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A Global Perspective on Nursing

Professor Jean WhiteChief Nursing Officer (Wales)

This presentation

• Why are nurses & midwives important? • International priorities - WHO• State of Midwifery – relationship to MDG• Health worker migration and shortages – Ethical

Code of Recruitment• Building the research base

What is a nurse? Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in patient and health systems management, and education are also key nursing roles. (ICN 2014)

Midwife – licensed to practiseICM sets international definition for this role – to ensure high educational standards support the scope of practice

Recognising Importance of Nursing and Midwifery

• For more than a decade WHO has made declarations recognising the contribution of the professions – signed by country ministries for health

• WHO regional plans to strengthen role & contribution of nurses and midwives to support in-country work

WHO European Region: Munich Declaration 2000 – A Force for Health

“We believe that nurses and midwives have key and increasingly important roles to play in society’s efforts to tackle the public health challenges of our time, as well as in ensuring the provision of high-quality, accessible, equitable, efficient and sensitive health services which ensure continuity of care and address people’s rights and changing needs.”

MDG 4 – Reduce Child Mortality-Target is to reduce by two thirds, the under-five mortality rate

MDG 5 – Improve Maternal Health-Target is to reduce by three-quarters, the maternal mortality ratio-Target is to achieve, by 2015, universal access to reproductive health

MDG 6 – Combat HIV/AIDS, Malaria and other diseases- Halt and begin to reverse, by 2015, the spread of HIV/AIDS - Achieve universal access to treatment for HIV/AIDS for all those who need it. - Halt and begin to reverse, by 2015, the incidence of malaria and other major disease

Millennium Development Goals

WHO Africa Region: Strengthening nursing and midwifery 2007-2017

Priorities – strong links to MDGs 4,5 and 6:

• HIV/AIDS

• Maternal, Newborn and Child Health

• Malaria

• Adolescent health and development

• Mental health

• TB

State of Midwifery 2013

• 289,000 women died from childbirth complications

• Nearly 3 million newborns die in the first month of life

• 2.6 million newborns are stillborn each year

• Current estimated shortfall of 300,000 midwives

• Focus moved from medical intervention - 87% of the essential care for women and newborns can be performed by an educated midwife.

• Implementing quality midwifery services could prevent about two thirds of women’s and newborns’ death globally

Priorities for Midwifery

• Educate more midwives – benchmark against international education standards; enable midwives to focus on maternal care

• Financial support for services; bring midwifery care closer to the woman

• Dispel myths about midwifery led care; provide respectful care

• Regulate, register and re-licence midwives; create and support infrastructure and resources for maternal and child health

Priorities for Midwifery – case study Bangladesh• Can yield 16x fold return

on investment

• 500 educated and deployed midwives can reduce maternal mortality by over 80%

• Decrease infant mortality by 75%

• Over the course of a 30-year career, save over 36,000 live

Health worker shortages and migration

A Universal Truth: No Health Without a Workforce (2013). Third Global Forum on Human Resources for Health Report

• The World will be short of 12.9 million health-care workers by 2035; today, that figure stands at 7.2 million.

• In developed countries, 40% of nurses will leave health employment in the next decade. With demanding work and relatively low pay, the reality is that many young health workers receive too few incentives to stay in the profession.

• Increasing ageing workforce will drive shortages

• Health worker migration a significant phenomenon globally

The Global Code of Practice on international recruitment of health personnel (2010)

• Developed by WHO at request of World Health Assembly – this is a voluntary code that countries can choose to sign up to.

• Tension – protecting health workforce in developing countries v the rights of the individual worker to seek to migrate for economic reasons

• Countries must use incentives to encourage their health workers to stay in country

• Given massive health worker shortages globally compliance remains problematic.

Healthcare in Rural Settings

World population roughly 50% urban and 50% rural

Nurses spread 62% urban and 38% rural

Physicians spread 76% urban and 26% rural

WHO designing tools to help governments recruit, spread and retain their workforce.

Research and Development

Important that we develop the evidence base for nursing and midwifery care

WHO Research Collaborating Centre being established in Cardiff University in association with Royal College of Midwives – only one in WHO European Region (53 countries)

The Future

• Future holds increases in nurse and midwife led care globally

• Evolution of advanced practitioners – able to diagnose and prescribe treatments – WHO European Region Compendium

• Greater involvement in research and development

• Having a greater say in policy and practice developments – having a more confident voice