Corporate Buzz: A Thousand Tiny Knots - On the Way to One Million Health Care Workers

By: Joy Marini, Director Corporate Contributions, Johnson & Johnson

A few months ago, I was sitting in a room full of “dai-moms” -- lay midwives in Dhaka, Bangladesh. These women are amazing. One of the most intriguing things about them is how they keep track of their activities. They use knotted ropes that they tuck carefully into their waistbands. Many of these midwives cannot read or write, so they keep an account of all births that they attend with the rope of tiny knots. Every knot represents a birth. Every knot represents a life. The dai-moms even remember who is represented by each knot and return to the families for newborn checks. Our partners -- Narigrantha Prabartana and the Global Fund for Women -- support these dai-moms with education, camaraderie and motivation, all of which are in short supply in the harsh, remote environments where the dai-moms work.   

Dai-moms struggle every day on the front lines of our current health care worker shortage. These trained – and powerful– lay women attempt, as best they can, to fill the severe and chronic gap of skilled birth attendants that plagues most of the developing world – particularly in Bangladesh where three out of every four women give birth with no skilled assistance. Sadly, though not at all surprisingly, the maternal mortality rate in Bangladesh is one of the highest in the world—there are 320 maternal deaths per 100,000 live births. In a more industrialized nation, such as the United Kingdom, there are only 8 maternal deaths per 100,000 live births. If it were not for the dai-moms, the rate in Bangladesh would be even higher.

A dai-mom is the perfect example of a “frontline health worker” who is the first -- and often the only - link to health care for millions of people living in the developing world. These women are the midwives, health extension workers, clinical officers, community health workers and in some cases, doctors and pharmacists positioned to be a critical resource for life-saving care to families in need. According to the WHO, there is a shortage of at least one million frontline health workers in the developing world, particularly in Africa and parts of Asia. Millions more existing health workers could save many more lives if they received better support, equipment and were trained in new skills and tasks. Not only are frontline health workers the backbone of effective health systems, they are the most immediate and cost-effective way to save lives and accelerate progress on global health and the Millennium Development Goals (MDGs).

At Johnson & Johnson we have made a firm commitment to the advancement of the MDGs, and as part of that, we joined in partnership with governments, the private sector and civil society to support the Frontline Health Workers Coalition as it issued the “One Million Health Workers Challenge." This is a new and diverse coalition urging greater and more strategic investment in frontline health workers in the developing world as the most cost-effective way to save lives and improve global health. Its vision is that everyone has access to basic preventative and curative health care by skilled, supported and motivated frontline health workers – like dai-moms. 

Being as resourceful as they are, dai-moms use whatever is available to make their beautifully knotted strings -- a scrap of a well-worn sari, a string that once tied a bundle of vegetables. Some of these strings have hundreds of knots. The One Million Health Workers Challenge will work to support the dai-moms – and all the frontline health care workers – to fortify their ranks and give them the ammunition they need to battle our most pressing global health challenges.