DEPARTMENT: On the Road
In many developing countries, infants often go unnamed for the first month of life. This is done because many don't live that long, said Daisy Mafubelu, the assistant director-general for family and community health at the World Health Organization (WHO) and a nurse midwife. At a March meeting at WHO headquarters in Geneva, she said that an estimated 4 million newborns die every year and one woman dies from childbirth-related causes every minute. But without a sufficient number of nurses and midwives, she said, “we can't change the picture.”
Nurses and midwives globally provide about 80% of health care and are essential to access to care, especially in undeveloped and rural areas, according to the WHO's Global Advisory Group on Nursing and Midwifery (GAGNM). Nursing and midwifery are crucial to countries seeking to fulfill the United Nations Millennium Development Goals, especially efforts to reduce rates of maternal and child death, HIV and AIDS, malaria, and other illnesses (see www.un.org/millenniumgoals). Yet despite the WHO's renewed embrace of the 1978 Alma-Ata declaration, which promoted primary care as the best model for providing health care to all, only 13 nurses serve in positions at WHO headquarters.
Nursing and midwifery at the WHO. Jean Yan, chief scientist and coordinator of the WHO Office of Nursing and Midwifery, is leading an effort to acknowledge the contributions of nurses and midwives within the WHO and encourage their appointment at all levels of WHO programs. Yan's office is gathering worldwide examples of nurses and midwives improving primary health care. This year-long project will produce a collection of case studies demonstrating successful models of primary care, a resource package promoting the best practices, a global award recognizing outstanding achievement, a photo exhibition compiled from WHO archives, and several publications. (Visit www.who.int/hrh/nursing_programme/en/index.html for information on WHO nursing and midwifery.)
Global efforts to strengthen nursing and midwifery. The March meeting brought together the GAGNM, which advises the WHO's director-general on how to strengthen nursing and midwifery services in health programs; the International Council of Nurses; the International Council of Midwives; the WHO Collaborating Centers for Nursing and Midwifery; and regional WHO advisers, among others. The participants reviewed global strategies to be implemented at all levels—local, national, and regional—as well as the work of the task force on Strategic Directions for Nursing and Midwifery for 2009 to 2015.
Members of the GAGNM presented the following recommendations to WHO director-general Margaret Chan:
- that the WHO support countries in implementing the Strategic Directions for Strengthening Nursing and Midwifery Services
- that the WHO establish a “high level commission” on primary health care renewal and include nurses and midwives
- that nurses and midwives be involved in global, regional, and national policy decisions on primary health care
- that nursing and midwifery education programs be adequately regulated
- that the WHO support nursing and midwifery efforts and partnerships to achieve primary health care goals
- that the WHO continue with competency-based recruitment
Peggy Chibuye of Malawi, a GAGNM member who met with Chan, said that the director-general was “generally supportive” of the recommendations but didn't support the idea of a “high level commission,” preferring the idea of a “group.”
“Now the WHO, the GAGNM, and the stakeholders will work together to put the recommendations into action,” said Yan. How and when that happens depends on the member states.
And indications point to the need for quick action: many countries are far from where they should be to reach the Millennium Development Goals by the target date of 2015. A 2007 report from the United Nations showed that “sub-Saharan Africa [was] not on track to achieve any of the goals.”
Maureen Shawn Kennedy, MA, RN, editorial director