Letter to the Foreign Secretary on Universal Health Coverage Day 2023

Dear Foreign Secretary, 

Today marks Universal Health Coverage Day. As you will be aware, governments across the world are off track to make the necessary progress towards universal health coverage (UHC) by 2030. Health is a fundamental human right, but half of the world’s population still lacks access to essential health services, and almost a quarter faces financial hardship due to out-of-pocket health spending. 

I am writing to you on behalf of the Royal College of Nursing, the United Kingdom’s largest professional body and trade union for nursing staff with over half a million members. Together with our international partners, we seek to promote the voice of nursing around the world. 

As Prime Minister, you passed the International Development (Official Development Assistance Target) Act 2015, which saw the UK’s ODA spending target rise to 0.7% of gross national income (GNI). As a result of this legislation, the UK government’s contribution to global health-related ODA peaked in 2020 at £1.6 billion. However, in the same year, the UK Government announced a temporary reduction in ODA to 0.5% of GNI, cutting spending at a time when investment in health system strengthening was needed more than ever. 

Had the target of 0.7% of GNI been maintained, an additional £9,188 million would have been available to fund vital development projects around the world between 2020 and 2022. Instead, between 2020 and 2022, UK bilateral ODA spending on health fell by 38.6%, and now represents just 10.1% of total bilateral ODA in 2022.  This downgraded commitment will have had stark consequences for health outcomes around the world. 

The WHO estimates an additional 9 million nurses and midwives will be required to deliver UHC by 2030, with current shortages concentrated in Africa and South East Asia. Despite the urgent need for action, in 2022 just 2% of the UK’s health-related ODA spend was allocated to projects to develop the global health workforce. 

The UK’s own nursing workforce is highly reliant on international recruitment with one in five nurses and midwives registered to practise in the UK receiving their training overseas. Alarmingly, one in ten new joiners to the Nursing and Midwifery Council register in the past year received their training in a country identified by the WHO as facing pressing workforce challenges. Active recruitment from these countries is not permitted unless under the terms of a government-to-government agreement. In the context of global nursing and midwifery workforce shortages, current international recruitment levels are unsustainable. 

It is vital that international recruitment is conducted ethically and in accordance with the WHO Global Code of Practice on the International Recruitment of Health Personnel.  As stated in the Code, international recruitment of health personnel must have mutual benefits for both source and destination countries. The allocation of ODA to projects that develop the nursing workforce in low- and middle-income countries provides an important means to redress the UK’s unsustainable over-reliance on recruitment from countries with critical workforce shortages.

On this UHC Day, I urge you as Foreign Secretary to be a voice within government for the reinstatement of the 0.7% of GNI ODA spending target and to recognise the scale of the global workforce challenge that confronts our shared aspiration of health for all. 

Yours sincerely,
  
Pat Cullen 

General Secretary & Chief Executive
Royal College of Nursing

CC Sarah Champion MP, International Development Committee Chair