All nations must invest in nursing and midwifery education and employment to improve health systems and advance gender equity
Nurses and midwives are central to the delivery of quality primary health services for all. Nurses are highly effective in delivering services that prevent illness, promote health and care for the physically and mentally-ill and people with disabilities. The global response to COVID-19 underscores how critical nurses are to health security. They must be supported to get the job done. On their part, midwives provide the essential care needed for every woman to have a positive childbirth experience, for every child to come into the world safely and for every newborn and child to avoid disease and death.
The World Health Organisation (WHO) is committed to strengthening its nursing and midwifery workforce as part of its quest to achieve universal health coverage (UHC). UHC is one of eight flagship priorities in the South-East Asia Region and the target that underpins Sustainable Development Goal Three, the health goal. In 2015 the region embarked on its decade for health workforce strengthening — a key initiative aimed at overcoming shortages and skill-gaps in health cadre across the region. By 2018 the region had increased the density of nurses and midwives to 18 per 10,000 population, up from 16 per 10,000 in 2014. In 2018 the global average density was 37 per 10,000 population. The minimum should be 40.
By 2030 the region will require as many as 1.9 million more nurses and midwives. Special focus must be given to ensuring that they are deployed where they are needed most — rural and hard-to-reach areas. At every opportunity, policymakers and administrators should empower female health workers to reach leadership roles and to be involved in decision-making. All of them must be paid fairly.
As the world marks the International Year of the Nurse and the Midwife, we must celebrate, support and strengthen this workforce, with a focus on several key areas.
The first step is strengthening education. Demographic changes are shifting healthcare needs and driving greater demand for services for noncommunicable diseases (NCDs), care for older people and the terminally-ill. For healthcare workers to respond to these needs, policymakers and administrators must review pre-service education, including curriculum and faculty development and where necessary, amend it. They should ensure all nurses and midwives are provided ongoing professional development opportunities, including in-service training, to enhance their knowledge and skills.Tomorrow’s challenges may be different from today’s.
Second, the policymakers and administrators should ensure that the work environment for healthcare professionals is safe, healthy and satisfying. The hours nurses and midwives work should be reasonable and aligned with national labour laws. The on-the-job hazards they are exposed to should be minimised and wherever possible, eliminated. They should never be subjected to violence. By providing a positive and enabling environment for them, policymakers and administrators will increase recruitment, retention and motivation. This is particularly important as countries enhance the quality of health services in remote and hard-to-reach areas.
Third, increased focus should be put on strengthening leadership and management. Evidence shows that countries that have a chief nursing officer and a nursing leadership programme have stronger regulatory environment for nursing and midwifery. This helps them to ensure that all healthcare providers have adequate capacity and skills and can work effectively in interdisciplinary teams. It also means that, when developing policy, they are more likely to benefit from the knowledge and experience these healthcare workers have. Hence, they must be enabled to develop leadership potential and participate in key decision-making forums.
Additional investments are needed. The first-ever State of the World’s Nursing Report shows that low and middle-income countries should invest an additional $10 per capita for nursing education alone. In most countries, this can be achieved with domestic funds. In some countries, development partners and financing institutions can help. By transferring human capital investments for education, employment, gender and other areas into national health workforce strategies, partners can strengthen the workforce while driving job creation, gender equity and youth engagement.
The WHO is committed to supporting all countries in the region to strengthen their nursing and midwifery workforce as together we pursue our overarching goal: UHC. Health for all at all ages is possible. We can and we must, make it happen.
(The writer is Regional Director, WHO South East Asia)
