Global Health

Baroness Warwick of Undercliffe Excerpts

Monday 25th March 2013 Grand Committee

[Baroness Warwick of Undercliffe]

My Lords, All the Talents is an excellent report from the two All-Party Parliamentary Groups on Global Health and Africa. It gets straight to the point—that there is a critical shortage of healthcare workers in many countries—and it sets out clearly what can be done to tackle the problem. Crucially, it also provides us with the evidence that global health services can be improved by giving people extra skills and changing their roles to enable them to expand their capability. I congratulate the groups on their work in bringing the evidence together in this report. I also take the opportunity to thank the noble Lord, Lord Crisp, for his tireless commitment and great contribution to international development.

I was particularly struck by the example of the creation of orthopaedic clinical officers, or OCOs as they are called in the report, in Malawi. Currently—this is an astonishing statistic—there are only seven orthopaedic surgeons for Malawi’s 14 million people. Here in the UK we have roughly one per 30,000 people. It is an astonishing contrast. These OCOs were once local medical assistants, people who left school at around GCSE level and, after a two-year course in basic clinical care, ran the country’s small health centres. An 18-month training course in orthopaedics has enabled these medical assistants to develop sufficient skills to give good-quality care to around 90% of all injuries. They are expected to be competent to treat burns, septic joints, osteomyelitis and Malawi’s high incidence of club foot deformities. They can provide casts for the most common fractures and emergency resuscitation in the case of severe injuries. Every district hospital in Malawi now has at least one OCO and they are estimated to treat more than 30,000 fractures a year. What a great example of task-shifting that is, and there are others throughout this report that are similarly inspiring.

Of course, task-shifting, or task-sharing, is not a new concept. We have been reminded by the noble Lord, Lord Crisp, that there is a shortage of 4.2 million health workers world wide, with 1.5 million needed in Africa alone. Therefore, in many countries with severe shortages of trained professionals, health workers often have no choice but to get stuck in and carry out tasks which are not in their job title.

This makes the words of warning contained in the report all the more important. If changes to a health workforce are managed badly, they can lead to poor-quality and unsafe services. We must not risk more burden being placed on poorly trained, poorly paid workers who are expected to deliver an increasing range of priorities. But done well, as this report shows us, giving people new skills can improve access to services, improve quality and possibly reduce costs. The report’s list of recommendations forms a sensible checklist of what will make the difference between success and poor-quality, even dangerous, care. When a health worker takes on a new task or responsibility, it is essential that they are effectively trained, supervised and supported.

The report emphasises that successful skills-mixing starts with health professionals and local health organisations leading the changes, with Governments and national health systems enabling them to do so. We need more evidence of the effectiveness of skills-mixing to help support further development. I was struck by the point made in the report that significantly more investment is made in drug research than in human resources research, even though health workers account for a much greater proportion of costs. This was reinforced for me by OECD Health Working Paper No.54, helpfully provided by the Library, which emphasised the many barriers to be overcome and how Governments have to support the process to overcome them. In her response to this debate, will the Minister tell us what measures the Department for International Development is taking to assist Governments to develop their HR and workforce planning capacity?

The real benefit of skills-mixing is that experiences can be shared between countries. That is where international and national volunteering can play an important role. International development agencies such as VSO can assist national Governments to train medical staff and draw up sustainable plans for skill-mix changes. I declare an interest as a life vice-president of VSO and draw your Lordships’ attention to the work that VSO is doing with regard to task-shifting, or skills-mixing.

VSO sees these as positive ways of getting skills and health services to the grassroots, and as close as possible to those who need access to services and education. Skills-mixing also supports VSO’s belief that citizens are active agents of change and that communities will prosper if people are given the skills and opportunities to develop. But—and there is always a but—for this approach to be successful and sustainable, it must receive continuous investment. If community health workers and volunteers are to be given increased skills, responsibility and tasks, they must have the equivalent increase in support. They need the professional training and management that will ensure that they are able to deliver this work effectively, and their increased responsibility must be reflected in their remuneration.

In every situation, in every country, ongoing training and support are vital in health services. Health workers should be supported to learn continuously, and to be trained in the latest medical developments, healthcare approaches and effective techniques.

VSO makes this happen whenever it can. I will give just one example, still in Malawi, where VSO volunteers are training health workers because, again, the country has a critical shortage. VSO is pushing for improved supervision and management of these health workers. The Malawian Government are listening and making a concentrated effort to tackle the shortage through recruitment, training and retraining. I hope the common sense approach contained in All the Talents will give extra support to VSO's representations in Malawi. I know VSO will make some of these points tomorrow to the APPG's review on overseas volunteering, which itself acknowledges the importance of the direct exchange of knowledge and skills between people.

The UK has taken some positive steps in this area. DfID's £20 million four-year health partnership scheme enables volunteer British doctors, nurses and midwives to train overseas healthcare workers across many disciplines. These skilled health professionals offer practical assistance to their counterparts in the developing world, including one-to-one mentoring and developing guidelines to ensure that clinics run more effectively. Will the Minister give us any assurances that opportunities for skills mix changes and task-sharing are being promoted as part of the health partnership scheme?

Health workers—midwives, clinical officers, community workers, nurses and doctors—provide healthcare in many of the world's hardest to reach areas. They face daily challenges and do amazing work, but there are not enough of them to get the job done properly. They often lack support and supervision, the right training and equipment. In the best possible way, All the Talents states the obvious when it addresses these points. It makes sense to develop the talents of everyone working in healthcare, so that money is not wasted, quality can continue to improve, and above all, so that more people can access the health services that they need.