WORLD HEALTH ORGANIZATION FIFTY-FOURTH WORLD HEALTH ASSEMBLY Provisional agenda item 13.4 A54/11 30 March 2001
Strengthening health services delivery Strengthening nursing and midwifery Report by the Secretariat
1. The Forty-ninth World Health Assembly, through resolution WHA49.1, urged Member States to strengthen nursing and midwifery through strategies that included: involving nurses and midwives more closely in health care reform and in the development of national health policy; developing national action plans for nursing/midwifery as an integral part of the national health policy; increasing opportunities for nurses and midwives to improve their skills, and strengthening nursing/midwifery education and practice in primary health care. 2. In support of these strategies, the Director-General was requested to increase support to countries in the development, implementation and evaluation of national plans for health development, including nursing and midwifery; to promote coordination between agencies and organizations concerned with strengthening nursing and midwifery; to promote the training of nurses and midwives in research methods; and to provide for the continued work of the Global Advisory Group on Nursing and Midwifery. 3. This present report, which briefly reviews progress made in implementing resolution WHA49.1, was submitted for information to the Executive Board at its 107th session. The Board’s discussion reflected widespread concern about the issues raised and their impact on the performance of health systems. 4. Nursing and midwifery services continue to play a pivotal role in public health and community initiatives. Nurses and midwives make up by far the largest group of health workers and are foremost in providing both services to traditionally underserved areas and vulnerable groups, and primary health care services. 5. Notwithstanding the difference in the organization and development of health systems in countries, a common concern is the widespread and increasing shortage of nurses and midwives. This is particularly acute in developing countries, where unstable and dwindling funding of the health sector, low salaries and poor working conditions have conspired to promote emigration to countries offering better prospects. 6. Significant progress has been made in developing national plans for nursing and midwifery. More than half WHO’s Member States have formulated, or are elaborating, national plans. In most cases, these plans form part of the overall national health plan.
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7. Progress in increasing the participation of nurses and midwives in health care reform and the formulation of national policies has been modest. In many cases, nurses have helped to collect data and to frame human resource policies, but there are only exceptional cases of full participation in the whole process of setting priorities or selecting policy options in areas that are not directly linked with nursing and midwifery services. 8. Overall, the number of post-service training fellowships for nurses has increased slightly. Both greater capacity for research and training in clinical and managerial leadership are reported. These increased opportunities, however, fall short of demand. 9. The improvement of any health system depends on careful stewardship and the establishment of regulatory mechanisms for nursing and midwifery practices. More countries are reporting the strengthening of existing mechanisms. Tools and processes for quality control, ranging from checklists, clinical audit and review of patient charts to streamlined procedures for lodging and investigating complaints against nurses, have been developed in many countries with the support of WHO. 10. In many countries, nursing and midwifery skills are put to limited use, despite their proven costeffectiveness. Many countries do not capitalize on the evidence that nursing and midwifery interventions and the appropriate use of nurses and midwives can drastically increase coverage of basic health interventions. 11. WHO has revitalized the work of the Global Advisory Group on Nursing and Midwifery which is responsible for advising the Director-General on policies advancing nursing and midwifery. The main recommendations of the Group relate to the importance of the participation of nurses and midwives in the formulation of national health policy and the need for sustainable programmes to produce leaders in nursing and midwifery who can contribute to policy- and decision-making processes. In addition, strategic alliances with partners are called for to identify uniform, core indicators and to build up a solid body of evidence to inform national health policy, particularly in areas of cost-effective nursing and midwifery services and their impact on country priority diseases such as HIV/AIDS, tuberculosis and malaria. In the light of the critical shortage of nurses and midwives globally, the Group recommends that national efforts on workforce planning should be enhanced to ensure that human resources are more relevant to actual service needs of the population. Given the importance of nursing and midwifery services in the delivery of health care, it is also recommended that WHO improve mechanisms for bringing nursing and midwifery expertise into the drawing up of WHO policies and programmes. 12. With regard to WHO’s role in strengthening nursing and midwifery services, technical support was provided in relation to country requests in several areas, such as the assessment of nursing and midwifery services and curricula as well as the development and implementation of national action plans and quality assurance programmes. Standards for nursing and midwifery education and practice were set with partners such as the International Council of Nurses and International Confederation of Midwives. Tools and guidelines have also been developed and implemented for disease control, risk reduction, health care management and service delivery. Work on advocacy has included the drawing up and endorsement of position statements and ministerial declarations. 13. Thirty-five WHO collaborating centres for nursing and midwifery support WHO initiatives. The main areas of support include capacity building, curriculum development, collaborative research projects, and intraregional and interregional initiatives with an emphasis on collaboration between developed and developing countries. The number of collaborating centres in the latter should be increased in the future. 2
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Review of progress has highlighted several activities that need more attention: • giving technical support to countries to strengthen nursing and midwifery services, and to draw up a systematic approach to documentation and dissemination of evidence on effective interventions; • promoting approaches, models and guidelines that are based on evidence, particularly for education and practice of nurses and midwives; • seeking with partners practical solutions to the global problem of staff shortages and migration; • increasing support for the Global Advisory Group on Nursing and Midwifery, strengthening the role of WHO collaborating centres and creating a broad alliance to champion nursing and midwifery; and • elaborating and using uniform indicators to monitor and measure progress at country, regional and global levels in achieving the stated goals.
ACTION BY THE HEALTH ASSEMBLY 15. The Health Assembly is invited to consider the adoption of the resolution contained in resolution EB107.R2.
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