Countries that invest in and develop their nursing and midwifery workforce can achieve a rapid, cost-effective expansion of high-quality universal healthcare (UHC).
That is the main finding of the Nursing and Midwifery. The Key to the Rapid and Cost-Effective Expansion of High-Quality Universal Health Coverage report co-authored by Aga Khan University Professor Sharon Brownie, Dean of the School of Nursing and Midwifery in East Africa, Lord Nigel Crisp, Co-Chair of Nursing Now, and Dr
The authors of the report: Dr Charlotte Refsum, (left), Lord Nigel Crisp (middle) and AKU's Professor Sharon Brownie (right) at the WISH 2018 summit.
Charlotte Refsum, Global Health Clinical Manager at Klynveld Peat Marwick Goerdeler, UK. It was commissioned by the
World Innovation Summit for Health (WISH) and launched at WISH 2018 in Doha, Qatar. The report argues that unless nursing and midwifery is rapidly expanded and developed, there is no possibility of achieving the World Health Assembly goal of a billion more people benefiting from UHC in five years.
The report includes new data on public perceptions of nurses and midwives in seven countries. The data shows strong public backing for nurses playing a bigger role in health services, and strengthens the report’s argument that nurses are in the pole position to manage the defining health challenges of modern times.
“The world is facing a shortfall of 18 million health workers needed to deliver and sustain universal health coverage by 2030,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization, in the report’s foreword. “More than half of that shortfall is nurses and midwives. This report makes a persuasive set of arguments for investing in nursing and midwifery as part of a multidisciplinary, people-centered workforce.”
“Current global policy on UHC barely mentions the health workforce, let alone nursing and midwifery,” Dean Brownie said. “There would be a profound effect on how quickly and effectively UHC could be rolled out if a significant part of the workforce were enabled to work more effectively or to take on new roles.”
Speaking at the launch of the report, Lord Crisp said, “To date, discussions on the delivery of UHC have focused on financing and access to service without sufficient consideration of investment in the health workforce. Our report shows that by redesigning health services at a national level to make better use of nurses and midwives, countries can achieve high-quality, cost-effective Universal Health Coverage and maximise their existing human resources.”
Building on the success of the Nursing Now campaign, which aims to empower nurses worldwide and has generated support in 67 countries since its launch in February 2018, the report breaks down the argument for investing in nursing and midwifery into the following headlines:
Rapid expansion
The report suggests that countries can achieve rapid expansion of UHC by adopting a strategy that combines investment in the workforce with changes in service delivery and practice. In practice, this means enabling nurses and midwives to work to their full potential through the creation of more nurse-led clinics, more specialist nurses and more midwifery services.
Cost-effective expansion
Evidence in the report shows that cost-effective expansion of UHC will heavily depend on enabling and training the existing workforce, including nurses and midwives, to work more effectively. In addition to the examples listed in Rapid Expansion, there is enormous potential for nurses to expand their scope of practice through task-sharing. One study cited in the report estimates that advanced-practice nurses can complete approximately 70 per cent of a general practitioner’s workload.
High-quality expansion
There is evidence of the positive impact that nurses and a patient-centered, holistic approach have on the quality of care, including studies showing that physicians and nurses generally achieve equivalent health outcomes for long-term non-communicable diseases management, though nurses often score higher for patient satisfaction and for treatment adherence. Nurses also often provide more health-promotion and disease-prevention advice at the same time.
“The research conducted in this report shows that the vast majority of patients do not mind whether they are treated by a nurse or a doctor and hold both professions in equal regard,” said Lord Darzi, Executive Chair of WISH. “These results suggest that there would be widespread public support for nurses making an even greater contribution to healthcare in the future, so we strongly encourage governments to adapt their national programmes accordingly.”
"ICN is pleased to welcome this new report on Nursing and Universal Health Coverage," said Annette Kennedy, President of the International Council of Nurses and Commissioner on the WHO High-Level Commission for NCDs. "Several studies have found that midwifery and nurse-led services are delivering positive and high-quality outcomes for patients, especially those related to non-communicable diseases, and are cost-effective for health systems. ICN supports the recommendations of the report and calls for investment in nursing and midwifery for rapid, cost-effective, high-quality UHC."
The report has been published in coordination with the Nursing Now campaign, which has a three-year mission to promote and empower nurses and midwives worldwide. The campaign will culminate with the Florence Nightingale Conference in 2020, an event marking the 200th birthday of the woman considered to be the founder of modern nursing.
