Scaling-up Nursing and Midwifery Capacity to Contribute to the Millennium Development Goals




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НазваниеScaling-up Nursing and Midwifery Capacity to Contribute to the Millennium Development Goals
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HEALTH SERVICE PROVISION


Meeting population health needs in an equitable, efficient and sustainable manner entails recognizing diversity and, addressing management of both urban and rural inequalities in service access and quality in light of the human resource for health shortage. Sustainable health systems strengthening for PHC has to be guided by a sound policy framework grounded on successful experiences and the evidence for practice. This requires that nurses and midwives are actively engaged, strategically adept participants in health policy development and implementation processes.

Great inequities in health outcomes still exist despite significant progress being made towards Health for All. Primary health care principles are more important than ever, especially from the perspective of consumer and community empowerment and partnerships.

A central tenet of PHC is that communities take responsibility for their own health. Nurses and midwives as the main providers of close - to- the- client care in the PHC settings, and most trusted by the community, are best placed to inform policy related to the delivery of health services. The experience of nurses in using a range of intervention for effective care illustrates the importance of maintaining their central role in PHC. Thus the availability of nurses and midwives at the health service provision level is vital to the sustainability of effective PHC services.

The main goal of this aspect of the programme of work is to support and equip nurses and midwives to function effectively in PHC policy formulation and implementation. Activities in this core element will;


  1. influence policy making at all levels aimed at improving the quality of life and health outcomes of all members of society within a primary health care context.

  2. produce best practice guidelines and policy option analyses supportive of the continuum of care.

  3. expand the evidence base of nursing/midwifery contributions to PHC and health systems,



PLAN OF ACTION: HEALTH SERVICE PROVISION

Just as there is a need for revitalization of PHC, the same need pertains to nurses and midwives, as key health service leaders and providers of care at all levels, enabling them to be at the policy-development, planning and decision-making table, to influence health systems and health financing, focused on PHC, in a transformative manner, responsive to the needs of society, in an equitable and effective manner.



objective

activity

target Date

indicator

expected results

  1. To engage leaders in policy making at all levels aimed at improving the quality of life and health outcomes of all members of society [within a primary health care context.].




Collection and dissemination of PHC best practice examples, evidence, with successful policy interventions


Provide an information package to front-line nursing/midwifery staff to assume leadership roles within PHC


Orientation programme on policy implementation for PHC.

September 2008


Dec.2008



Evidence, best practice and policy materials such as case studies from 6 regions in a compendium on the contribution of N&M towards PHC


Nurses and midwives in 6 participating countries are utilising the information package.


The active participation of a representative number of nurses and midwives in regional and global consultation on PHC supported.

Nurses and Midwives assume leadership of PHC


  1. To update education and practice programmes to reflect the renewed PHC approaches.

Document existing evidence on the provision of nursing and midwifery services and education in a multidisciplinary, collaborative PHC


Revision and update of programmes.

Dec. 2008


Dec. 2009



Data base of evidence

Framework for inter professional education and collaborative practice in health service provision


Number of countries adopting the PHC focused programmes.






  1. To expand the evidence base of nursing/midwifery contributions to PHC and health systems.




Conduct studies on nurses as a tracer profession for successful PHC implementation, through the strengthening of evaluation research.

Dec. 2009

Two countries participating in tracer studies

Research evidence to support policy decisions on nursing and midwifery practice in PHC



WORKPLACE ENVIRONMENTS


A healthy work environment has been defined as a practice setting that maximizes the health and wellbeing of nurses, quality patient outcomes, staff retention and organizational performance (RNAO 2007). Increasingly studies, research and reports point to the negative impact on the quality of workplace environments, job satisfaction and retention of nurses and midwives. Unhealthy workplaces and poor organizational structures and climates characterize many of the places where nurses and midwives work. This situation is so pervasive that it is highlighted in the Islamabad Declaration on Strengthening Nursing and Midwifery as needing urgent attention (WHO, ICN, ICM 2007).

The World Health Organization’s 2002 -2008 Strategic Directions for Nursing and Midwifery Services (2002) recognized the challenges of tackling workplace problems when countries – particularly in many low and middle income countries – face overstretched health budgets and unsuitable employment policies. The strategy recognizes that improving the quality of workplace environments entails adopting multifaceted, comprehensive strategies, using a multisectoral approach and different stakeholders such as government, employers, trade unions and professional organizations. The six conditions Kristensen (1999) found as characterizing optimum workplace environments are proposed as an organizational framework for developing the programme of work on positive workplace.

The main goals of this aspect of the programme of work are to;

  1. assist Member States to develop mechanisms for improved working conditions of nurses and midwives

  2. develop a framework that supports and promotes positive workplace environments.



PLAN OF ACTION: WORKPLACE ENVIRONMENT

objective

activity

target Date

indicator

expected results

  1. To assist Member States to develop mechanisms for improved working conditions of nurses and midwives

Dissemination of ILO 2005 brochure to Member States, professional associations and regulatory bodies


Review of the implementation of the ILO Convection in relation to the nursing and midwifery workforce.


Development of Fact Sheets to assist Member States in presenting to/ influencing policy makers to strengthen nursing and midwifery practice

December 2008


Dec.2008



30 % of countries established policies or frameworks supportive of the ILO Convention


HRH Department websites updated to include tools and situation analysis on positive workplace environment


Evaluation results on the implementation of the ILO Convection


Fact sheets developed on workforce resiliency

( retention and workforce satisfaction)

Productive nursing and midwifery workforce retained in locations of greatest need ensuring patient safety and improved productivity and health provider satisfaction.

  1. To build capacity for Training in positive workplace environment

Conduct an inventory of programmes with positive workplace environments.


Establishing programmes that promote and supports positive workplace environments.

Dec. 2009


Dec. 2009


Dec. 2009 (Long Term)

An inventory of programmes with positive workplace environments.


Programmes on positive workplace environnements






CAPACITY BUILDING IN LEADERSHIP (TALENT MANAGEMENT)


Given the role that nursing and midwifery play in fostering and maintaining an effective and efficient health system, it is imperative that PHC leaders develop and support the talents of the nursing and midwifery workforce. There is a need to define a clear set of policies, goals and targets to enable this to happen, to ensure that nurses and midwives make an optimum contribution towards improved health outcomes.


Derek Stockley (2007) defines talent management as ‘a conscious, deliberate approach undertaken to attract, develop and retain people with the aptitude and abilities to meet current and future organizational needs’. ‘Talent management for nursing and midwifery helps to clarify skills, abilities and expectations for nurses and midwives at all levels of the organization. It involves creating support systems that enable all nurses and midwives to be able to;

  • Work to their capacity

  • Contribute to improving community health goals

  • Participate in their own career and professional development

  • Experience satisfaction and rewards for the work they do; and

  • Feel supported in their career development by their peers and superiors’



Nurse and midwife leaders need competencies in leadership and management to ensure that they have the appropriate expertise to develop and maintain the effective contribution of nursing and midwifery staff towards the delivery of PHC services. It is for this reason that talent management becomes imperative. Talent Management involves identifying talent through: the recognition of early signs of leadership in individuals and the provision of a working environment that encourages personal development and recognition of achievement. Talent also needs to be nurtured through an investment in individual growth and development as well as through personal development programmes, mentorship and opportunities for experiential learning. The appropriate use of talented individuals requires the careful monitoring of levels of responsibility and designated authority that they are given. This must be matched with their abilities so as not to undermine personal confidence while at the same time allowing for the individual to extend their skills and accomplishments. Rewarding talent is also important as this reinforces the values that underpin high levels of performance. This can be done through promotion, commendation and recognition.

Developing policy that supports talent management requires that an enabling environment for effective talent management can take place. Improving talent management requires leadership and advocacy from those who currently hold responsibility, both those who have leadership positions and those who aspire to them. Critical thinking skills, problem solving skills, social skills such as interpersonal skills, communication and negotiating skills as well as skills in information technology are core elements of effective talent management.

The main goal of this aspect of the programme of work is

  1. To equip nurses and midwives with the skills and expertise required to enhance their talents and lead PHC service delivery

  2. To develop strategies for sustainable leadership amongst government CNO’s


PLAN OF ACTION: CAPACITY BUILDING IN LEADERSHIP (TALENT MANAGEMENT)



objective

activity

target Date

indicator

expected results

  1. To equip nurses and midwives with the skills and expertise required to enhance their talents and lead PHC service delivery

Mapping of gaps in capacity of the Nurses and Midwives in PHC setting and identify key areas for intervention


Establishment a global/regional leadership/management self support group using problem solving techniques

Development of strategy for required skillset for the effective implementation of PHC.

Dec 2008


On-going



A programme of priorities for intervention


Strategies for the effective delivery of PHC identified

Competent effective leaders in nursing and midwifery contributing to quality health care delivery with particular emphasis on the PHC approach

  1. To develop strategies for sustainable leadership amongst government CNO’s

Establish a global network made up of representation from the regions


Identification of opportunities and mechanisms for leaders to access available training programmes.


Development and publication of key indicators for supporting the roles and functions of Government Chief Nursing and midwifery Officers (GCNMOs)

December 2008


Dec. 2009


Dec 2009 (Long Term and ongoing))

Dissemination of brochure to all Members States


Institution of formal meetings every two years with annual meetings carried out through virtual technology.


Integrated training activities into programme of meeting events.


No. of leaders and managers trained


Indicators for evaluating the roles and functions of GCNMOs compiled.



Increase participation of Government Chief nursing and midwifery officers in decision-making, policy formulation and program implementation




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