CRISIS, EXPERTS SAY
A group of international experts that met at WHO
Headquarters in Geneva recently concluded that nursing and midwifery
services are in "crisis". This crisis is mainly a result of
poorly planned workforce policies that do not work, fragmented health
systems and epidemiological and socioeconomic trends.
The experts met at the Sixth Meeting of the World
Health Organization’s (WHO) multi-disciplinary Global Advisory Group
for Nursing and Midwifery.
Nurses and midwives around the globe are leaving
the health system, driven away by underpay, hazardous working
conditions, lack of career development as well as professional status
and autonomy. In addition, there is a sharp decline in new recruits to
the profession for similar reasons. If the world’s public health
community does not correct this trend, the experts agreed, the ability
of many health systems to function will be seriously jeopardized.
In countries such as the UK, Canada and USA the
average age of nurses was between 43 and 45, indicating that young
people were not taking up the profession for exactly the same reasons.
"Skills drain", where nurses are recruited into developed
countries from developing countries exacerbates the situation. For
example, the number of overseas nurses coming to the UK has risen by
48% in 12 months. For the most part, the new recruits are from non-EU
countries such as South Africa, Australia, the Philippines, New
Zealand and the West Indies.
Speaking to the group, Dr. Gro Harlem Brundtland,
Director-General of WHO, said, "Nursing and midwifery services
are vital for effective health services. We should better understand
the causes of this crisis and encourage Members States to
Participants heard how, in one hospital in Zambia,
which need 1,500 nurses to run smoothly, only 500 nurses were
currently employed. Ten years ago in Poland, over 10,000 new nurses
were being graduated annually from educational courses. That figure
number has fallen to 3,000. In Chile, out of 18,000 nurses in the
country, only 8,000 are actively working in the field.
In Egypt, for example, most nurses and midwives
were trained by and employed in the public sector. Now private sector
healthcare providers are luring them away with higher salaries. The
result was a shortfall of nurses and midwives in the public sector
with some professionals holding two jobs, one in each sector. The
overall quality of the nurses’ and midwives’ work suffered,
"The poor are always the first to suffer
during times of health care crisis. Nurses and midwives play pivotal
roles in providing essential services to the poor, marginalized and
underserved populations. Effective nurse-midwife service models exist
but they are not translated into effective health policy," said
Dr Naeema Al-Gasseer, Senior Scientist for Nursing and Midwifery, WHO.
Participants heard, for example, how 94% of
"well-baby" clinics in Chile are run by nurses. Since these
clinics began in the 1970s, infant mortality in the country has dropped
from 110 per 1000 child births to 11 per 1000.
Also, it is most often nurses who work in the local
clinics and health stations where most information on prevention and
control of diseases such as HIV is disseminated.
The experts agreed that the best remedy for the
problems currently facing nursing and midwifery services was to ensure
that these concerns were priorities on the public and political
agenda. Experts called for more systematic evidence of the impact of
inadequate nursing and midwifery services within the health system and
urged policy makers to take action.