WHO updates: What role do nurses play in achieving universal health coverage?
December 2, 2024
A society is considered to be aging when over 40% of its population is aged 65 or older. In Australia and New Zealand, the transition from an aging to an aged society took approximately 60 years, while Japan experienced this shift in about 25 years. In contrast, French Polynesia and Vietnam are projected to make this transition in less than 20 years. Furthermore, the proportion of deaths attributed to non-communicable diseases (NCDs) is expected to rise in the coming years.
NCDs are currently the leading causes of death and disability in the region, with diabetes, cardiovascular diseases, cancer, and chronic respiratory diseases accounting for nearly 87% of all fatalities. This situation signifies an increasing demand for a broader range and greater volume of health services. Dr Midori Anami Akimoto (pix), Nursing Officer at the WHO Western Pacific Region Office, emphasized at the 22nd Asia Workforce Forum (AWFF) and the 18th Alliance of Asian Nurses Associations (AANA) meeting—hosted by the Malaysian Nurses Association (MNA) and the International Council of Nurses (ICN) from November 20-22—that "the health workforce must adapt to sustainably and equitably meet the evolving health needs of the population." While the U.S. service coverage index has seen significant improvements in many countries over the last two decades, household health expenditure has doubled since 2009, and service coverage has expanded. Financial hardship remains a critical issue that necessitates immediate action to transition toward sustainable Universal Health Coverage (UHC). These challenges are exacerbated by rapid economic, social, and environmental changes across the region. Nursing workforce in the Western Pacific Region Countries with a higher number of health workers per 10,000 population tend to achieve better service coverage for UHC, underscoring the vital role of health workers in delivering essential services. However, a significant gap in the availability and distribution of health workers persists in this region. Among the eight countries—Kiribati, Lao PDR, the Federated States of Micronesia, Papua New Guinea, Samoa, Solomon Islands, Tuvalu, and Vanuatu—listed in the WHO Health Worker Support and Safeguards List 2023, these nations face the most pressing challenges and require focused investment and support. Over the past two decades, improvements in the number of health workers relative to population growth have been inconsistent. For nursing and midwifery personnel, countries such as China, the Cook Islands, Fiji, Kiribati, Malaysia, the Republic of Korea, Samoa, Solomon Islands, and Vietnam have made significant strides. However, progress has been slower in Cambodia, the Lao PDR, Papua New Guinea, and Vanuatu. Addressing these disparities is crucial to ensuring equitable and sustainable development of the health workforce. Notably, the percentage of health workers practicing abroad compared to the domestic workforce is concerning. For instance, 52% of medical doctors from the Cook Islands and 34% of nurses from the Philippines are employed overseas. Additionally, countries like Fiji and Tonga also experience significant emigration of both nurses and doctors. The outward migration of health workers poses significant challenges, particularly for small island nations and low- and middle-income countries. As these nations face a worsening shortage of health workers, access to essential healthcare for their populations becomes increasingly limited. To combat this issue, it is critical to strengthen local training for health workers and create incentives for them to remain in their home countries. The region is home to approximately 6.9 million nurses, representing about one-fourth of the global nursing workforce. Nurses account for 68% of all health professionals in the region, surpassing the global average of 59%. However, there is an estimated shortage of 350,000 nurses, particularly in primary care and education. Addressing this gap is essential for strengthening health systems. Advancing nursing education Significant progress has been made in enhancing nursing education, yet ensuring consistency and institutionalizing continuing professional development (CPD) remain key challenges. Advancing these efforts will empower nurses to deliver high-quality care and further strengthen health systems across the region. Enhancing nursing service delivery to meet healthcare needs To meet the growing healthcare demands, it is essential to expand advanced nursing laws and strengthen nursing councils. Currently, advanced nursing laws are established in only 52% of countries, while nursing councils exist in 78%. Advancing these initiatives will enable nurses to take on more central roles in healthcare delivery, thereby reinforcing health systems throughout the region. Strengthening nursing leadership Education and support are essential for empowering nursing leaders to actively participate in policy-making. In this region, 74% of countries have established a chief nursing officer position, yet only 43% have implemented a nursing leadership development program. To tackle these challenges, the South Pacific Chief Nursing & Midwifery Officers Alliance (SPCNMOA), led by the WHO Collaborative Centre, plays a crucial role. This alliance consists of senior leaders from 22 Pacific countries who exchange insights through bi-monthly online meetings. Additionally, the Regional Nursing Leadership Program, also spearheaded by the WHO Collaborative Centre, is making a significant impact through initiatives like the Pacific Leader Program and the Global Health Nurses Leadership Program. Dr Midori emphasizes that these initiatives aim to empower nursing leaders to engage in policy-making and strengthen health systems across the region. The pandemic's impact and actions to address nursing shortages The pandemic has exacerbated the global nursing shortage, leading to higher attrition rates and increased demand for nursing personnel. This issue is compounded by a growing inclination among nurses to leave the profession, particularly affecting health systems in low- and middle-income countries. For example, in Canada, job vacancies rose by 17%, while in England, the vacancy rate for registered nurses was 11.9% as of September 30, 2022. Germany is projected to need 150,000 new nurses by 2025, and Singapore requires 4,000 new nurses by the end of 2023, reflecting rising attrition rates. Meanwhile, the USA anticipates a 6% growth in the demand for nurses from 2021 to 2031. In response, WHO is advancing efforts under the Global Code of Practice on the International Recruitment of Health Personnel, which is under review this year for the next WHO 2025 agenda. Collaborative efforts are vital to protecting nursing careers and building a sustainable global health system. Regional framework to shape a health workforce The regional framework was adopted by Member States at the 74th Session of the Regional Committee for the Western Pacific last year. This framework outlines five strategic areas of action necessary for building a future health workforce:
Furthermore, the framework emphasizes the importance of improved data and analysis on human resources for health to accelerate critical reforms aimed at achieving universal health coverage and sustainable development goals. Specific priority actions related to nursing are included, highlighting nurses as key enablers in the pursuit of universal health coverage. To support member states in strengthening their nursing workforce and advancing the implementation of this framework, WHO organized a regional nursing and midwifery forum in Manila, February this year. Key challenges identified During the forum, several key challenges for nursing and midwifery were identified, including:
Action plans for member states and the Western Pacific Region Offices The forum emphasized the importance of strengthening nursing leadership, providing a valuable platform for participants to share experiences and discuss nursing and midwifery policies. For member states, the action plans include:
For the Western Pacific Region offices, the plans involve:
Additionally, an implementation workshop was organized to shape the future health workforce in the Western Pacific. Dr Midori shared that this workshop, held at the beginning of November aimed to strengthen governance and policy development in human resources for health while enhancing networks across the region through valuable exchanges of ideas. Key topics discussed included primary health care and human resources governance, with a focus on cross-country learning and the framework's discussion phase. The New Regional Vision: 2025 - 2029 The new regional vision for 2025-2029 focuses on promoting health for families, communities, and societies. The framework includes the transformation of primary health care to achieve universal health coverage. It involves integrating service delivery approaches as the first point of contact, tailored to the specific context of each country. Key components include developing suitable models of care delivery and modernizing primary health care through digital technology. |
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