Lord Nigel Crisp

Lord Nigel Crisp, a member of the Health Worker Migration Global Policy Advisory Council (the Council), served as Chief Executive of the U.K.’s National Health Service from 2000 to 2006. The Council’s secretariat is based at Aspen Global Health and Development (GHD), along with the Ministerial Leadership Initiative for Global Health (MLI).

As ministries work to strengthen health systems, health workers are a crucial ingredient, providing the services on the ground. In a recent blog at the Global Health Magazine, Lord Nigel Crisp reminded the “great and powerful” participants of the Davos World Economic Forum that everyone has a stake in ensuring all health systems are strong:

“[Devastating pandemics] will probably incubate in the poorest countries with the weakest health systems and develop there undetected before spreading outwards with all the facilities of the global transport systems at their disposal. We all need to be concerned about health in other countries and to cooperate if for no other reason than our own good.”

Lord Crisp is just back from Bangkok, where the Global Health Workforce (GHWA) hosted the Second Global Forum on Human Resources for Health on January 27-29, 2011. The Bangkok Outcome Statement couldn’t be clearer: “A robust health workforce is a core element of health systems in all countries, and critical to achieving the Millennium Development Goals (MDGs) and Universal Health Coverage.”

So what does this mean for the ministry leaders in MLI’s five countries?

It means the challenge of working together with donor countries to mitigate the negative effects of health worker migration. “Happily,” Lord Crisp explains, “the world has just begun to take the first steps to act on the problem.

“The World Health Assembly has agreed on a Code of Practice, the UK increased its own training levels and effectively shut its borders to health workers in 2006 and even the U.S., the largest importer, has at last started to expand its medical schools.” And GHD’s Health Worker Migration Global Policy Advisory Council, of which Lord Crisp is a member, has highlighted some of the innovations countries have developed to manage the flow of trained caregivers from poorer to richer economies.

It also means working to support health workers in country, especially in rural areas, in order to retain them. GHWA posted a video exploring the effects of health worker migration and strategies for retention. But we have also heard about this directly from Dr. SAS Kargbo, Director of Reproductive Health in Sierra Leone’s Ministry of Health. 

“You hear about all the bad health indicators for Sierra Leone. The reason is because the resources are not there – the human resources.” Dr. Kargbo told John Donnelly that he has seen migration play out first hand, and even felt the pull himself.

“In my class, 53 of us got government scholarships, and 16 went into general medicine, but only four of those 16 went back to Sierra Leone upon completion of their studies.” Dr. Kargbo speaks of gratitude to his country, but also of the importance of worker recognition, a living wage, responsive management, and professional development opportunities. Health workers cannot subside on gratitude alone.

But even with better managed migration and health worker retention, the world needs more health workers. “About 135,000 trained health workers have left countries in Africa in the last 35 years,” writes Lord Crisp. “It is an enormous number, but 1.5 million are needed there today. If every African health worker returned home it wouldn't even deal with 10% of the problem.”

The solution? Support from donor organizations and countries – led by country ownership.

“Richer countries can supply some of the resources, the technology and the trainers - many of whom would do this voluntarily - whilst poorer countries must define the need, the types of workers, the curricula and the delivery of the training as well as providing their share of the resources…this won't be Europeans and Americans coming to tell Asians and Africans what to do or simply exporting their ideas and ideologies about health care and health workers.”

We all have the need to ensure health systems the world over are as strong as possible. Lord Crisp believes that to do this, we need to work together on the priorities set by those who know best: country leaders.

This photo of Lord Nigel Crisp discussing his latest book, Turning the world upside down - the search for global health in the 21st Century, was taken during The Aspen Institute's Global Health Roundtable Series event on January 20, 2010.