The 7th of April marks World Health Day and this year’s theme, ‘Support the nurses and midwives’, could not be more apt. Nurses and midwives, are the backbone of health systems globally, accounting for approximately 50% of the global health workforce. Of the world’s 43.7 million healthcare professionals, more than 20 million are nurses and midwives. They play a critical role, particularly in the sub-Saharan Africa (SSA) region, as quite often they are the first and only healthcare professionals that community members requiring medical attention come into contact with. In various settings, nurses provide primary and community care as well participating in disease prevention and health promotion programs.
Because nurses and midwives respond to the needs of people in all settings, they are critical to the achievement of global health agendas. As such, the World Health Organization recognises the vital role that nurses and midwives play in promoting universal health coverage and sustainable development. Universal health coverage is largely dependent on quality care provided by available and adequate numbers of well-educated and –trained medical personnel, the bulk of which is made up of nurses and midwives. In addition the health agency states that for the realisation of the global goal on health to be realised by 2030, there is an urgent need for an additional 9 million nurses and midwives. On average, there is only one nurse and/or midwife for every 1000 people across the sub-Saharan region. SSA is home to 1.7 billion people, making up approximately 15% of the global population and 24% of the global burden of disease. Unfortunately, it only has 3% of the world’s workforce.
The leading causes of death in SSA remain infectious diseases, newborn, nutritional, and maternal conditions which are all dependant of the availability of enough, well-trained, supported, resourced and deployed health workforce. The lack of adequate human resources in the health sector has a negative ripple effect across all other sectors, but most importantly on the mortality rates of a population, especially for women of reproductive age and children under five years of age. Most of the nurses and midwives prefer to live and work in urban areas, for better opportunities, even though 60% of the population resides in rural areas (). In urban areas, though a majority of the population resides in informal settlements, trained health professionals prefer to work in the more developed areas. As a result, residents of urban informal settlements have poorer health indicators in comparison to their counterparts in rural areas and other urban areas.
Adequate numbers of healthy and motivated health professionals are critical to governments’ effective responses to public health emergencies such as Covid-19. Nurses often form the bulk of the first-line responders, often risking exposure to infection. Recently, the WHO Investment Case for Vaccine-Preventable Diseases Surveillance in the African Region 2020-2030 was released. In sum, these guidelines highlight the drastic consequences of failing to invest in disease surveillance while stressing the need for a strong health workforce.
The challenges
The 2030 deadline, although feasible, might not be attained. Responding to the prevailing global shortage of healthcare professionals, in particular for nurses and midwives in South East Asia and sub Saharan Africa is an uphill task. In addition to the constant brain- drain of skilled professionals, the health workforce in SSA suffers from inadequate training capacity, persistent gender stratification of professional status as well as low remuneration and poor working conditions. In all, most of the challenges beleaguering the health sector are due to the chronic under- investment in the health sector by governments across the region.
Nursing, like other caring professions, is highly demanding and even more so in developing countries, where demands on staff are often greater than the support offered. The Global Health Workforce Alliance and the Lancet Commission highlight a major mismatch between current healthcare challenges and professional education, leading to further divergence between patient/population needs and the competencies of healthcare professionals. For instance, whereas the population structure in the region is changing, with more people living longer, ageing- related training in Africa is not common.
Professional training in SSA is largely limited to a technical focus on clinical care with little attention to health promotion and disease prevention at the community level. A focus on medical care limits the understanding of the broader context in which people’s health is dependent. This is particularly important for vulnerable populations for whom factors such as environment, housing, income level and education are important predictors of their health and wellbeing. Healthcare professionals, especially nurses and midwives, need to understand these social determinants of health so as to provide more holistic, comprehensive healthcare to the communities they serve.
While challenges abound in the health systems of many low and middle income countries, there are healthcare professionals who are highly engaged in their work, are healthy, and continue to do a good job in the process. However, working in the health sector need not be a survivor challenge, but a hark to a calling that replenishes even as it takes.
A thriving nursing and midwifery workforce- what is needed?
In the past few years countries have instituted reforms to nursing and midwifery education, shifting from content- driven curricula to competence- based programs that are responsive to the primary healthcare needs. Digital technologies have been successfully used to support learning of healthcare professionals globally and progressively in SSA.
However, many challenges still prevail. These include inadequate preparation of mentors and educators, lack of resources to implement the changes and, limited involvement of key stakeholders. Nevertheless, several more steps can be taken to address these challenges, and increase the number of nurses and midwives across the region.
In addition to curriculum reforms, innovative teaching strategies are needed responding to the career stages of the different healthcare professionals, accommodating those in training and in practice. These technologies have the potential to support learning of nurses and midwives in training as well as those in practice, allowing them to benefit from mentors and educators who are physically distant while giving them flexibility to create learning goals in their preferred locations.
There is also potential for greater collaborations between regions and countries, as a way sharing best practices. Strategic collaborations between the public and private sectors are necessary to support initiatives that strengthen the nursing and midwifery workforce.
Furthermore, health care managers need to make work environments conducive to enhance job engagement by ensuring that all nurses and midwives have job resources such as working equipment and social support that they need to thrive on the job. Making work environments conducive through provision of work tools and protective gear for the health workforce is an absolute necessity. Occupational health and safety measures through adequate infection prevention and control is paramount in SSA, as elsewhere, to ensure that the few health workers that are not lost or have to take leave.
To support all these initiatives, the role of enabling health systems is critical. With strong leadership and political commitment to transforming lives, matched with more domestic funding for the health sector, we can build a stronger workforce and achieve the 2030 goals on health.