Thirty years ago, I was Chief Executive of a predecessor of today’s Oxford University Hospitals Trust and later became Chief Executive of the English NHS. More importantly for this article I have worked mainly voluntarily for the last 20 years on health in African and South Asian countries.
We can learn a great deal about health from industrialised countries and the rapidly growing countries in Asia where China and South Korea, for example, are leading the way with virtual hospitals and facilities. We can also learn from countries in Sub-Saharan Africa and elsewhere where people without our resources and, importantly, without our vested interests and the baggage of our history, are often freer to innovate1.
One current example is the introduction of community health workers into Pimlico in London in 2022. Many countries have these types of workers: community health workers in much of Africa, Lady Health Workers in Pakistan and ASHAs in India. People with a short training who visit every household in their area once a month and make themselves available to the community.
Their work is based on a Brazilian model with responsibilities covering “all areas of health promotion and support … encouraging childhood immunisation, … chronic disease management, breastfeeding, mental health and loneliness, supporting people to navigate the health and care system, offering informal counselling and empathic listening, and keeping digital records of household and community needs.” They support and are accountable to primary care teams locally.
The model has already demonstrated its worth and been expanded into other areas. It is now incorporated in the new NHS 10-year plan and is likely to become an essential part of any neighbourhood health service2.
Global health partnerships
Partnerships between UK hospitals and institutions and their equivalents in low- and middle-income countries enable mutual learning and development. Many of these countries with very low levels of professional staffing and other resources can benefit from UK expertise and training programmes.
The Zambia Anaesthesia Development Program (ZADP) is an excellent example. It was set up in 2012 to provide specialist training locally. None was previously available. The programme involves UK consultants and trainees working voluntarily in Zambia3. 48 Zambian doctors have so far been supported in their anaesthetic training and 31 have completed training as clinician anaesthetists. More than 100 UK trainees and consultants have been involved. The evidence shows that these UK doctors also benefit enormously from the experience of working in difficult and resource-poor conditions.
Global Health Partnerships, formerly THET, supports many of these partnerships. It recent work includes developing a network of diaspora health workers entitled Experts in our Midst.4 And of course, Oxford is heavily involved. The University of Oxford works with local communities, hospitals, governments and partners to disseminate knowledge and local NHS professionals are involved in global partnerships5.
These sorts of partnerships were supported by the Government until the recent cut in Overseas Development Aid. Now only a few, including important work on supporting Myanmar health through the civil war workers, are still funded. Most, however, have continued without government support.
Health is made at home, hospitals are for repairs
Perhaps most importantly, of all, experience in low-income countries reminds us of the importance of improving health – not just health services – and of the role played by the wider social, economic and environmental determinants of health. Professor Francis Omaswa who ran the Ugandan health service at the beginning of the century used the expression Health is made at home, hospitals are for repairs to emphasise the importance of focusing on communities, housing, hygiene, education, employments and other aspects of society as well as clinical services.
This is turn has led to the understanding that any adequate health strategy must address health services, prevention of disease and health creation – by which I mean creating the conditions for people to be healthy and helping them to be so. There are thousands of people outside health who are creating these conditions and health professionals can have an important role in supporting them. It is not enough just to treat people for their problems and then discharge them into the conditions which may have created the problems in the first place6.
Re-thinking Health: Hope for the Future
A group of young health professionals and students have launched a campaign Hope for the Future with the aim of “refocussing health education to better meet the challenges of the future by championing health creation and disease prevention alongside health services and care7.
They want to be better prepared for the needs of a future which will see remarkable scientific and technological development in health services and prevention and a continuing need to improve health in a healthy and health-creating society. They are helping prepare the way for a more effective approach to health, fit for the future.
- Crisp N: Turning the World Upside Down Again- Global health in a time of pandemics, climate change and political turmoil; CRC Press 2022. ↩︎
- Ibid p 172 ↩︎
- https://gadpartnerships.com/current-programs/zambia-anaesthetic-development-program/ Accessed 30 November 2025 ↩︎
- https://www.england.nhs.uk/long-term-plan/ accessed 30 November 2025 ↩︎
- https://www.globalhealth.ox.ac.uk/research/working-in-partnership. Accessed 30 November 2025 ↩︎
- Crisp N: Health is made at Home, Hospitals are for Repairs, Salus Global, 2020. https://healthismadeathome.salus.global/ Accessed 30 November 2025. ↩︎
- Contact the campaign at rethinkinghealth@hotmail.com ↩︎
