Baroness Jolly
Main Page: Baroness Jolly (Liberal Democrat - Life peer)World Health Organisation
Baroness Jolly Excerpts
Baroness Jolly (LD)
My Lords, I am grateful to my noble friend Lord Ribeiro for raising this important issue and for his thoughtful and incisive comments based on years of commitment and experience. He and I went to Zambia two years ago in the summer, so I have seen him in an area in which he is hugely expert asking extremely pertinent questions of the Minister for Health, on the one hand, and the sister in charge of a hospital in the bush, on the other. I also pay tribute to the work of the noble Lord, Lord Crisp, and the All-Party Parliamentary Group on Global Health. We have heard the personal and local experience of my noble friends Lady Chalker and Lord McColl. As the noble Lord, Lord Hunt, said, this debate has been totally fascinating, and I hope that I can get through my speech and answer all noble Lords’ questions.
The noble Lord, Lord Crisp, and my noble friend Lord Ribeiro, through their work, have highlighted the importance of surgery across the whole world, and indeed it is a key part of disease prevention and treatment, and a public health good. We welcome the All-Party Parliamentary Group on Global Health’s recent activity to highlight this issue, including the film “The Right to Heal”.
We very much support the strengthening of emergency and essential surgical care and anaesthesia in developing countries as a component of universal health coverage, and see it as an issue of great importance. To answer a question of the noble Lord, Lord Hunt, on whether surgery can relieve many of those conditions, yes, indeed—we heard many examples in this debate, including treatment of cataracts, cleft palate and fistula.
The UK supports further consideration by the WHO executive board in January—I say that in response to my noble friend Lord Ribeiro’s first question. Action must be taken to help prevent avoidable death and disability as a result of surgery. Indeed, surgically treatable diseases are among the top 15 causes of disability worldwide. Speakers today have highlighted different examples of the appalling statistics and human suffering resulting from poor training and procedures. This position can be changed by working together. The WHO process is an important part of this work and will help commit the international community to making greater progress in raising awareness, improving data and monitoring, and increasing global collaboration on this issue.
The Government aim to improve the provision of basic health services for the poorest by strengthening health systems. Surgery is a key aspect of health service provision and is addressed in this context: the UK is supporting efforts in developing countries to increase the skills and availability of health workers, and to expand access to essential medicines and equipment. Increasing coverage, access and quality will strengthen health services in addressing all health problems, including those requiring surgical treatment.
In answer to my noble friend Lord Ribeiro’s question on DfID raising the profile of surgery, and the question of the noble Lord, Lord Crisp, on partnerships, we have a number of programmes that specifically improve access to surgical services. The UK is supporting partnerships between the UK and developing countries to improve health services in those countries through sharing skills and capacity development, and bringing benefits back to the UK through volunteer NHS staff returning with stronger skills—I underline the point made by the noble Lord, Lord Hunt—that can be useful when they come home. The health partnership scheme is supporting a range of programmes to achieve better outcomes following anaesthesia and surgery, such as supporting training for healthcare workers in surgical and theatre nursing skills in eight countries in Africa. By June 2014, the scheme had trained 26,600 overseas healthcare workers, and UK health professionals had spent 31,000 days volunteering overseas.
The noble Lord, Lord Crisp, inquired whether the Government would consider welcoming Africa Health Placements. The Government’s “Health is Global” strategy includes work on health system strengthening. Officials work with many organisations and will be happy to meet Africa Health Placements. Other work being undertaken includes the provision of and training in obstetric services, including the availability and quality of caesarean sections and episiotomy, where necessary, and eye surgery. In humanitarian contexts, we also support the UK International Emergency Trauma Register of deployable specialist staff—primarily from the NHS—and a deployable surgical field hospital.
I want to pay tribute to the royal colleges and others for the work they undertake in this area, and the Association of Surgeons of Great Britain and Ireland, which is a member organisation of the International Collaboration for Essential Surgery. Governments, health professionals and the voluntary sector all have a role to play. An organisation that is trying to tackle the basic issues around lack of anaesthetist skills in many countries is Lifebox, mentioned by my noble friend Lord Ribeiro. Its purpose is to provide equipment and support services in low resource and lower-middle-income countries at no or reduced costs. UK hospitals, universities, health and international development third-sector organisations have well established and expanding relationships with healthcare institutions in lower and middle-income countries. These range from: training and capacity building for staff; providing practical skills; continuing professional development; supporting improvements within developing-country organisations; facilitating research; and, indeed, curriculum development. Those are all in line with points raised by many noble Lords.
In response to my noble friend Lord McColl, regarding the funding of Mercy Ships, I can say that DfID has indeed funded mercy ships in the past but currently is not so doing. The noble Lord, Lord Hunt, inquired about the brain drain. The Government are committed to the World Health Organisation code on ethical recruitment of health workers, which is designed to prevent brain drain from countries with a shortage of healthcare professionals.
British health volunteers have a key role to play in improving health in other countries, as highlighted by the all-party group last July in its report Improving Health at Home and Abroad. The noble Lord, Lord Crisp, will be interested to know that the Department of Health and the Department for International Development will shortly publish an updated framework for voluntary engagement in global health by the UK health sector, which will seek to bring greater clarity as to how these activities can contribute, in a sustainable way, to building capacity in low and middle-income countries. It also outlines the benefits and opportunities for UK employers, professional associations and, indeed, individual health workers in the UK.
The medical training initiative accommodates overseas postgraduate medical specialists to train in the UK for up to two years. Participants can return to their home country and apply the skills and knowledge developed during their time in the UK. I think the noble Lord, Lord Crisp, inquired about this; I am happy to give noble Lords figures in a letter.
I would finally like to focus on some priorities for the Government that are linked to this topic. First, as part of any progress in surgical interventions, if basic surgery is to have any chance of widespread continued success, I stress the importance of the need for access to and rational use of antibiotics. This has not been mentioned this evening, but it really is critical. It links to the work that the UK, along with international partners, is leading on tackling antimicrobial resistance, which is one of the biggest global health challenges facing us today. The World Health Assembly recently committed to developing a global action plan. As part of this wider effort, the Prime Minister has today launched an international commission to identify what action may be taken by the global community.
Secondly, we recognise that the rates of maternal and newborn mortality remain unacceptably high and further action is needed. The UK Government have made commitments to save the lives of 50,000 women in pregnancy and childbirth and 250,000 newborn lives. They also support the WHO and UNICEF global action plan, Every Newborn: An Action Plan to End Preventable Deaths, which was launched in Johannesburg this week. The links between newborn and maternal survival and access to quality surgery are clear. It is estimated that one in three pregnant women needs some intervention during birth and between 5% and 15% require a caesarean section. Improving the quality of maternal and newborn care is one of the strategic objectives of the action plan.
Finally, another area where the UK is working, both at home and abroad, is in eliminating female genital mutilation and supporting women and girls affected by this practice. The recent adoption of a WHO resolution on violence against women is a welcome development. Through our work on FGM and reproductive and maternal health, we are also working to prevent and manage obstetric fistula—a hole in the birth canal—which WHO estimates affects between 50,000 to 100,000 women worldwide each year.
All this links to our work towards a health goal in the post-2015 framework. The UK wants to ensure it includes commitments on key areas such as: newborn and maternal health; ensuring access to essential medicines; and universal health coverage—all issues identified in the course of the debate, and all linked to access to quality surgery and anaesthesia. We have been involved in these discussions through the High-level Panel of Eminent Persons on the Post-2015 Development Agenda, which was co-chaired by our Prime Minister, and remain involved through the deliberations of the open working group.
I am grateful for the opportunity to focus on these issues through the debate and will keep noble Lords updated on further discussions by WHO’s executive board. By taking action now at a global level, and by all sectors working together, we can truly make a difference to lives and tackle avoidable mortality and disability.
I will take what time I have left to pick up on a few points that came towards the end of the speech. My noble friend Lady Brinton asked about DfID and the Department of Health supporting successful projects, such as the one she outlined. Working with NGOs and civil society forms an integral part of the Government’s approach to reducing poverty. We will be happy to provide information on funding for NGOs and civil society organisations in a written reply.
My noble friend Lord Ribeiro asked about a stand-alone target on surgery. I hate to disappoint him, but the Government are not in favour of a stand-alone target on surgery in a post-2015 framework. Rather, we think it is more helpful to measure health outcomes, such as reductions in mortality. Surgery may be required in some cases to achieve those, but we also support the inclusion of a target on universal health coverage, which will help to expand the availability of essential health services.
I will write to all noble Lords who have taken part in the debate to answer unanswered questions, but I will also try to arrange a meeting with the relevant Minister to take up these points further.