Anne Walsh, Senior Nutrition Specialist, The Power of Nutrition.
Last week, the nation marked the 70th birthday of the National Health Service. The NHS was launched in July 1948, based on the belief that good healthcare should be available to all regardless of wealth, an ideal that went across all political parties. It was based on 3 principles, which remain at its heart 70 years on:
- It meets the needs of everyone
- It is free at the point of delivery
- It is based on clinical need not ability to pay
Those 70 years have not always been easy – funding and running a universal cradle-to-grave health service is no small challenge, especially within an ever-changing world and evolving health needs. Nonetheless, the NHS has made an astonishing contribution to every aspect of life and society in the UK and had a massive impact on the nation’s health and wellbeing.
The ideals of the NHS have many parallels across the globe, where disparity and poverty are still a major block to economic and social progress. So, as it passes this important landmark, it makes sense to ask if there are lessons to be learnt that can help accelerate progress and change in other countries health and nutrition systems.
The success of the NHS has stemmed from the huge political and popular will to have an equitable, high quality health system supported by strong governance and robust delivery mechanisms. The systems were developed immediately post war, where the country had proven skills in strategy and highly effective logistics, along with the financial support to maintain the principle of equality that emerged during the war years.
One of the major successes of the NHS has been to have a strong preventative approach to good health, focusing on the life cycle, integrating nutrition particularly into pregnancy, delivery and early years care for infants and young children. This is the approach now being adopted by less developed countries through the focus on the first 1000 days of life, from conception to the age of two.
Like the UK in 1948, Liberia today is emerging from a difficult and defining challenge in its recent history and the country is having to rebuild much of the framework of society after the Ebola crisis. There is a clear need to improve childhood nutrition so that the post-Ebola generation can be strong and healthy. Liberia has the political will and the public motivation to rebuild after such a devastating crisis. The Power of Nutrition are providing much needed financial support to assist the government rebuild health structures and strengthen the delivery systems. Like the NHS, the combination of political will, motivation and finance is enabling the rebuilding of a health system that is giving women access nutrients such as iron and folic acid during pregnancy, and ensuring critically malnourished children are treated and parents have the skills to prevent it happening again.
Similarly, in Tanzania we are working with the government to focus on the first 1000 days of life through strengthening of management and governance in the health system in order to improve delivery of services. As with the NHS, the key to success is not simply a question of identifying the best actions and interventions, but also in ensuring there is an effective system in place with which to deliver them – and the ability to learn, evolve and continually improve how that system operates. By measuring performance more effectively, the Tanzanian Government has been able to learn valuable lessons from situations where it is not meeting delivery targets. Rather than constituting failure, these lessons enable the government to improve its systems and drive up the delivery of key services. This is the type of systemic change that will have a clear and positive impact on people’s lives.
Of course, there are some areas where the NHS struggles. Constantly needing to adapt and invest in new skills and infrastructure as technology and science produce new solutions to health delivery and treatment of disease, and balancing hospital-centred care with the ever-increasing need for services going out to communities for people of all ages. Both present major challenges for an institution first designed immediately after the Second World War.
These are complex challenges and seeing how the NHS continues to evolve and adapt will provide valuable insight for all those seeking to support less developed health infrastructure and delivery systems. Sharing knowledge and learning from both success and failure is essential to this work – which is why the Power of Nutrition places great emphasis on monitoring and evaluation of the programmes we fund. There is much that can be shared across different countries than can help improve public health outcomes. Indeed, as more developing countries invest in the health of their population there may also be valuable lessons that they can share with the NHS – particularly in terms of community health programmes.
Meanwhile, there is a lot to learn from the history of the NHS, not least the transformational impact that investment in public health systems can have when there is the political and popular will to make it happen.
As the NHS has helped improve health outcomes for the millions of people of all social backgrounds who have grown up in the UK since its inception, so investment in major public health programmes such as nutrition can enable countries around the globe to improve people’s lives and drive social and economic development.