Spent the weekend cocooned in a hotel near Stellenbosch, in the middle of the wine region of the Western Cape province of South Africa. The reason – a meeting of an advisory council convened by Johnson & Johnson to discuss some of the major challenges facing health care globally and what different actors can do about it. It was a somewhat diverse group, including Derek Yach from the Rockefeller Foundation, Kgosi Letlape, president of World Medical Association, Tommy Thompson, former US Secretary of Health and Human Services, Stig Pramming and Christine Hancock from the Oxford Health Alliance, Delon Human and Nigel Majakari from Health Diplomats, a company based in Geneva which looks at ways in which health professionals can build alliances that can tackle some of the issues where the politicians have failed. We had a wide-ranging discussion – there are a lot of challenges! However we homed in on a few key issues.
One was what is, for many countries, a crisis already facing the health workforce. This was highlighted in the 2006 World Health Report. Several points emerged. One is the need for new types of health workers, and in particular nurses with enhanced skills who, with the benefit of newly emerging technology such as miniaturised testing kits will be able to take over many of the tasks currently undertaken by doctors or, more often, not undertaken at all because there is no-one to do them.
Of course this is critically dependent on the ability to retain skilled staff in each country’s health workforce. One problem is migration. Here a major driver is the failure of the USA to train enough nurses. Although things are now improving a bit, if there is not a dramatic increase in recruitment of student nurses in the US that country could suck in an enormous proportion of the next generation of nursing graduates from across the developing world.
A second problem is retention. We were told that the number of qualified nurses living in South Africa but not working as nurses exceeds the number of South African nurses working abroad. It is obvious that much needs to be done to improve the rewards and working conditions for health professionals. So far this is stating the obvious, but we were able to explore a number of ways in which these issues might begin to be addressed.
Clearly there is no point in having skilled workers if they don’t have the tools to do the job. And often they don’t. In many countries drugs are either unavailable or unaffordable. We discussed the recent excellent report on access to drugs - http://mednet3.who.int/medprices/CHRONIC.pdf - . This confirmed the problems that people with chronic diseases face in accessing the pharmaceuticals they need to function and, in many cases, to stay alive. However, a critical finding from their assessments was the extent to which the cost of drugs was driven by mark-ups in country, such as taxes, tariffs and, particularly, mark-ups along the distribution chain. However, there are other problems. In some countries, such as Russia (which I know best) there is an enormous amount of inappropriate prescribing of drugs sold at inflated prices, simply because doctors are getting back-handers from the pharmacists from whom patients must buy their drugs. Yet the situation is even worse because, in many countries, there are substantial numbers of counterfeit drugs – it was estimated that 26% of all drugs prescribed in South Africa were counterfeit, with even higher levels in many other parts of Africa. Yet we also learned that there was no room for complacency even in developed countries and we heard about a patient in the USA who was deteriorating unexpectedly while on chemotherapy. Her nurse checked out the drugs she was getting from the local pharmacy and discovered they were counterfeit and ineffective. We also learned of an initiative to raise awareness among nurses worldwide about this problem, so that they would at least think of it when the response to therapy was worse than expected. Again, things can be done. There was consensus that the responsible pharmaceutical industry must understand the ways in which its products get to people across the world. It is not enough just to put a product on the market and hope that it will get to those who need it. There is also a need for global action on counterfeit drugs, something that will require the creation of new alliances linking many different players.
Health is everyone’s business. The benefit of meetings such as this is that we can draw on experiences from people who have experience in government, international agencies, the private sector, academia, and NGOs. Of course we need to do much more than talk but I did feel that this group has the potential to catalyse actions that can begin to address some of these challenges, as well as to enable others to understand the challenges we all face in bringing our own communities with us as we move forward.