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Debate on the Address

My Lords, I welcome the continuing commitment shown in the gracious Speech to tackling global poverty and to the millennium development goals. I welcome also the way in which the Government have given effect to that commitment through increases in DfID’s budget. Relatively little has been said on international development in this debate—no doubt because there is no legislation—but, like other issues, it is difficult and complex, and contains many risks and opportunities for us all. As with those other issues, I know that there is great knowledge of and support for international development in all parts of this House. I hope that, during this Parliament, there will be many opportunities to debate the issue to create a better understanding of it and its relevance to us all. Perhaps I may illustrate that with a single example, which is the critical shortage of health workers in many developing countries. Last year, the World Health Organisation published a report in which it assessed that there was a shortage of 4.3 million health workers in the world. One can question the assumptions, but whatever the answer—whether the figure is 3 million or 5 million—it is a substantial number. The WHO said also that 57 countries were in crisis, most of them in Africa, but some in other parts of the world. What it did not say, and what is becoming evident, is that this is truly a global, and not an African, problem. An insufficient number of health workers will have a major impact on our ability to deliver on the millennium development goals. Norway has recently published a study of the numbers of health and social workers that it will need in 2030, with an ageing population, and has estimated that it will need double the number of health workers that it has now. This problem is coming to the developed world, as well as being a present and immediate problem in the developing world. The shortage of health workers in the developing world is a classic, important and complex public issue and there are many reasons for it. Some are related to migration to the west or the north; some, sadly, are related to death and injury in the dangerous profession of providing healthcare in developing countries. A great deal of internal migration and circular migration between countries takes place. In a number of countries in Africa, there are unemployed health workers, because the resources to employ them do not exist. In addition, a number of the so-called ““vertical”” funds, which deal with single issues or single diseases, often scoop from the pool of local employment, perhaps by paying higher wages, and therefore, paradoxically, while improving services for one group of patients, they perhaps deplete the local health service. I know that the Government have made impressive steps in working with Malawi to try to retain health workers there and increase their numbers, but much more can be done. When I talk about health workers, I do not mean specifically doctors and nurses, although one needs them. If I understand the Ethiopian Government correctly, they say that 70 per cent of the burden of disease in their rural community can be tackled by what they call community health workers; that is, people with a relatively low level of training. As they have a relatively low level of training, they can be trained quickly and much less expensively, and they are much more likely to stay in the country. I shall illustrate that further and declare an interest, in that I am shortly to become chair of Sight Savers International, a major international charity concerned with blindness and the rehabilitation of blind people. The charity has an impressive record in Africa in particular of training what we call mid-level workers. Those are people who have, perhaps, been nurses and who have then been trained through Sight Savers’ work to become cataract surgeons, for example—and very good at it they have proved to be. There are other examples, but I take that one as a matter of personal preference, as noble Lords will understand. Evidence has already been gathered about the impact and effect of community health workers. I know that people listening to or reading this debate will say that previous experiments in having large numbers of community health workers have failed. To some extent, that is true, but the reasons are well understood: they have not been supported. You need people to supervise and support the community health workers but, to put it in terribly simple words, the triangle of the health professions in somewhere like Ethiopia is very different from how it is in England. There is a very broad base of community health workers, with some mid-level workers, some nurses and a few doctors, as opposed to the approach that we have in this country. So there are some things that we can clearly do. You also need a different education approach, based on primary care, prevention and training people locally, and you need subsequently to employ people. As we have seen in Malawi, the Government have been willing to step in and support local employment of people within the country. What is the UK going to do on a greater scale in its leadership role, as one of the major global developers in the world, but also as a major global employer? We all understand that there are many people in this country in our health services who have come from overseas. What more will the UK do to tackle this critical shortage in health workers? Let me move on to congratulate the Government once again on a new initiative announced in September, an excellent approach called the international health partnerships, in which the UK, together with the World Bank, the WHO and a number of other countries, agreed to work together to stop one of the major problems in international development, which is fragmentation—when different people duplicate what others are doing in individual countries. For example, a Minister from Mozambique said to me that he did nothing but deal with foreign aid workers. His line was, ““When I was appointed, I thought that I was going to be the Health Minister for Mozambique, but I discovered that I was the Minister for health projects in Mozambique, run by foreigners””. The Government’s attempt to deal with fragmentation is fantastically important, as in the field of human resources it leads to disjointed training schemes, a lack of focus on pre-service training schemes and competition for workers with the inevitable inflation that that brings to salaries throughout the continent of Africa. Do the Government see the international health partnerships as one way in which to work together to tackle these complex problems of getting an adequate health workforce in developing countries? That is a truly wicked problem. Secondly and more generally, how will they measure the success of the international health partnerships? A lot of people have supported the initiative, but it will be interesting to see how success can be measured. Finally, I return from developing countries to global health issues. While this arises in developing countries, it is deeply relevant to developing countries. Earlier this year, the Chief Medical Officer published a report on global health issues as a draft strategy for government. It would be useful to know when the Government will address that and publish their response. While I have not addressed any legislation in my few remarks, these issues will, I hope, come back to the House in the next year in various different ways. They are big public policy issues, which I believe are very much worthy of discussion here.