UK health system can learn from innovations in world’s poor regions, conference hears

BMJ 2013; 346 doi: (Published 18 April 2013) Cite this as: BMJ 2013;346:f2500
  1. Matthew Limb
  1. 1London

Young doctors and health activists who embrace a new “spirit of equity in global health” can help to transform the way rich and poorer countries interact, a conference has heard.

Experts from the United States, Europe, and Africa said that they looked to the “new generation” to accelerate shared learning in ways that could raise the quality of care worldwide and tackle health system imbalances.

Nigel Crisp, a former chief executive of the NHS in England, told a conference at King’s College London on 15 April that traditional forms of international development were top down, paternalistic, and outdated.

He chaired the event, entitled “Turning the World Upside Down,” and launched a website to accompany it ( aimed at fostering more equitable and far reaching “co-development.”

Crisp said that health systems in rich nations, such as those in the United Kingdom, could learn from new ideas and practices developed in the world’s most disease prone and resource poor regions.

He told the BMJ, “The intention is to keep promoting the ideas and start to change people’s mindset.”

The conference heard about health initiatives in various low and middle income countries. Some had common features, including a strong focus on empowering patients and communities and ways to bring together medical, public health, and preventive approaches.

Maureen Bisognano, president and chief executive of the US based Institute for Healthcare Improvement, described her involvement in a project in Malawi to reduce maternal and neonatal mortality. She said, “We realised we had more to learn than we had to teach.”

She described how mothers there held the medical records for their families and that it was their duty to carry the records from one provider to another. “We have nothing like this in the US,” she said.

Matthew Harris, an academic clinical lecturer in public health at Imperial College London, said that the “effective” model of primary care support provided by Brazil’s lay “army” of 250 000 community health workers might be adapted for use in the UK. He said the locally recruited workers had played a big role in Brazilian cities and rural areas, providing extensive support to households, such as sexual health, nutritional, and lifestyle advice and monitoring population health.

Harris, who heads a collaboration that is planning to test the feasibility of such an approach for use in north Wales, said that implementing such “reverse innovation” could be a “game changer for the NHS” if successful.

Charles Alessi, who chairs the National Association of Primary Care and NHS Clinical Commissioners, said, “The north Wales experiment needs to become an English experiment.”

Paul Farmer, a professor at Harvard University’s department of global health and social medicine, welcomed the idea, saying, “It’s a beautiful solution: an army of health workers with weapons of mass salvation.”

Farmer said that interest in global health equity was growing and that young doctors and other healthcare staff in particular were a driving force.

Babulal Sethia, honorary treasurer at the Royal Society of Medicine, said that a better and fairer system was needed to help medical students to work overseas on elective placements. Sharing learning should be a “lifelong experience,” she said.

Fiona Godlee, the BMJ’s editor in chief, said that younger doctors attuned to ideals of transparency would surely play a part in efforts to combat the global problem of corruption in health research.

Shams Syed, an adviser to the World Health Organization, said that the issue of patient safety had the potential to be a “global unifier in co-learning” to solve problems common to many countries. Syed leads the WHO programme African Partnerships for Patient Safety, which partners African hospitals with European hospitals to try to reduce medical error and harm to patients.

He said that a way needed to be found to reflect the benefits of “south to north” learning in peer reviewed medical journals.


Cite this as: BMJ 2013;346:f2500

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