Global attention may have shifted from the U.N.’s Sustainable Development Goals (SDGs). But many still intend to achieve them, including Dr. Poorna Gunasekera, associate dean (international) of the Faculty of Health at the University of Plymouth in England.
His focus is on SDG target 3.8, which aims at universal health coverage, enabling everyone to access good, affordable health care. The World Health Organization estimates that, to achieve this target, an additional 11 million health workers will be needed by 2030, mostly in low- and lower-middle income countries.
Gunasekera believes that target can be achieved through a revolution in the training of health care personnel. He said that medical schools train their students for general medical practice, and then the students specialize. In his case, he received 12 years of training before he became a practicing eye surgeon. He believes that the basic skills needed for eye surgery could be taught in just three years of intensive training. If the needs of the global community are to be met, he argues, more health care workers need to be trained directly in their specialization — not just doctors, but also nurses, midwives and others.
While Gunasekera agrees that “long-duration medical training programs” are needed, he also sees the importance of health care workers developing “micro-credentials in clearly defined competencies.”
“That is the only way to build capacity at the rate the world community needs,” he said.
Gunasekera was inspired by an Indian initiative that has enlisted over a million women, training them in a few weeks to meet the first-line health care needs of their communities. A recent review concluded that these Accredited Social Health Activists “have proven to be indispensable assets to India’s health care system, their strengths lying in maternal and child health programs.”
While this approach may threaten the status of medical practitioners like him, he said that status is already being undermined by the internet. Specialized knowledge that used to be the preserve of the few is much more widely available. And while education could reduce inequality, he said that the reality is that it often does not.
“Instead of building hierarchies, let us meet the needs of communities,” Gunasekera said.
A Decision at 18
His conviction that health care should serve communities, not hierarchies, goes back to a decision he made at 18, when a group spoke at his school in Sri Lanka. He said the group’s conviction that each student could help create a better world if they were prepared to start with themselves resonated with him.
The group invited Gunasekera to a young leaders’ conference at the Initiatives of Change center in India, where he resolved to live by the values of honesty and love.
“This, for me, was a transforming experience,” he said. “These values have been central to my work ever since.”
He trained in medicine with the aim of becoming an eye surgeon. At one stage, he was working for Sri Lanka’s leading eye surgeon, Christopher Reginald Seimon, who asked him to investigate the unexpectedly high level of blindness among newborns. He carried out the research, which suggested a link between rubella in pregnancy and blindness in that local cluster. In 2020, Sri Lanka, along with Maldives, became the first two countries in the WHO’s South-East Asia region to eliminate rubella.
Form Surgeon to Trainer
He was offered a scholarship to University College London. There he encountered preventive community medicine, and realized that there was a realistic possibility of raising the quality of health across the globe. He sensed a calling to take this on as his life’s aim.
He could best contribute to this goal, he decided, by training health care workers. So he turned aside from eye surgery and, for the past 25 years, has taught in medical schools in Britain while also heading a team of 400 conducting medical research in Ghana. This has enabled him to explore new approaches to medical training and to encounter others committed to the same goal.
In 2015, well into the work, the U.N. launched the SDGs, underpinned by two founding principles: “Leave no one behind. Reach for the furthest behind first.”
“Suddenly this was no longer just my message,” he said. “One hundred and ninety-three nations promised that by Dec. 31, 2030, everyone would have access to quality care with no financial burden. I was speaking on their behalf.”
Gunasekera realized that global health leaders needed to be convinced that a credible path could be found to reach this goal. This led him to the U.N. Institute for Training and Research (UNITAR). Next year, with the cooperation of UNITAR, the University of Plymouth will launch a master’s program in Global Health Leadership with the aim of developing the approaches and building the partnerships that can achieve universal health coverage. He recognizes that the 2030 deadline will probably be missed, but he is determined to sustain the commitment beyond that date.
That leaves the other half of the task, the one he started with: the workforce itself. He believes that countries such as India, with its 858 medical schools in 2026, could be key to this. He has just visited Indian medical schools to discuss cooperation.
“The key to scaling up is a personal commitment to meet the health needs of every person,” he said.
He is finding this commitment in many places. The network is growing, and as it grows, SDG target 3.8 becomes more achievable.
For Gunasekera, the task is to build the leadership that keeps universal health coverage on the global agenda, and the workforce capable of delivering it. The deadline may slip, but he is determined that the promise to leave no one behind will not.
