Recently at the 78th World Health Assembly, I had the privilege of attending a powerful panel co-hosted by Global Health Partnerships and the UK Government titled “The Power of Global Partnerships for Achieving Universal Health Coverage.” It was chaired by Prof. Ged Byrne, Global Director of NHS England, and featured keynotes from Jim Campbell of the WHO and Ben Simms of Global Health Partners.
The discussion was rich with real-world examples of international cooperation. But beneath the optimism lay a sobering theme: many global partnerships are being forced to compensate for retreating domestic investment, particularly from the United States.
The U.S. withdrawal from WHO and major reductions in USAID funding have left a dangerous vacuum. As one of the panelists made clear, malaria doesn’t care about budget cuts. Health inequities don’t respect borders.
Yet amid these challenges, one message came through clearly: global partnerships work best when they complement strong domestic systems—not when they’re asked to substitute for them.
Who Fills the Void When Domestic Systems Collapse?
The panelists shared stories that underscored this point:
- Dr. Nonhlanhla Makhanya, Chief Nursing Officer of South Africa, highlighted her country’s 20-year partnership with Cuba to train physicians—proof that South-South collaboration can work when rooted in shared goals and respect.
- Johanna Banzon, from the Philippines Department of Health, emphasized how repetition and spaced training in international partnerships have improved knowledge retention—a concept central to The Learnery’s microlearning approach.
- Dr. Margaret Muhanga Mugisha, Uganda’s Minister of State for Primary Health Care, spoke proudly of work with the UK on malaria, but warned that U.S. cuts to USAID have jeopardized their progress.
- Dr. Ade Jubaedah, representing the Indonesian Midwives Association, shared the monumental challenge of delivering digital and primary care reforms across a nation of 17,508 islands—a logistical feat requiring both foreign and local innovation.
- Margaret Caffrey, GHP Technical Director, summed it up bluntly: the USAID vacuum has forced nations to improvise.
- “South-South vs. South-North Cooperation
- South-South: Collaboration between developing countries—grounded in shared experiences, peer learning, and mutual benefit.
- South-North: Traditional aid from wealthy nations to poorer ones—often top-down and less tailored to local contexts.
- South-South partnerships are more equitable, sustainable, and contextually relevant.”
Nursing as a Case Study: A Global Crisis with Local Roots
This backdrop makes the current global nursing crisis even more urgent. High-income countries—including those on the #WHA78 stage—continue to rely on international recruitment to mask chronic underinvestment in their own systems.
In the U.S., over 65,000 qualified applicants were denied entry into nursing programs in 2023, primarily due to faculty shortages, limited clinical placements, and infrastructure constraints. In the UK, the picture is similarly concerning. Nursing student enrollment has dropped 21% since 2021, with 13.1% fewer new students accepted in England in 2024 compared to the previous year.
Compounding the issue, the UK government eliminated nursing bursaries in 2017, shifting the cost of nursing education to students. This policy change has been widely cited as a barrier to entry, particularly for students from lower-income backgrounds, further shrinking the domestic talent pipeline.
Meanwhile, international recruitment is accelerating. According to The Health Foundation, over 40% of all newly registered nurses in the UK in 2022/23—both domestic and international—came from low and lower-middle-income countries, a sharp increase from just 10% in 2018. This growing reliance on foreign-trained nurses is coinciding with a 35% decline in domestic nursing applications since 2021—suggesting that increased international hiring, coupled with financial barriers, may be discouraging local candidates from pursuing nursing careers.
This pattern isn’t collaboration—it’s dependency. And the costs are mounting.
Global Gains, Local Losses
As we mentioned in a recent post, countries like the Philippines, Ghana, Kenya, and Nepal continue to export nursing talent, often encouraged by governments banking on remittance flows. But as panelists made clear, remittance dependency is not a workforce strategy. The financial inflow does not compensate for the human toll: empty clinics, overworked health staff, and underserved populations.
Moreover, migration frequently involves deskilling and exploitation:
- Credential recognition delays
- Lower pay and reduced authority
- Language and cultural discrimination
This not only undermines the dignity and economic return for migrant nurses, but it also erodes trust in the very systems that recruited them.
Recruitment is Not a Remedy
International recruitment is a pressure valve, not a solution. By leaning on it, countries delay the hard work of structural reform. The true fix lies in:
- Expanding domestic education pipelines
- Incentivizing clinical training sites
- Supporting faculty development
- Offering competitive compensation
- Addressing burnout and moral distress
Without bold investment at home, no amount of international recruitment or partnership can secure long-term sustainability.
Global Partnerships Still Matter—But They’re Not a Bailout
What this week’s panel made clear is that global cooperation works best when it’s built on mutual benefit—not dependency. The partnerships shared on stage were impactful because they were strategic, ethical, and long-term.
Global health partnerships are powerful, but they should support, not replace, a country’s responsibility to invest in and fix its own healthcare system.
As countries gather to discuss Universal Health Coverage, climate resilience, and health equity, we must not overlook the centrality of nurses to every one of those goals. Nurses are infrastructure. They are not spare parts for broken systems.
A Call from WHA78
To every government represented at WHA78: invest in your own workforce.
To development agencies: honor your commitments.
And to global health leaders: ensure that every partnership is built on equity, reciprocity, and sustainability.
Because health systems don’t collapse from a lack of nurses. They collapse from a lack of vision to support them.
#GlobalNursingCrisis #HealthWorkforceEquity #WHA78 #UniversalHealthCoverage #InvestInNursing #NursesMatter #TheLearnery #EthicalRecruitment #RemittanceReality #HealthcareMigration #SpacedLearningWorks
