International Day of the Midwife and International Nurses Day: Accelerate Region-wide improvements in the nursing and midwifery workforce

by Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia

To mark this year's International Nurses Day (12 May) and International Day of the Midwife (5 May), WHO is urging countries of the South-East Asia Region to accelerate improvements in the density, skill-mix and distribution of the nursing and midwifery workforce, building on the strong progress made under the Region's Decade for Strengthening Human Resources for Health (HRH) 2015-2024.

Globally, WHO projects a shortfall of around 10 million health workers by 2030. The world currently faces a shortage of around 900 000 midwives, which represents a third of the required global midwifery workforce. Evidence shows that midwifery-led models of care can avert two-thirds of maternal and neonatal deaths and stillbirths. As highlighted by the COVID-19 crisis, nurses and midwives are critical to building health system resilience and achieving universal health coverage (UHC) and health security.

Since 2014, WHO and its Member States in the South-East Asia Region have intensified action to strengthen HRH, in line with three of eight Regional Flagship Priorities: accelerating reductions of maternal, neonatal and under-five mortality; strengthening emergency risk management; and continuing progress towards UHC. Between 2014 and 2022, the Region improved the density of nurses and midwives by 83%, averaging 20.41 nurses and midwives per 10 000 population.

Throughout the COVID-19 response, countries have continued to implement national HRH action plans, and most have significantly improved HRH data. Nine of 11 Member States have in place a nursing council or other regulatory authority, and eight Member States report regulations on working hours and conditions for nurses.

Six Member States have a chief nursing officer or equivalent position, which all Member States should urgently adopt. Last year, Member States reiterated their commitment to fully implement the Regional Strategic Directions on Strengthening Midwifery 2020-2024, calling for a midwifery-led, primary health care approach to accelerate further reductions in maternal and neonatal deaths and stillbirths.

Today, to strengthen the nursing and midwifery workforce, WHO is calling for action in several key areas.

First, although the Region has made significant progress, we are still short of nurses and midwives. Before the COVID-19 pandemic, the Region needed as many as 1.9 million more nurses and midwives by 2030. New calculations are required after COVID-19 has pressured health systems even more and governments need to ensure population health needs are met to ensure health security in countries. Production rates must be re-evaluated to ensure we can meet the target for 2030. We must also be conscious of nurses, midwives and health workers leaving the profession or leaving the country to work in other countries.

Second, it is important to assess the current composition of health care teams and understand the optimal composition of health care teams to meet the needs of communities based on people-centred service delivery models. Introducing and regulating enhanced scope of practice for nurses and midwives where needed can help fill gaps. Specialist nursing programmes are essential for acquiring additional nursing skills for greater responsibilities in complex health settings. In a conducive environment, advanced practice nursing roles can provide effective health services that are instrumental to achieving UHC.

Third, distributional inequalities exist in addition to health workforce shortages. To increase production, recruitment and retention to rural, hard-to-reach or remote areas, interventions should be interconnected, bundled and tailored to each local context. Policy recommendations can include setting up new nursing and midwifery institutions in rural and hard-to-reach areas; targeting admission policies to enroll students with a rural background to nursing and midwifery education programmes, providing financial scholarships, bursaries or other education subsidies and non-financial incentives for nurses and midwives working in rural and remote areas and providing a safe and secure working environment.

Fourth, nurses and midwives along with health workers need safe, healthy, supportive and dignified conditions of work to provide respectful quality health services with dignity. Conducting assessments of working conditions and environments would give insight to which management and policy actions can be adopted. Interventions may include developing and improving occupational health and safety management systems; investing in areas of enabling work environments, fair and equitable remuneration and providing social protection; enacting and strengthening legislation against discrimination; and safeguarding rights such as providing the right of freedom of forming and joining trade unions and collective bargaining.

As we celebrate the International Day of the Midwife and International Nurses Day 2023, WHO reaffirms the commitment to strengthen these vital health workforce even beyond the Regional Flagship Decade for Health Workforce Strengthening 2015-2024 to progress toward universal health coverage and the sustainable development goals.

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