal health), Zambia (family medicine, midwifery), and Malawi (family medicine, maternal health, pediatrics, and mental health). We have also found that as health outcomes improve, morale and teamwork improves in these facilities too, strengthening providers’ abilities to collectively address growing disease challenges, including those caused by climate change.

2.     How was impact measured: strategy, metrics used, tools employed, relevant standards, etc.?

Seed has a dedicated monitoring, evaluation and learning department and our approach to measuring and evaluating impact is deeply embedded in partnership. Each year, we collaborate with our partners to review and adapt what success looks like for the year ahead, and co-develop an impact framework, as well as what our learning goals are for the partnership.

Seed also carefully considers and incorporates targets and goals from the national health systems strategies from each country in which we work, ensuring that our initiatives are well aligned with national Ministry of Health priorities. We also leverage global and regional frameworks developed by the World Health Organization, and draw inspiration and concepts from global membership bodies such as the International Confederation of Midwives in providing respectful maternity care.

3.     How and where are you reporting impact (internally, externally)?

We predominantly report our impact internally, and among our programmatic and philanthropic partners, sharing information relevant to understanding successes and challenges in our ongoing work in order to improve upon our approach and programming year-over-year.

Section 4: Partnerships

1.     What organizations (e.g., civil society, public sector organizations, businesses, governments) did you partner with to complete this initiative? How did these partners contribute throughout the initiative’s lifecycle? What role in this partnership does your organization play (e.g., funder, convener, etc.)?

Seed works with a diverse ecosystem of partners, from universities and health systems, to civil society organizations and philanthropic leaders to advance its mission. You can see a comprehensive list of our partners on the Seed website: https://seedglobalhealth.org/partners/

Seed’s role is that of an implementer and advocate for health workforce programs.

2.     How is the initiative actively involving impacted communities throughout the initiative lifecycle (e.g., in the identification and alignment of priorities, (co-)creation and delivery of interventions, in measurement and review, etc.)?

Seed’s programs are designed and led by global health professionals who are proximal to the challenges that we seek to address — we have registered local offices and teams in Malawi, Sierra Leone, Uganda, and Zambia — and work closely with all local partners to co-create and advance our strategy. Impact measurement is also a collaborative process. Seed meets with its partners on a regular basis throughout the year - first, to set initial goals and KPIs for the partnership, and then to review progress together and assess any changes needed as the year progresses.

Section 5: Learning & Next Steps

1.     How has the initiative evolved over time based on ongoing learnings, if at all?

As Seed’s work has progressed and grown over the course of the past ten years, key lessons learned have emerged about how best to support our partners in driving toward a stronger health workforce, and many of those lessons are deeply tied to communication and partnership. One key area where Seed has played a critical role is in both forging stronger relationships between academic institutions and the clinical environments in which their new graduates operate, and also in supporting cross-partnership learning, or connecting institutions that share similar goals and challenges, however might be operating in a different part of a country, or across the continent altogether, but have much to learn from each other. Seed’s model rests on a balanced idea that while the challenges and opportunities that each community faces are unique, and our approach must take those into account, there is also much we can take from best practices that have worked in one context, and may be able to be adapted elsewhere.

We have also seen the incredible need for — and a growing global interest and acknowledgement in the importance of investing in the health workforce. That movement requires a coalition of partners to work together in a fundamentally new way: a role that Seed is taking on with its partners. We are excited to be co-leading and advancing a historic $100M commitment made last year at the Clinton Global Initiative to build a pan-African, African-led compact to tackle the serious health worker shortage across the continent, together with partners at the African Union, the Africa CDC, Amref Health Africa and four Ministers of Health from Malawi, Sierra Leone, Uganda, and Zambia.

2.     What is the future vision for the initiative / approach? Will it scale to other regions, translate to other drivers of health? What is the strategy for long term sustainability?

Leveraging the commitment mentioned above, Seed will support its four partner countries — Malawi, Sierra Leone, Uganda, and Zambia — as well as additional countries that sign onto the commitment to

advocate for the resources and provide the technical support needed to transform and prepare their health workforces for the future as burdens of disease continue to grow and evolve.

Seed is also currently in the process of developing its new five-year strategic plan, which will guide the future of our work — however, we endeavor to stay ambitious in our goals to attract greatly-needed financial resources, media and visibility, and strategic partnership to our global health workforce challenge.