A Clarion Call to Care for Africa’s Nurses and Midwives

April 8, 2020

By Peter Kibe, Research Officer 

Nurses and midwives play a central role in enhancing essential primary health care across the world. The Universal Health Coverage (UHC) 2030 underscores the contribution of nurses towards the Universal Health Coverage in the run-up to achieving sustainable development goals. In many countries, nurses/midwives are the first line professional contact with patients. This is particularly true for many low and middle-income countries (LMICs) where nurses and midwives are the only health professionals seen by patients in primary health care facilities.  

The work of nurses and midwives appears well cut out, ranging from supporting and managing patients’ treatment, assisting in surgical processes and taking care of the injured.   Nurses/midwives still go beyond taking care of ill patients, to providing care for their families and communities. The training curriculum prepares nurses and midwives well to handle many of the health-related challenges, the non-health related aspects are well learned with experience under the supervision of their experienced seniors in their work environment (Skar.R,2009). Learning from seniors is premised on an organized system with a seamless flow of roles and responsibilities.

Nurses/midwives face many challenges stemming from glaring gaps which could be health system aspects like shortage of workers against the workload, inadequate equipment, leadership and financial constrains (Figueroa CA, et al.2019). Nurses and midwives working in the community face more challenges arising from the demand side of care mainly from grappling with community expectations amidst structural barriers. This cadre, therefore, juggles between huge tasks that are interlinked with many relations both professionally and personally.  In a BBC interview, a nurse described her typical day as, “a lot harder… it is really tough, feeling you are not doing a brilliant job all the time.”  This is an account for many other nurses and midwives who continue to encounter frustrations and risks such as physical injuries, psychological risks and many more risks (Foley Marley). Nurses/midwives have further experienced violence and trauma in the line of work as documented by Health Care in Danger initiative by the International Red Cross and Red Crescent Movement.

While some risks arise from the nature of work, the risks have been exacerbated by mutable factors as was evidenced during the Ebola pandemic in West Africa. Health workers were infected largely due to deficiencies in infection and prevention control measures as cited by the WHO Ebola infection report. The report states that 50% of the infected health care workers during the Ebola crisis were nurses. While acknowledging the existing risks, the big question remains: How do we take care of our caregivers to keep them safe and motivated as they provide quality health care? By designating the year 2020 as the year of Nurse and Midwives, the World Health Assembly gives us the opportunity to not only recognize and celebrate nurses/midwives but also the opportunity to address the challenges limiting these front line caregivers.  Speaking at the International Council of Nurses Congress, Dr. Tedros Adhanom, the WHO Director-General said: “It’s about harnessing the power of nurses to achieve our vision for 2030, to achieve universal health coverage and to have a world which is healthier, safer, fairer for everyone. “We all have a role to play in honoring this clarion call, starting with leaders in government, private sector and other partners. Leaders in these sectors can contribute more to the health and well-being of nurses/midwives by partnering to ensure nurses/midwives are protected, motivated and supported to deliver health care. Secondly, the users of nursing/midwifery services which essentially means all us must be in the frontline to enable nurses/midwives feel safer in delivering care. We can do this by advocating for better working terms for caregivers and volunteering to promote healthy behavior in our social circles. Community health volunteers are already taking up this and we should support these initiatives (Woldie M, et al 2018).  Finally, the nurses/midwives need to heed to this opportunity and make their voices heard. As a trained nurse, I am doing this by advocating for better care for our caregivers. I urge more colleagues to come forward and tell their stories as well as take part in designing nurse programs that are responsive to their patients and to their safety and make us all understand how to make our contribution.