‘Mission critical’: nurses’ champion reflects on global healthcare, development and open learning

Since starting out as a nurse in inner-city Birmingham, Open University alumna Barbara Stilwell has had a stellar career in global healthcare development. 

Having trained in the US to become Britain’s first nurse practitioner, and led the UK’s first nurse practitioner training programme, she went on to champion the role of health workers worldwide while working for the World Health Organisation and then the global health NGO IntraHealth. 

She is currently Executive Director of Nursing Now, a global campaign to put nursing at the forefront of thinking on global health.

Barbara studied for the Open University’s MSc in Development Management between 1998 and 2001.

What led you to study the OU’s MSc in Development Management?

I was working in the WHO Department of Health Systems having come from the Royal College of Nursing, so my experience was in nursing, teaching and performance improvement. I realised I didn’t really know anything about development.

I did one module, and became absolutely hooked, because the module work was completely related to my job. For example, it made me realise the contracting mechanisms of consultancy at WHO were very loose (they have changed now). Then I went on to the module on negotiation and how you create a ‘win win’, and this really appealed. WHO eventually said to me ‘you’re so good at this, we’ll send you on a negotiation course at Harvard’. 

How did studying the MSc change you?

It was a watershed. Like many people who go into international work, I kind of drifted into it – I did feel passionately about working in countries that needed support, but I didn’t have any skills in that area, and the courses taught me that there are skills to be had. Now I recommend these courses all the time. Many years later, when I was working in Afghanistan and Palestine, I used to go back to my old course notes just to help me think through problems.  

The message I took away is ‘never underestimate the importance of development’. That’s not rocket science, but it is mission critical to be thinking in a development paradigm. So many in Health and Development don’t think about development. 

What are the challenges of your role at Nursing Now?

We are a campaigning organisation that is really a social movement for nurses. It’s about improving health by maximising the contribution that nurses can make, so we also want to target policymakers and politicians and get them to invest in nursing. 

Nursing often develops without a structure or legal framework, especially in low-income settings where nobody else will go. We are saying: if you invest in supporting nurses, giving them a framework and education, you’ll get a return on that investment that will include better health for the population. 

We’re doing some work on leadership for young nurses, so they feel more enabled to step up and be influential. Leadership that is actually a little bit disruptive, we want them to start changing things. With over 20 million nurses in the world, imagine what they could achieve with support and recognition for what they do. 

That’s our global message, and it’s gone viral, over 75 countries have signed up. 

Is there a gender dimension in this?

There is. Nursing is a very gendered occupation. I think it’s no coincidence that #MeToo and Nursing Now launched around the same time. They’re both about people stepping up and saying ‘I’m valuable’.

Looking back over your international career, what have been the greatest areas of progress in global health?

We’ve made great strides in bringing people out of poverty; things are still dire, but better than they were. Vaccines, HIV/AIDS, treatment of diarrhoeal disease, we are making huge progress in these.

And the areas where most remains to be done?

It is in the countries with least money, the ‘almost failed’ states where the challenge really is governance. How can we use everything we know about technology, systems, investment, return on investment to support these countries? Some are so corrupt and governance is so weak, nobody will really invest in them. Until these countries can take responsibility for that, they are not going to see an improvement in healthcare.

I worked in fragile states like Afghanistan, Iran, South Sudan, and I realised there is no good in just giving a country that has collapsed gazillions of dollars. You have to bring them to a certain level of development before they can start investing that money in the way that will build their health systems. 

What contribution has open and distance learning, and specifically the OU with programmes like HEAT and OpenWash, to make to global health?

There has been resistance in certain low-income countries – not all – to the validity of open and distance learning, there is a suspicion that people can cheat. Now with the advent of blockchain, you can make sure that doesn’t happen. I think that open and distance learning will be huge. Things like HEAT are the future, what we need is to iron out their acceptability to accrediting authorities, and we can do that, because the technology is improving all the time.

How optimistic are you about the future of healthcare globally?

Cautiously optimistic. I went to a lecture by Bill Gates recently, and he was talking about a vaccine for malaria within a decade. He was very optimistic. Things are not as dire as they are often painted.