GAG Report 03-03-11 - World Health...

H U M A N RESOURCES FOR HEALTH

NURSING AND MIDWIFERY CAPACITY TO CONTRIBUTE TO HEALTH SYSTEM STRENGTHENING AND THE ACHIEVEMENT OF MDGS

13TH MEETING OF THE GLOBAL ADVISORY GROUP FOR NURSING AND MIDWIFERY DEVELOPMENT18–19 MARCH 2010GENEVA, SWITZERLAND

&N U R S I N G M I D W I F E R Y

World Health Organization

Department of Human Resources for Health

20 Avenue Appia

CH–1211 Geneva 27

Switzerland

www.who.int/hrh/nursing_midwifery/en/



WHO/HRH/HPN/10.8

This publication was produced by the Department of Human Resources for Health, World Health Organization.

This publication is available on the Internet at: http://www.who.int/hrh/nursing_midwifery/en/

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© World Health Organization 2011

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Edited by: Elizabeth Girardet, Freelance Editor, Geneva, Switzerland.

Design and layout: L’IV Com Sàrl, Morges, Switzerland.

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N U R S I N G A N D M I DW I F E R Y C A PA C I T Y TO C O N T R I B U T E TO H E A LT H S Y S T E M S T R E N GT H E N I N G A N D T H E A C H I E V E M E N T O F M D G S1 3 T H M E E T I N G O F T H E G LO B A L A DV I S O R Y G R O U P F O R N U R S I N G A N D M I DW I F E R Y D E V E LO P M E N T ( G A G N M ) — M E E T I N G R E P O R TW H O H E A D Q U A R T E R S, G E N E VA , S W I T Z E R L A N D, 1 8 – 1 9 M A R C H 2 0 1 0

ACKNOWLEDGEMENTS 3

1. INTRODUCTION 41.1 Overall objective 41.2 Specific objectives 41.3 Expected outcomes 51.4 Agenda 5

2. MEETING DELIBERATIONS (GLOBAL UPDATES) 62.1 Introduction to meeting objectives and agenda 62.2 WHO initiatives on Health system strengthening(HSS), PHC and MDGs 6

Summary of discussion 7 Recommendations 8

2.3 Human resources for health (HRH) Strategic Directions and implications for healt professional networks nursing and midwifery (HPN) 8


2.4 Accelerated human resources for health response to MDG5 9 Summary of discussion 11

Recommendations 122.5 Interprofessional Collaboration (IPC) 13


3. STRENGTHENING NURSING AND MIDWIFERY 153.1 The GAGNM questionnaire: Summary of findings 15


3.2 Strengthening nursing and midwifery: Progress Report 16 Summary of discussion 17

Recommendations 173.3 High level Group on PHC 17


3.4 Scaling-up nursing and transforming medical and nursing education 19 Summary of discussion 19

Recommendations 203.5 Scaling-up nursing and midwifery education 20


3.6 Optimizing GAGNM role in health policy change and HSS strengthening at all levels of WHO 21


4. REGIONAL UPDATES 234.1 WHO Regional Office for Africa (AFRO) 234.2 WHO Regional Office for the Eastern Mediterranean (EMRO) 24

TABLE OF CONTENTS

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4.3 WHO Regional Office for Europe (EURO) 264.4 WHO Regional Office for South-East Asia (SEARO) 264.5 WHO Regional Office for the Western Pacific (WPRO) 28


4.6 Quality improvement and faculty development in nursing and midwifery education 31


5. WHO PRIORITY PROGRAMMES UPDATES 325.1 Role of nurses and midwives in emergencies 32


5.2 Occupational health nursing: Opportunities and challenges 33 Summary of discussion 34

Recommendations 355.3 Mental health 35


6. GAGNM RECOMMENDATIONS TO THE DIRECTOR-GENERAL 376.1 Review of draft recommendations 376.2 Final briefing note and recommendations to the DG, 19 March 2010 376.3 Feedback from GAGNM meeting between GAGNM and the Director General 38

ANNEXES 391. List of participants 392. Agenda 413. GANM questionnaire 42

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The Department of Human Resources for Health of the World Health Organization gratefully acknowledges the input of the participants and observers who attended the 13th Meeting of the Global Advisory Group for Nursing and Midwifery Development (GAGNM) in Geneva from 18 to 19 March 2010. Special thanks go to the GAGNM Chairperson, Dr Rowaida Al Maaitah, and the Vice-Chairperson, Dr Lu Shek Eric Chan.

The 13th meeting was organized by a team of the Health Professionals Network: Nursing and Midwifery, Department of Human Resources for Health, World Health Organization, Geneva, Switzerland. The report was prepared by Ms Mwansa Nkowane.

ACKNOWLEDGEMENTS

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The GAGNM has continued to support nursing and midwifery strengthening through the provision of strategic and policy advice for improved health at the global and regional levels. The guidance GAGNM provides helps WHO, Member States and development partners maximize the impact of their investments for the delivery of quality health services across the continuum of population health. The WHO Programme of Work and Strategic Human Resources for Health (HRH) plan served as the basis for the discussions, deliberations and recommendations of the GAGNM of this 13th GAGNM meeting.

1.1 Overall objective

The main objective of the GAGNM meeting this year was to provide sound policy and technical guidance in the key areas of interprofessional collaboration, accelerated human resources for health (HRH) response to maternal newborn health (MDG5), scaling-up nursing education, as well as strengthening nursing and midwifery based on the WHA Resolution 59.27.

1.2 Specific objectives

The specific objectives of the meeting were to:1. Review available evidence, background documents, updates and identify

critical issues in the following areas; interprofessional collaboration, Millennium Development Goals 5 (MDG5), scaling -up nursing education and strengthening nursing and midwifery;

2. Deliberate, discuss the critical issues and propose strategies, mechanisms or plan of action for strengthening nursing and midwifery capacity to address them;

3. Discuss the Strategic Directions for Nursing and Midwifery 2009-2015;4. Agree on indicators for evaluating GANM’s work performance; and5. Prepare and present a set of recommendations on strengthening nursing

and midwifery capacity to contribute to health system strengthening and achievement of MDGs for support by the WHO Director General.

1. INTRODUCTION

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1.3 Expected outcomes

The expected outcomes included:1. Strategies and plan of action for ensuring adequate number of competent

nursing and midwifery workforce to provide quality health services across the continuum of population health needs (within the context of health system strengthening and Primary Health care (PHC)); and

2. Recommendations to the WHO Director General for strengthening nursing and midwifery capacity to contribute to health system strengthening and achievement of MDGs.

1.4 The agenda

The overall agenda consisted of discussions on accelerated human resources for health (HRH) response to MDG5, High Level Group (HLG) on PHC, scaling-up nursing and midwifery education and strengthening nursing and midwifery education. Three priority WHO programmes also shared the collaborative activities, namely, Strategy, Policy and Technical Development (Health Action in Crises), Interventions for Healthy Environments and Mental Health and Substance. These programmes highlighted current and potential collaborative activities on nursing and midwifery development. The agenda and list of participants are in the annex of this report.

The report presents summaries of the presentations and discussions during this meeting.

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2. MEETING DELIBERATIONS

2.1 WELCOME AND INTRODUCTION TO MEETING OBJECTIVES AND AGENDA: ROWAIDA AL MAAITAH

The Chair Person of GAGNM, Rowaida Al Maaitah, welcomed the participants to the meeting and invited Dr Carissa Etienne, Assistant Director General (ADG), Health Systems and Services (HSS) to address the meeting.

2.2 WHO INITIATIVES ON HEALTH SYSTEM STRENGTHENING, PHC AND MDGS:CARISSA ETIENNE

Dr Etienne welcomed participants and reiterated the importance of group to the Director General (DG) of the World Health Organization. In this presentation issues related to progress towards MDGs, PHC renewal, integrated support to providing support to countries were outlined. Current evidence shows that countries are having mixed levels of achievements of MDGs, especially MDG5 and even MDG6. Africa appears to be lagging behind. It was further emphasized that inequities exist among regions and within countries, for example, life expectances among the vulnerable. Therefore, health system strengthening is important in meeting MDGs. Health system strengthening underpins human society. Globally, people value good long health and access to good quality care. Health system strengthening requires various inputs as shown pictorially in the box below. It is important to note that people are central to all this.

Box 1:The systematic approach

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It was reiterated that not much is understood about health system strengthening and thus research on issues such as health system policy is critical. Information is critical to understand what is required and needs to be done. The nursing profession ought to be represented in each of the building blocks. Nurses should have a greater role in governance as well as technology. In the World Health Report of 2008, the focus was on PHC emphasizing values of Alma Ata and its principles with the 4 reforms:

• People centred care;• Public policies for public health;• Inclusive leadership; and• Universal access to services.

At the centre of all this is participation. The challenge is how to reach people centred care, care build on peoples expectations, care that is integrated. Donors usually build on a particular disease or a problem. Given these facts, how can services at primary health care level be integrated to ensure comprehensive care. In all this the role of nurses and midwives should be clarified. People centred care requires looking at individual not just one diseases or compartments.

Dr Etienne highlighted the roles of nurses and midwives as:• providing quality accessible care; integrating community health services; • training for care providers; • strengthening interprofessional collaboration- (a nurse must belong to an

interprofessional team);• leadership by calling for removal of fragmented services;• conducting community assessments; and• helping community identify problems and seek solution.

Nurses should deliver according to expectations and ensure efficiency and health outcomes. Having nurses of different entry levels and multiple exists able to touch the community’s need, can contribute significantly towards the attainment of MDGs. The upward trends for promotion and other conditions of services should also be considered concurrently. Consideration should be made to continue beyond 2015. WHO in collaboration with Unites States President’s Emergency Plan for AIDS Relief (PEPFAR) is working on MDG 5 to ensure training of professionals. Furthermore, WHO is developing guidelines on recruitment and retention as well as a code to guide ethical behaviour. Much more effort is being spent working with regions and other UN agencies, the Global Fund and the Global Alliance for Vaccines and Immunizations (GAVI) to ensure systems are in place for achievement of MDGs.

Countries require support in developing and implementing human resources for health national plans based on evidence, policy dialogue, life cycle issues, investments etc. In all this, nurses must have a voice and become fully involved at all levels.

Summary of discussions

• There is concern that scaling up training may comprise may compromise standing of a nurse which should be preserved.

• Progress on MDGs will be slow until concrete things are done. There is need to invest in education that makes people stay in rural areas through models of training that maintain people in their own communities.

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• Sub-systems that make the health system work do interact and the perspective on people centeredness should be looked at as a whole.

Recommendations1. The roles of nurses and midwives in PHC should be clarified.2. Derive mechanisms to enhance the roles of nurses and midwives in health

system strengthening.

2.3 HUMAN RESOURCES FOR HEALTH (HRH) STRATEGIC DIRECTIONS AND IMPLICATIONS FOR HEALTH PROFESSIONAL NETWORKS NURSING AND MIDWIFERY (HPN): MANUEL DAYRIT

This presentation by Dr Manuel Dayrit, director, Department of Human Resources for Health (HRH)addressed progress made since 2006, implications for MDG5.

Progress since 2006

Critical to determining progress is that we need to address country level achievement. It has to be determined as to whether countries are aware of the human resources for health crises and whether they are developing plans to address this crisis. For example, 45 out of the 57 with human resources for health crises have plans but the question is how well planed are they? Most countries may not be investing to reverse the crisis even when plans have been developed. Evidence shows that only 6-10 countries are getting resources to implement their plans. Currently there are more countries reporting (from 10-15% to now 50-60%). Even Ministries of Health that have human resources for health units reporting is not quite high. Multiple data sources brings about problems of reliability. Nevertheless, awareness in countries is increasing especially on the international code of practice for recruitment and retention.

Implications for MDG5

The impact on achievement of MDG5 is very slow. It is hard to show how the initiative to improve national planning impacts on MDGs. What is key is getting things right through governance. Better governances is important to enhance the impact on MDGS. Governance could include: rules that distribute roles and responsibilities among government, providers and beneficiaries. Governance should aim to define interactions among these groups inclusive of the civil society. It is important to look at governance at various levels; global, national and sub national.

Implications of the two above on policy

GAGNM as a group that looks at policy issues related to nursing and midwifery should include; a recommendation to DG to improve governance to achieve MDG 5 taking into account the perspective of nurses and midwives including at country level.

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• Many countries are in the process of planning for human resources for health. However, these plans may not be implemented if there are no financial resources to support implementation. One of the dimension of planning should be costing of future plans with real figures. Scaling up means investing. It is important to support teams of providers.

• Nurses and midwives are key to achievement of MDGs. Delegation of roles is required with authority to make effective decision in delivery of services

• Agreement on issue of scaling-up is essential. WHO is only one player in the global arena. WHO provides strategic info. e.g. statistics, influence strategic investments working with other partners, funding innovative approaches to addressing mal distribution etc.

Recommendation

1. WHO should support Member States to improve governance to achieve MDG 5 taking into account the perspective of nurses and midwives including at country level.

2.4 ACCELERATED HUMAN RESOURCES FOR HEALTH RESPONSE TO MDG 5:

MONIR ISLAM

This presentation centred around the need for skilled birth attendants to reach the MDG5 targets. Dr Monir Islam, Director, Department of Making Pregnancy Safer, highlighted the challenges faced in this area which based on these statistics below:

The picture outlined above is a result of either lack of access to or unavailability of services. Furthermore, there is less emphasis on the newborn children. Although there is so much evidence and a lot of discussions, these do not translate into funding of activities to address MDG5. More advocacy is therefore necessary.

Achievement of MDG5 is lagging in Africa and Southeast Asia where maternal mortality is high. This scenario can be attributed to health system issues. Maternal mortality ratio is by far the highest in Sub-Saharan Africa, where 1 in 23 women face life time risk of dying, when compared to 1 in 2300 in Europe. Forty countries in Africa and Asia contribute to high maternal mortality rates including newborn deaths.

Box 2: Global Situation

• 180-210millionpregnancieseveryyear,• 75millionunwantedpregnancies,• 55millioninducedabortions,• 20millionunsafeabortions,• 20millionwomensufferfrommaternalmorbidity,• 600,000diefromcomplications,• 3millionnewbornsdiewithinthefirstweekoflifeand3millionbabiesareborndead.

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Skilled Birth Attendants (SBAs), at birth are key in addressing maternal and infant mortality rates. Most countries however do not have adequate SBAs. For example, access to SBA is only 6% in Ethiopia and 18% in Bangladesh.

Progress

Due to increased access to SBA and emergency care, countries such as Thailand and Malaysia, reserved the situation. There are intercountry differences in SBA coverage. Rwanda has increased SBA from 20-50% and introduced social service insurance and incentives for using services. The rich and urban people have much more services that could achieve MDGs than the poorest; yet deliveries are happening in rural areas where there is no access to services. The main causes of death are haemorrhage, sepsis, preeclampsia, obstructed labour, unsafe abortion. These are preventable causes.

Quality of care Even when the coverage of SBA is adequate the quality of care may not be that good. If quality of care could be improved in 40 countries a reduction of 120,000 maternal deaths and 500,000 of newborns could be achieved. There are several factors that constitute quality that are as demonstrated in the table below.

Box3:QualityFacilityChildbirths

Policy

Equipment

Transport

Managementandsupervision

Drugs

Supplies

Startingwithexistingfacilitieswithincreasingaccessandcoverage

Healthprofessionalswithmidwiferyskills(promotingutilisation,pregnancycare

andprovidingcarefornormaldeliveriesandObstetricFirst

Aid,newborncare)

HealthprofessionalswithskillstoprovideComprehensive

EssentialObsteticandNewbprnCare

HealthProfessionalswithskillstoprovideBasicEssential

Obstetricandnewborncare

Referral

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Challenges

There are many challenges some of which are presented below:• 95% of women in Namibia have access to SBA but this has not reduced

deaths;• Kenya still need 12, 000 midwives, yet they have 15,000 midwives but 60%

coverage due to maldistribution; • In Japan the number of deliveries is going down and thus closing down

because they do not have the competencies for complicated cases.• Lack of resources in training schools is evident in many countries. In

Zimbabwe there is only one midwifery book, no maniques etc. The school of midwifery has a faculty 3 members instead of 9.

In most countries, e.g. Bangladesh, if midwives conduct home deliveries, they would only deliver 50 per year. Yet, if the delivery is facility based, midwives can manage the delivery, refer complicated cases and receive supportive supervision. Therefore, the emphasis is on improving facilities, supply, increase demand of services, improve quality, health seeking behaviour supported by a good monitoring system.

Accelerating quality of SBA coverage for MDG 5

The key to accelerating quality of SBA are the following; skill development and enhancement, effective regulation, improvement of working conditions, management and retention, increasing production capacity and ensuring proper workforce distribution, management and retention policies. Having so many issues to address, WHO has prioritized what needs to be done first given the available resources. These are to :

• address regulations;• develop competences;• generate evidence for interventions and research; and• scale-up partnerships.

The WHO Department of Making Pregnancy Safer (MPS) has developed documents and guidelines to support its work. Specifically the programme is working in working in 40 countries to access quality. Such work requires strong partnerships.


• Some countries, such as the Solomon islands are still using Traditional Birth Attendants (TBAs). Their training was interventional but remains a key contributor to maternal and child health.

• The problems of access to health facilities is underdevelopment. Governments are not keen in investing in new facilities. However, encouraging governments to improve quality of existing facilities could make a difference.

• There are country experiences to draw lessons from. For example, an initiative for rural areas where the whole health team was trained together at PHC level as well as referral systems in both theoretical and clinical areas. The problem was transport and mobilization of the community members with resources e.g. cars to help to sustain community actions. In Colombia, the government had adopted PHC which was working very well. It helped to improve the health

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system. There is need to look at what went wrong. In India more nurses are delivering births at PHC level. There currently 25,000 PHC centres which means 75,000 more nurses and midwives are needed. For the first time nursing budget has been discussed at cabinet level and has been sanctioned. There are plans in India to infuse the concept of SBAs into pre-service education.

• In support of the 57 countries with critical human resources for health shortage, there is need to encourage and support the improvement of quality of the existing services in a comprehensive way within the means of what is there now.

• Improving monitoring system is important. There is need to determine what is available and how to improve what is available. In Bangladesh the community is doing quality control e.g. if the doctor does not come to the centre the community calls the Ministry of Health.

• Issues pertaining to maternal and child health should not only focus on antenatal care but should be inclusive of pre and post natal aspects.

Recommendations

• Governments should retrain current health personnel at each of the levels. They should be trained together and guidelines developed on how they will refer patients from each other.

• Develop continuous monitoring systems including volunteers from the communities.

• Nurses and midwives should be empowered to provide better services based on a systematic framework.

• Removing regulatory bottle-necks, for example, allowing midwives to give oxytocin, will be of no extra cost to the government but will move nursing and midwifery into the future.

Box4:MilesStonesonIPC

FrameworkforAction(2010)2007WHOStudyGrouplaunched

76globalprofessionalorganizationsidentified2008MappingofHealthProfessionalOrganizations

50healthprofessionalorganizationsagreedontheneedforcollectiveaction2009GlobalConsultation

Platformtofacilitateexchangeofexperiencesandviews2009HealthProfessionalsGlobalNetworklaunched

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2.5 INTERPROFESSIONAL COLLABORATION(IPC) CHRISTIAN WISKOW

This presentation was based on the work that has been done over the past one year by WHO. This is outlined in the box:

In the context of human resources for health crisis, IPC can have an impact as it allows collaborative education and can produce readily collaborative human resources for health for better outcomes.

In addition to the milestones shown above, a moderated discussion hosted by WHO and partners of IBP Knowledge Gateway Consortium took place over a period of two weeks with more than 1,000 individuals. Half of the contributions came from developing countries participating in the discussions. Summaries from these discussions showed that IPC makes a difference in health workers’ daily work, in particular integrated health care and patient cantered care and that IPC has potential to enhance holistic care.

Enabling factors were viewed as having an understanding of roles and tasks of others, common goal; an open mind-set, willingness and commitment, mutual respect inclusiveness and involvement of all stake holders and supportive environment. However, challenges and barriers still exist such as lack of understanding of IPC, interdisciplinary, superiority and inferiority complexes, resistance to change, focus on specialization, competition, hierarchical system and lack of support.


• What is needed to be effective is well known but it is the how to get there which is a problem. Various organizational levels must e work together, provide the right remuneration, adapt to the environment, provide right information and capacity support.

• Obstacles to IPC should be identified such as issues of the role of professional organization and associations. Strengthening professional associations is a cultural shift but this must be done.

• Nurses in policy making should be at equal level with doctors. Nurses should adopt interdependence not dependence scenario. The key is to start with socialization of students so that they are prepared for the future. Brazil initiated a process at undergraduate level in which nurses and midwives worked together with full involvement of faculty. This led to a change of curriculum and remodelling of teaching experience.

• Care must be taken in introducing IPC. In rural areas, there are only nurses and no other professions. While in the Solomon Island there were only doctors and nurses. It is only now that training of social workers and others has been introduced due to the tsunami experience. IPC is a nice concept but there is uncertainty as to whether it will make a difference.

• Mali experience also WAWU (50 countries) three languages, Portuguese, French and English. IPC would be more difficult at university level especially because it is under Boards.

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• Other participants shared to the contrary that IPC were it has been successful is at university level. Post qualifying level success shows is those with clear professional identity. Therefore, there is need to bring nursing framework within the health education framework.

• The WHO Compendium of PHC case studies shows that IPC works. There are cultural differences in education, but all meet around the patient. It is better to start around education. A country like Ethiopia when have inter collaborative experience in the last year showed this has been effective with team work.

Recommendations

1. Propose an education course to pilot IPC; and2. Work with the 45 committed members of the group and members of the IPC

initiative who are committed to support the work.

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3. STRENGTHENING NURSING AND MIDWIFERY

3.1 THE GAGNM QUESTIONNAIRE: SUMMARY OF FINDINGS: NABIL M KRONFOL

A survey among members of GAGNM to determine the scope of their involvement was conducted through a simple questionnaire attached in the annex. This presentation summarized the findings from this survey. Overall, the establishment of GAGNM was viewed as a major development for the nursing profession which has so far made a significant contribution to put nursing in the forefront. The terms of reference (TORs) are still valid but may need to be reviewed in light of the current needs and changes that have occurred in the last decade. The achievements of the TORs need to be monitored by defining both quantitative and qualitative indicators to include the preparation of strategic plans for nursing and midwifery to help countries implement changes. Documentation of the role of GAGNM is very important. Such documentation should include:

• The role of GAGNM in strengthening nursing and midwifery globally in collaboration with WHO and partners; and

• nursing and midwifery work in partnership with stakeholders to strengthen health systems.

As part of an addition to the current TORs, it was further suggested that GAGNM should be able to respond to requests from the Director General of the WHO and should also be able to propose initiatives on its own.

“GAG is an opportunity for the further development of nursing and midwifery. It may become a liability if officials and reviewers conclude that its effectiveness is marginal or limited.

“GAG members ought to keep on responding to this question: “How can I further strengthen the nursing and midwifery professions and hence play a more effective role in health policy and health systems development”.


• GAGNM should believe that they are doing something otherwise the WHO Director General would have commented on it.

• The International Confederation of Midwives (ICM) would like to be recognized as a distinctive group and documents that are produced should reflect this. Thus development of documents and plans should be inclusive of ICM to maximize strengths.

• To question whether GAGNM should exist is not useful. Without GAGNM nurses and midwives will disappear. GAGNM is an opportunity that should not be questioned otherwise it could be made invalid.

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• Recommendations by GAGNM seem to be narrow as they are not directed to country activities.

Recommendations

The respondents to the questionnaire put forward these recommendations:

1. WHO to encourage and ensure active participation and stronger input of GAGNM members in the proceedings.

2. The GAGNM should be more assertive and play a more effective role to influence health policy.

3. Clarity on the objectives of the annual GAGNM is needed.4. Open discussions on GAGNM-related matters and on specific issues such as:

disparities of nursing and midwifery around the world, progress to achieve MDGs, communication.

5. Document obstacles faced and success stories on strengthening nursing and midwifery through GAGNM

6. Triple AAH 15 country meeting 5th year will be hosted by Indonesia. It is an opportunity to look at nurse density. GAGNM would be better to work closely with RNAs and document this.

7. Clarify GAGNM’s external and internal roles. GAGNM should be heard outside WHO. There needs to be some emphasis on whether GAGNM should act outside the group for example, the media and other national groups.

3.2 STRENGTHENING NURSING AND MIDWIFERY: PROGRESS REPORT: JEAN YAN

This report was largely around the WHA Resolution 59.27 Strengthening Nursing and Midwifery and GAGNM Recommendations, including the Global programme of Work (GPW) 2008-2009 on Scaling-up the capacity of nursing and midwifery towards achievement of the MDGs.

The GPW was implemented in 6 countries (Bhutan, China, Nicaragua, Serbia, Somalia and Zambia). Each of these countries implemented activities relevant to their own context, as summarized below:

• Bhutan: Development of a BSc nursing/midwifery programme;• China: Development of integrated community health nursing services;• Nicaragua: Competence development in PHC nursing/midwifery and

management; development of new leadership talents, taking issues of gender into account; provision of safe and high-quality work environments for the nursing and midwifery workforce;

• Serbia: Alignment of model of nurse and midwifery education with EU standards;

• Somalia: Establishment of a nurse/midwifery programme that will increase the number of nurses/midwives and scale up tutoring and quality assurance mechanisms;

• Zambia: Development of a national nursing and midwifery strategic plan for 2009 to 2013, and development and implementation of an operational plan.

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Other areas of work globally related to policy such as the UK Commission on the Future of Nursing and Midwifery and the work in Argentina on Nurse Emergency Act. Kenya, China, India the European Union focused on People-centred care. The Caribbean Community (CARICOM), Kenya and Accenture Partnership, the WHO and United States President’s Emergency Plan for AIDS Relief (PEPFAR) are working on Innovation in Nursing Education. This work entails looking at regulation, accreditation, quality of care, capacity for training, mapping out priorities, short and long-term options or solutions to problems and enhancing collaboration/partnerships. A Framework for Action on interprofessional education and collaborative practice has been developed.

In addition, WHO with its partners, worked on enhancing nursing and midwifery roles in disasters. There is a recognition that nurses and midwives play a pivotal role, multi-skilled, comprehensive primary health care providers, work with interdisciplinary team in coordinated effort, they are more accessible and work in close proximity with those in need and most trusted health provider by the community. Nurses have therefore been in the forefront in situation of emergencies and disasters e.g. in China and Haiti.

This area of work responds to the WHA resolution 59.22.” WHO to building local and national capacities including transfer of expertise, experience and technologies among Member States in the area of emergency preparedness and response”.


• GAGNM has been in existence for some time. What is required is to determine its impact on nursing and midwifery in WHO.

• The report shows what is being done in this area which could have even started before the recommendations. It does not relate to GAGNM.

• To be able to measure GAGNM impact it may take some years, however, the potential power of advise is great.

Recommendations

• Monitor how WHO used and (uses) the advise provided by GAGNM.• WHO to call on GAGNM in between meetings.

3.3 HIGH LEVEL GROUP ON PHC: GILL DUSSAULT/ JUDITH SHAMIAN AND ROWAIDA MAAITAH

This presentation was aimed at outlining the progress made since the formation of the High Level Group (HLG) on PHC group based on GAGNM recommendation to the DG in 2008. The presenters stressed that it was important to convince people on how to deliver on PHC, make better use of resources and that the nursing and midwifery workforce has the capabilities. It was also noted that there are obstacles to be overcome. However, suggestions should be brought forward on how to address these obstacles. The HLG was to determine what is known, what the contribution of nurses and midwives to PHC are and how to respond based on the findings. The review on contribution nursing and midwifery highlighted some of the reasons for insufficient contribution to PHC which are presented in the table below.

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Priority Areas

There were three priority areas which were identified:1. PHC Knowledge Management and Mobilization;2. System, Practitioner and Citizen Preparedness for PHC Change; and3. PHC Policy Commitment and Leadership.


• In AFRO there is the PHC Ouagadougou Declaration. What is lacking is the component of nursing and midwifery. There is need for a road map to guide implementation.

• There is no reference to any funding sources or partners. This has to be clarified. Furthermore, Political Will ought to be secured to effect change in training environments linked to PHC.

• PHC is something that all countries should work at including developed countries. However, the concern is how to follow up. It is not clear to whom the HLG recommendations are directed and the recommendations are too many. It is better to consider a few at a time.

• The problem is the experts who talk about primary care and tie funding to that and is not relevant to PHC.

• The focus should be on PHC rather than primary care. The issue of education in most countries is not under control of health. Universities are not interested in social needs. Work has to be done on reorientation of universities.

• A top down document without securing nurses and midwives inputs starts with obstacles. Many countries are already faced with obstacles. To entice Ministries of Health there is need to start in a positive way, on what could be done better in PHC.

• If the idea of HLG was supported by the WHO Director General, there should be some recommendations on what has been started.

Box5:Reasonsforinsufficientcontribution

• Lackofuniversalaccesstonursingandmidwiferyservices• Nursesandmidwivesnotworkingtofullscopeofpractice• Insufficientprofessionalproductioncapacity• Lackofknowledge,insufficientskills/education• Lackofinterprofessionalcollaborativemodels• Inadequategeographicaldistributionoftrainedhealthworkers• UnstablelabourmarketretentionwithincountryandPHCsetting,includes

compensationandlivingconditions• Lackofaccesstobasicresources(e.g.,technology,medicines)• FundingnotinplacetosupportPHCrenewalandnursingandmidwiferyservices• Biomedicalmodel&unbalancedpowerstructurebetweenmedicine,nursingand

midwifery,andcommunities• LimitedpolicyemphasisonnursingandmidwiferyforPHC

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Recommendations

• A consultative process is required. The work should not be a result of three people as this could later be used central to work of WHO and not only people who champion nurse and midwives.

• Prioritize the issues and seek funding from relevant partners. • The roles of Regional Advisors for Nursing and Midwifery) and countries

should be specified.• Take advantage of opportunities to have head’s of States bring this to the

attention of the G8 Summit.• Explore possibilities of developing policy briefs from evidence.

3.4 SCALING-UP NURSING AND TRANSFORMING MEDICAL AND NURSING EDUCATION: FRANCESCA CELLETTI

This work is being supported by PEPFAR. The justification for embarking on this work is well known. The facts are that 4.3 million additional health workers are needed globally, 800, 000 additional doctors and nurses and that 140 % increase in health workforce is required in sub-saharan Africa. Above all this, production is a large contributor to global human resources for health crisis. The scope of the WHO/PEPFAR collaboration is as follows:

2010- 2011: Rapid assessment and implementation of innovative intervention in nursing and medical schools in selected countries

2010-2011: Development of policy and technical guidance on transforming

and scaling up medical and nursing education 2011- 2013 and beyond: Implementation of the guidance in selected countries

and early evaluation

The above activities overlap. For example, evidence gathering which will feed into policy and technical guidelines, followed by a five year implementation plan. There is also a rapid assessment for rapid implementation of solutions to increase production of nurses in Lesotho, Mali and Zambia. A broad range of partners such as research institutions, civil societies and educational institutions are involved in this initiative. These partnerships will evolve and expand.


1. The project is drawing on selected partners, but these partner groups which include medical education, nursing education, regulatory bodies and civil society can be expanded.

2. The work will be based on evidence thus there are reference groups. Partnerships we can work with WHOCCs.

3. The WAWO, the Economic Community of West African states (ECOWAS) developed a statement inclusive of Anglophone - although these countries have had less problems on education. Francophone countries have problems with levels of nursing and education and qualifications. The region is now

20


working on harmonizing nursing and midwifery standards with Anglophone countries. A resolution has been proposed some key messages include importance of harmonization of curriculum and delegation.

4. PEPFAR is focusing on Anglophone first because the initial assessments have been conducted in these countries. However, expansion to other non-Anglophone countries is planned.

5. Faculty development is the most important barrier to quality education. Somalia, South Sudan and Afghanistan should be considered in the WHO/PEPFAR initiative as well.

6. Critical in this project is defining the attributes for better contribution to health outcomes. The starting point is with nursing, midwifery and medical education. Faculty development is part of the package. However, the package will be extended to include retention of faculty.

7. WHO does not have implanting capacity but looks at difference resources in the global community. WHO carried out a study on positive synergy group which started interactions between global health initiatives. The responsibility of WHO is to maximize investment e.g. all resources going into in-service education and not so much on pre-service, which is long term.

Recommendation

1. Design global guidelines based on rapid assessments in different cultural environments on strengthening nursing, midwifery and medical education.

3.5 SCALING UP NURSING AND MIDWIFERY EDUCATION: CHEHEREZADE GHAZI

This presentation was on transformative scaling up of medical and nursing education. Key to this approach is to have a larger, more sustainable workforce with greater capacity to serve the health needs and strengthening of technical partnerships between countries and stake holders. The presenter emphasized that documentation of work and policy and technical guidance is critical. The approach has to be comprehensive responding to the shortage of health workers, training and retention. The overall framework embraces documentation work and policy and technical guidance which entail:

• Development of services to meet the overall health needs,• Creation of supportive policy environment; and• Scaling-up transformative medical and nursing education through

strengthening of overall institutional capacity.


• There is consensus that quality nursing services are imperative. Entry requirements into nursing and midwifery should be of high standing.

• There is no clarification and emphasis on the role of nurses. There are nurses in the workforce but also new entrants. Emphasis should be on both.

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• Education is a shared responsibility between the Ministry of Education and Ministry of Health. A comprehensive approach is necessary, embracing issues pertaining to quality, financial support, retention, partnerships and appropriate policies.

• WHO Country Representatives should be able to have the mandate to bring institutions together within the country to discuss issues pertaining to HRH.

• The idea of bringing nurses and medical students together is based on studies that show that graduate nurses make fundamental contributions to quality care.

• Information exist in the area of scaling-up faculty in AFRO. What is required is building a consortium to strengthen their contribution.

• Professionalization of nursing and midwifery must be maintained to avoid dilution of the profession.

• There are many insistences when nurses teach medical students. This only happens when the nurse commands respect in that profession.

• China produces 500,000 nurses a year, but only half will get employed because of the saturation. This results in the employer giving less value to those employed. Most of the time, there is a deployment problem.

• Figures from countries of the European Union are not current. On unemployment there is a need to discuss how much scaling-up is required to address issues such as medical tourism. In some countries nurses as high as 40% are not working in health care. This is the issue that needs to be discussed.

• Recommendations should look at contextual issues which even include cost of services and quality.

• Working conditions in the private sector are not necessarily that good. Regulation for private sector to ensure nurses are being paid properly should be developed.

Recommendations

1. Globally there are different problems. In light of PHC orientations, there is need to develop guidelines on changing curriculum. The PHC approach has not been worked out effectively. There are changes in technology e.g. e-learning which ought to be taken into account.

2. In Denmark there is still no nursing education in universities. WHO should come up with a statement on scope of nursing education.

3. GAGNM should address standards of nurse/physician ratios.

3.6 OPTIMIZING GAGNM ROLE IN HEALTH POLICY CHANGE AND HSS

STRENGTHENING AT ALL LEVELS OF WHO: NABIL M KRONFOL

This paper was briefly summarized and discussed. The draft paper on optimizing GAGNM’s role in health policy change and health system strengthening was presented and briefly discussed. The draft drew on work done by WHO and its partners on nursing and midwifery over the past few years. The paper outlined the analysis on the following areas of work:

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1. The role of nursing and midwifery in PHC renewal;2. Policy issues outlined in each of the WHO regions;3. WHO/PEPFAR collaboration in scaling-up health workforce development;4. Framework for international Action and Health system strengthening;5. GAGNM commissioned paper on nursing and midwifery;6. Terms of Reference for HLG; and7. Framework for Action on IPC


• There are so many fragments of work being done. The challenge is to link all this to the overall agenda of WHA resolutions, strategic directions on strengthening nursing and midwifery (SDNM) and the Global Programme of Work. They should not be presented as separate issues.

• It was felt that the paper should be appended to HLG as part of the road map. There were many comments and suggestions on this. The paper can facilitate the work and future directions. It is simply a guide to the discussions on the role of GAGNM.

Recommendations

1. The need for a model on how to get a synthesis on what GAGNM does in a short document and show linkages to WHO’s efforts on strengthening nursing and midwifery.

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4. WHO REGIONAL UPDATES

A joint regional summary report was presented by Kathy Fritsch on behalf of the regions on regional activities 2009-2010.

4.1 WHO Regional Office for Africa (AFRO)

AFRO continues to implement activities outlined in the WHO/AFRO guidelines for implementing the Strategic Directions for Nursing and Midwifery 2007-2017 and the Ouagadougou Declaration on Primary Health Care and Health Systems in Africa “Achieving better health for Africa in the New Millennium” 2008. Last year, 2009, a number of activities took place.

Activities and achievements

1. Orientation and capacity building meeting on use of tools and guidelines to scale up health, nursing and midwifery service delivery in the context of PHC renewal, 20-24 April 2009. One hundred (100) participants from 21 Anglophone countries were represented by Chief Nursing and Midwifery Officers from governments, representatives of nursing and midwifery Regulatory Bodies, Presidents of Nurses Associations as well as relevant WHO priority programmes.

The major outcome of this meeting was draft country specific strategic plans on nursing and midwifery.

2. Several activities on strengthening nursing and midwifery education were carried out.• Curriculum evaluations for pre-service nursing and midwifery education

programmes have been undertaken in Benin, Burkina Faso, Cap Verde, Gambia, Mali, Niger, Sierra Leone and Zambia.

Challenges identified include; curricula are not competence based, unclear distinctions between nursing and midwifery especially in francophone countries, shortage of teachers inadequate training, teaching materials and infrastructure

• A partner consultation on strengthening pre-service education in West Africa was held in November 2009. Participating in this meeting were UNFPA, World Bank, ICN, ICM, Federation of European Nurse Educators (FINE), Regional and national professional associations, WHO priority programmes (HIV/AIDS, MPS and IMCI) educators and directors of training from 7 countries (Benin, Burkina Faso, Gambia, Mali, Niger, Nigeria & Senegal).

Outcomes– specific action plans to address the identified challenges were developed in collaboration with partners. All countries have requested WHO and other partners to support faculty development in their respective countries.

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AFRO has developed a project proposal to mobilize resources to support faculty development in six West African countries (Benin, Burkina Faso, Gambia, Mali, Niger and Senegal). The proposal has been shared with potential funders.

3. Curriculum updates have been supported in Sierra Leone and Zambia. Support has also been provided to Sierra Leone to develop competencies for the different categories of nursing and midwifery education programmes. All curricula have been reviewed and updated with new competencies. Activities are under way to review and strengthen regulation which supports the educational changes. In Zambia, a post-basic nursing curriculum was reviewed with the support of WHO. Based on the recommendations made during the review process, the country has initiated a Bachelor of Science generic nursing programme as an entry into practice.

4. Strengthening legislation and regulatory processes is critical in many countries in light of the new initiatives including task shifting and weak regulatory systems that already exist in some countries especially Francophone and Portuguese speaking countries. AFRO in collaboration with other partners such as, ICN, ICM, UNFPA, JICA, representatives of Regulatory Bodies, educators, professional associations and Ministries of Health have drafted a Professional Regulatory Framework which will be used as a prototype to guide the needed changes at country level.

5. Activities related to the establishment of WHOCC at the University of Malawi, Kamuzu College of Nursing have began. Terms of reference and plan of action have been developed and the completed designation Form has been submitted to AFRO as part of the process towards designation.

4.2 WHO Regional Office for the Eastern Mediterranean(EMRO)

Challenges in the region include:• Disparities between supply and demand of health workers;• Increasing demand for reform of existing pre-service nursing and midwifery,

and allied health education, and for development of new educational programmes and educational capacity building in post-conflict countries;

• Accreditation of nursing and allied health education programmes;• Shortage of qualified nursing and allied health educators; and• Enhancing capacity for nursing directors and their staff for effective policy

making and planning, management and implementation of programmes. Activities and achievements

Several activities have been carried out in the area of strengthening education and infrastructure for nursing, midwifery and allied health workers:

1. Activities on orienting basic nursing and midwifery curricula towards PHC involved collaboration with countries on training of teachers and practitioners through fellowships and national training activities. Upgrading teaching and learning materials and furnishing of educational facilities were supported. It also included twinning between institutions and the WHOCCs for nursing

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and midwifery development. Several nurses, midwives and allied health professionals were awarded long and short-term fellowships for studies within and outside the region.

2. Sudan was supported with the development of nursing and allied health resources as well as strengthening the existing nursing and midwifery and allied health educators. The Rumbek Institute of Health Sciences is under construction and will cater for the education of nurses, midwives and allied health professionals.

3. In collaboration with key partners including WHOCCs, WHO assisted in the completion of the post-basic nurse midwifery curriculum and programme in the schools of nursing and the institutes of Health Sciences in Mogadishu, Hargeisa and Bossaso. Similar support was provided in Afghanistan. In addition, activities to improve pre-service nursing, midwifery and allied health education were supported in Djibouti, Iraq, and Sudan. Twinning of a newly established university level education in Tunisia with a nursing faculty in Lebanon has been achieved.

4. With the support of ICN, a fourth leadership management training programme took place in Saudi Arabia, Yemen and the United Arab Emirates. A similar programme has been established in Bahrain. In Jordan, this programme is also supported under the patronage of Her Royal Highness Princess Muna Al Hussein, the WHO Patron for Nursing and Midwifery in the Region.

5. Development of job descriptions of nurses and midwives has been achieved in Yemen, while in Syria a community and PHC nursing services and education programme is under development for the north eastern region of the country with the lowest health indicators.

6. Mapping of all institutions preparing nurses , midwives and lady health visitors has been initiated in Pakistan.

7. The regional nursing and midwifery strategic plan for UNRWA was developed. Furthermore, support was provided to Syria, Sudan and the United Arab Emirates on the establishment of National Nursing and Midwifery Councils to regulate the nursing and midwifery practice and education.

8. A regional meeting on infection control of upper respiratory diseases as well as injection safety was held in July, Beirut Lebanon for nursing and midwifery.

9. Evaluation Meeting on pandemic/epidemic prone cute respiratory diseases, Bangkok, Thailand, 2009, safe Injection Network meeting, Geneva, 2009 and the Gulf Cooperation Countries Technical Nursing Symposium on nursing and midwifery education and human resources.

Future activities will include review and updating of the current strategy for nursing and midwifery, implementing the revised WHO nursing and Midwifery Strategic Directions and Islamabad Declaration and strengthen partnerships and collaboration with WHOCCs.

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4.3 WHO Regional Office for Europe (EURO)


1. Two resolution (EUR/RC57/R1 (2007) and EURO/RC59/R4 (2009). These resolutions reflect regional specificities and provide directions and strategies for action, to both Member States and Regional Office for Europe. The Tallin Charter calls for investment in human resources for health, as a critical component of strengthening health systems.

2. Monitoring and evaluation of the 2000 Munich Declaration “Nurses and Midwives: A Force for Health” was carried out.

3. A report, Nurses and Midwives: A Force for Health Survey on the situation of Nursing and Midwifery in the member States was produced. The report highlights the developments in nursing and midwifery. The results and recommendations were presented to the EU Government Chief Nursing Officers. Another presentation will take place in April during the annual European Forum for Nurses and Midwives Association (EFNNMA) , Sofia, Bulgaria.

4. A draft publication 10 Years after Munich Declaration- Strategic directions for moving forward Nursing and Midwifery in the European Region has been prepared.

5. Serbia in the European Region is one of the participants in the Global Programme of Work, focusing on strengthening nursing and midwifery capacity.

6. Two biennial Collaborative Agreements on nursing and midwifery have been reached with Uzbekistan, Serbia and WHO.

7. As contribution to PHC, a Working Group on Family Health Nursing was established in order to develop a project and link it to the Universities in Europe. The group is chaired by the University of West of Scotland.

8. Since 2008, each EU presidency country organizes a Chief Medical Officers Meeting since 2008. A similar Government Chief Nursing Officers’ meeting has taken place. The last meeting took place in Spain, February 2010. The Meeting deliberations included the advanced nursing roles. The next meeting will take place in Belgium in autumn 2010, Hungary 2011.

4.4 WHO Regional Office for South-East Asia (SEARO)


1. A second meeting of South-East Asia Nursing and Midwifery Educational Institutes Network was held in April 2009 in Myanmar. Forty seven participants from twenty four educational institutions, international organizations and WHO participated in the meeting. Deliberations focused on the health related MDGs, nurses’ and midwives’ contribution to PHC, public health nursing

27


programme and improvement of the quality of education through quality assurance. During the same meeting guidelines on nursing and midwifery workforce planning were reviewed and adopted.

2. The first batch of students of the three year Diploma in nursing and midwifery programme in 3 piloting schools in the DRP Korea with WHO support have completed the programme. Programme evaluation is in process.

3. Bhutan has developed the curriculum for the first Bachelor of Science in Nursing and Midwifery. Implementation will begin in 2011.

4. A three year Diploma programme in nursing and midwifery at the National University in Timor Leste was launched in 2009, while a 2 year Diploma programme at the Institute of Health Sciences is ongoing. Mobilized funds ensured the procurement of educational materials including textbooks, models and midwifery mannequins for 11 nursing and midwifery schools.

5. In collaboration with the making Pregnancy Safer Unit, a Regional Meeting on Bi-regional Consultation on the application of socio-cultural approaches to accelerate the achievement of MDGs 4 and 5 was held in Tanah Lot, Bali, Indonesia in August 2009.

6. Support was provided to member countries on scaling up the number of skilled birth attendants by revising midwifery education curriculum, standards and training building capacity of midwifery teachers and procurement of educational equipments.

7. In Bangladesh a policy statement on utilization of nurses and midwives in support of MDG4 and 5 was developed and a proposal on strengthening midwifery services for accelerating the reduction of maternal and neonatal mortality and a position paper on strategy on reducing maternal and neonatal mortality: promoting skilled care for every birth.

8. In collaboration with WPRO support was provided to nurses and midwives to participate in the second Asia-Pacific Disaster Nursing Network meeting in Cairns, Australia in September 2009. Outcomes from this meeting include a website, development of core competencies, curriculum and research framework for emergency and disasters.

9. An evaluation meeting on WHO supported project on prevention and control of pandemic prone acute respiratory diseases in the community took place in Bangkok, towards end of 2009. Apart from the participating countries (Egypt, Bahrain, Jordan, Korea, Thailand and China), India, Indonesia, Nepal, the Philippines attended the meeting. Participating countries, reviewed activities and achievements made and mapped future activities.

10. A regional consultation on self-care in the context of PHC took place in January 2009 in Bangkok. Other meetings were the regional meeting on Health Reforms for the 21st Century (October 2009, Bangkok) and the regional meeting of Public Health in Medical schools(December 2009, Bangkok). They all emphasized the need for nurses and midwives to maximize their contribution at community level.

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11. Work on workforce database template and on the draft code of practice for international recruitment of health personnel was carried out collaboratively with the Human Resource for Health Unit.

4.5 WHO Regional Office for the Western Pacific (WPRO)


1. Several documents have been published. These include A Global WHO Nursing/Midwifery Case Study Synopsis, including cases from six WPRO Member States including, Disaster and Emergency Nursing Competencies and emergency and disaster nursing articles in referred journals.

2. As part of information and dissemination sharing of resources, courses, research and publications, the Yonsei University WHOCC has established a website containing materials and reports from 6 countries encompassing three regions of WHO on pandemic prone acute respiratory diseases in community settings. Furthermore, the Hong Kong Polytechnic University, another WHOCC has also established a bi-lingual website for over 70 nursing schools and universities throughout China. The Shandong University School of Nursing has established and sustained an Asia Pacific Emergency and Disaster Nursing network (APEDNN). Several other publications have been produced and disseminated.

3. The American Pacific Nurse Leaders Council (APNLC) has conducted country mapping of nursing and midwifery workforce, education and regulatory structures/functions and faculty development efforts with financial support from the Robert Wood Johnson PIN Grant. WHO provided technical support in collaboration with WHOCC.

4. In Cambodia, with support from expert midwives training and capacity building activities were conducted in provincial hospitals and nursing schools. A nurse scholar who worked at WHO/HQ worked across Making Pregnancy Safer and HRH/Nursing work areas as well as on the Workforce Projection Tool. The Tool has now been presented to the MOH for possible adaption into HRH planning.

5. Working groups and expert committees for community health nursing pilot site supported by tools, seed grant and technical support was launched in Beijing China in December, 2009.

6. WHO in collaboration with Hong Kong Polytechnic University, co-hosted a planning meeting with the Ministerial Officials of the Department of Medical Administration and Community Health Services and other key partners in August 2009. Proposals were developed and initial pilot sites have been identified.

7. Leadership for Change Programme (involving WHO, ICN, the China MOH and China Nursing Association) Phase 1 completed with 27 graduates, 10 of whom were trained as trainers. Six groups completed their team projects. In Vietnam, the programme was delivered under the leadership of the Ministry of Health in collaboration with WHO. Thirty participants, primarily nurse

29


teaching staff from colleges and universities across the country participated in the training. There are plans to scale-up the programme. An impact analysis questionnaire has been completed.

8. In the Philippines, there was a launch and dissemination of a National Call to Action for revitalizing PHC at Silliman University, Dumaguete City, August 2009. Furthermore, nursing core competencies are being re-assessed by a group of educational institutions in the context of revitalized PHC.

9. A follow up capacity building and training on emergency and disaster nursing took place in Cairns, Australia. Following the outbreak of H1N1 and the tsunami, over 50 nurses were trained in 2009 in these areas, among many other topics such as mental health, disasters and infection control.

10. A two day Leadership Summit held in January 2010 in collaboration with

the University of Hawaii and Sigma Theta Tau in Honolulu, addressed the application and evaluation of the Global Standards for the initial education of professional nurses and midwives, nursing entry into practice competencies within the context of PHC and strategies for faculty development.

Areas of Collaboration

Regional Advisors for Nursing and Midwifery identified key ares where they could collaborate as shown in the table below.

REG

ION

PAH

O

WP

RO

SEAR

O

EUR

O

EMR

O

AFR

O

KEY

RES

ULT

AR

EA

STR

ATEG

IC W

OR

K4 X X X X 1and2 Leadership

5 X X X X X 3 Preserviceeducation(quality)

6 X X X X X X 3 Facultydevelopment

4 X X X X 1 Strengtheningservicedeliverythroughcapacitybuildingdisasterpreparednessandresponse/infectioncontrolnursing

4 X (within

broaderhealthprofessionallegalscope)

X X X X 2 Regulation

5 X (Community

health nursing);NPs)

X (public/

community health)

X(advancedNursing)

X X (HIVtreatment,

prescribing)

4 StrengtheningandexpansionofscopeofnursingincludingMDG4-6inthecontextofPHC

3 X X X 1 Review/updatingStrategicDirectionsandrelevantregionalframework

5 X X X X X(CNO,WHOCCs

etc)

5 Buildingandsustainingnetworksandpartnership

3 X X X 1 Research

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• AFRO has included resource mobilization on its activities. In addition, AFRO has began working with two countries with national plans and has now there are 7 of them. Other areas of work relate to strengthening regulation systems.

• In EMRO one third of the countries are either in conflict or post conflict situations. The focus is on improving nursing education and establishing accreditation systems. The region is working on establishing a regulatory framework and also International Council of Nurses (ICN) on leadership development. For example, the leadership training programme in Syria was started with ICN. The emphasis now is to develop a core of trainers for leadership development. The region has actively been involved in resource mobilization which is critical especially for countries like Somalia whose government cannot pay incentives to teachers.

• EURO survey for nurses and midwives on the 2005 Munich Declaration. A report is available including recommendations.

• In WPRO there are strong and regional collaborations among partners: The region is using illuminate more as a cost serving measure.

• Collaboration among regions can be quite challenging due to unique contextual issues. Perhaps common issues such as research would be feasible. The GPW showed that there are different ways of working on different priorities. In EURO the work is mainly bilateral and not does not intercountry.

• AFRO benefits from collaboration in sharing of information as well as working on a faculty development project with EURO.

• The three potential inter-regional collaborative areas are; in pre-service education, strengthening nursing and expanding scope of nursing including MDG 4-6 in the PHC context and building and sustaining partnerships and net works.

• WPRO research carried out through partner institutions. Advocacy would be important, for example, drafting media release on GAGNM. However, a communiqué issued by GAGNM could end up with a political back fire.

• Zambia developed broader strategies by developing a national plan on nursing and midwifery which involved input from key partners. Funders seem to be interested because they have been part of the strategy development process.

Recommendations

• RNAs should work on a common proposal as this would attract funding.• One regional adviser is not enough. There is a need to make use of junior

professional officers where possible. • Networks are valuable in identifying potential partners. It is also possible to

call upon GAGNM for support

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4.6 QUALITY IMPROVEMENT AND FACULTY DEVELOPMENT IN NURSING AND MIDWIFERY EDUCATION: KATHY FRITSCH

This work originates from an informal educational consultation convened in Honolulu, Hawaii, which proposed collaborative efforts of Sigma Theta Tau International (STTI), the WHO, the University of Hawaii School of Nursing, various partner institutions and WHO Nursing and Midwifery Collaborating Centres. The aim is to facilitate improvement in the quality of nursing and midwifery education through:

1. the application and evaluation of the global standards for professional nursing and midwifery education;

2. operationally testing nursing entry to practice competencies within the context of PHC; and

3. faculty development and capacity-building interventions.

The thrust of the Action plans from this meeting include:

• Development, validation, application and testing of evaluation criteria and processes for global academic quality standards;

• Operational testing and analysis and monitoring of nursing educational outcome/practice competencies, linked to primary health care; and

• Faculty capacity-building core courses and supportive mentoring developed and tested across a network of institutions.


• Canada investing in inter-professional collaboration. There are modules for faculty development, students are on line etc.

Recommendations

1. It is important to take into account other educational frameworks such as the Lisbon Frame Work on Education

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5. WHO PRIORITY PROGRAMMES

The presentations covered in this section were made by representatives of three priority programmes in WHO headquarters namely, Strategy, Policy and Technical Development (Health Action in Crisis), Interventions for Healthy Environments ( Health Security and Environments) and Mental Health: Evidence and Research( Mental Health and Substance Abuse).

5.1 ROLE OF NURSES AND MIDWIVES IN EMERGENCIES: CHEN REIS

The presenter emphasized the need to engage nursing and midwifery professions in emergencies. Most of the time there is disregard of frontline workers who can assist people in accessing various other services including sexual health. During emergencies nursing and midwifery roles encompass, being first responder, triage officer, providing direct care, on-site coordinator of care, information provider and educator and mental health counselor. In response to World Health Assembly (WHA) resolutions in 2005 and 2006 on building national and local capacity in emergency preparedness and response the Cluster on Health Action in Crisis (HAC) at global level has moved towards ensuring more accountability. A cluster approach to work was adopted. A Global Health Cluster lead by WHO has been formed. The Group includes, WHO and partners such as the Inter Agency Standing Committee (IASC). Its mission states to:

Provide health leadership in emergency and crisis preparedness, response and recovery; prevent and reduce emergency-related morbidity and mortality; ensure evidence-based actions, gap filling and sound coordination; and enhance accountability, predictability and effectiveness of humanitarian health actions.

To facilitate the work of this group guidelines have been developed. Other collaborative work on nursing and midwifery have involved working with WHO, WPRO and Asia Pacific Emergency and Disaster Nursing Network and Health Emergency Partners on capacity building meeting (Jinan, China 2008), followed by the 2009 meeting (Cairns, Australia). More recently during the Haiti earthquake. This involved participation in technical working groups at WHO headquarters, sharing information from networks and regional colleagues with HAC. Nursing networks have participated in the review and provision of input into WHO, United Nations High Commissioner for Refugees (UNHCR) and United Nations Population Fund (UNFPA) clinical management of rape in humanitarian settings e-learning programme. For the future, there is a need to determine to work together not only in emergencies but also to increase engagement of nurses and midwives in emergencies.

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• The response to the Haiti earthquake revealed problems. There was a great need for nurses and midwives as it was not organized forming of a network on nurses who went to Haiti so they can be able to respond in the future would be helpful.

• In responding to situations like this, it is important to first activate local human resources for health. Local health workers are more accessible to the local population terms of language, culture etc

• In deploying human resources it is important to understand the needs and skills, to ensure right individuals are deployed. It is a lot easier for a doctor to leave to go and serve somewhere on short notice. Nurses find it difficult to negotiate with employers. For example, nurses in the United Kingdom who had the skills had left to go to Afghanistan and there were political issues to be taken care of.

• Based on the tsunami experience, it is better to have a plan. It is important to work with nursing mangers who should indicate their needs. Nurses coming from abroad, still require to show documentation to demonstrate that they are qualified. Often, most people are not trained in emergency situations.

• In emergency situation it is important to activate partnerships. For example having join groups and organizations such as the Red Cross who will ensure that human resources deployed are trained and undergo simulations so that they can respond to disasters in a much more coordinated manner.

• The most important part is the government who should involve nurses in planning. Canada was able to set up hospitals at beaches through their military. As a result of this, country planning with other partners is ongoing. This requires follow up over the years.

• Malawi has a good model for planning and responding to emergencies. The progamme is led by a nurse.

Recommendations

1. Regulatory framework provisions should be developed for emergency response.

2. Develop competences for in-service and pre-services on engagement of nurses on planning and response.

3. Formalize work in emergencies and the document experiences.

5.2 OCCUPATIONAL HEALTH AND NURSING: OPPORTUNITIES AND

CHALLENGES: IVAN IVANOV (ON BEHALF OF SUSAN WILBURN)

As described in 1978, Declaration of Alma Ata Primary Health care is “ the first level of contact of individuals, the family and community with the national health system bringing health care as close as possible to where people live and work, and constitutes the first element of a continuing health care process.” The work on occupational health and nursing is firmly built on Resolution WHA 60.26 from 2007 as well as the Workers’ Health: Global Plan of Action. The thrust of the activities is to bring occupational health care to those in biggest need and provide Occupational

34


Health Care for health-care workers. The basic occupational services include:• Prevention of occupational risks;• Early diagnosis and referral of occupational diseases;• Medical surveillance of workers and;• Workplace health promotion.

These activities are already taking place in China and they will be initiated in Thailand, and India soon. The focus is to care for those who care.

Through the GPW, 2008-2009 on strengthening nursing and midwifery capacity, WHO is supporting immunization of health care workers against hepatitis B. Studies on occupational risks to bloodborne pathogens show that there are 2 million exposures per year. In healthcare workers, 37% of hepatitis B, 39% of hepatitis C and 4.4% of HIV. Most of these risk exposures are due to needlestick injuries. Although only 1,000 health care workers deaths per year are a result of occupational HIV. All can and should be prevented. Despite 95% efficacy of HBV immunization over 80% of healthcare workers remain unimmunized in many parts of the world.

WHO aims to assist Member States to develop mechanisms for improved working conditions of nurses and midwives including National Occupational Health and Immunizations, disseminate specific information on Occupational Health and Safety, conduct the review of evidence on immunization of health workers and immunize health workers in particular nurses and midwives, against hepatitis B. In addition to the above occupational risks, there are many other occupational risks to address such as;

• Biological - Influenza, SARS, TB, HIV/AIDS, Hepatitis; • Chemical – drugs, disinfectants, latex;• Ergonomic – lifting, transfers;• Psycho-social – Stress, violence, staffing shortages, shift rotation; and• Physical Hazards – radiation, heat, noise.

Supporting materials and other information area available and can be found at this web site: http://www.who.int/occupational_health/topics/hcworkers/en/


• In trying to integrate occupational health in PHC, the focus is on workers in the work place. Nurses can help in screening for occupational risks.

• Efforts are being directed towards working with organizations to develop good policies as well as mobilizing private sector to employ nurses. However the challenge is that there is a crisis on human resources for health.

• There is a major clinical dimension in places where there are more elderly patients whose care is mostly in the home. Nurses working in the home could experience occupational hazards. Occupational health is much more important in an aging population

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Recommendation

1. Need to develop competencies on occupational health in the context of PHC.2. Document contribution of nurses in the context of PHC.

5.3 MENTAL HEALTH:

DUA TARUN

Mental health is often neglected. In spite of the fact that MDGs cannot be achieved without mental health. Mental health is a key aspect of the WHO constitution. The collaborative on work mental health and nursing has resulted in a joint product: WHO and International Council of Nurses ATLAS in Nursing. The facts comprised in this ATLAS was derived from data collected from 177 countries. The ATLAS is the most comprehensive source of information on mental health nursing resources. Another collaborative activity is on literature review on involvement of nurses and midwives in brief interventions on alcohol and other psychoactive substances. This work is a response to the many challenges as shown below:

• High burden: 14% of the Global Burden of Disease (GBD) measured in Disability Adjusted Life Years (DALYs) attributable to mental, neurological and substance use disorders.

• Large treatment gap: 76.3% to 85.4% in developing countries for serious mental disorders including epilepsy.

• Resources are scarce: inequitably distributed and inefficiently utilized.• Substance use: In 2004 an estimated 2.5 million people died worldwide of

alcohol-related causes which accounted for 3.8% of global mortality in all age groups (6.1% in men, 1.1% in women, 320 000 young people between 15 and 29 years old). 4.6% of all DALYs lost worldwide are due to harmful use of alcohol (7.1% in men, 1.4% in women).

To address these issues a programme: mental health Gap (mhGAP) Action Programme Scaling up care for mental, neurological and substance use disorders has been developed. Priority conditions to be addressed have been identified. They include: depression, schizophrenia, suicide prevention, epilepsy, dementia, disorders due to use of alcohol, illicit drug use and child mental disorders.

With regard to substance and alcohol use, activities evolve around increasing capacity of health and social welfare systems to deliver of the following;

• prevention, treatment and care for alcohol-use and alcohol-induced disorders and co-morbid conditions,

• supporting initiatives for screening and brief interventions for hazardous and harmful drinking at primary health care and other settings as well as improving capacity for prevention of, identification of, and interventions for individuals and families living with fetal alcohol syndrome and a spectrum of associated disorders.

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As part of the recommendations from the ATLAS, nurses are recognized as essential human resources for mental health care. Therefore, there is a need to ensure that adequate numbers of trained nurses are available to provide mental health care and to incorporate a mental health component into basic and post-basic nursing training. mhGAP is a framework for a global response and is geared towards context specific responses and entry points.


• Need a programme on preventing mental health problems in PHC settings.• Emphasis in mental health should not be specialists only, it should be inclusive

of nurses, social health workers, psychiatrist etc.

Recommendation

1. Develop an integrated approach to mental health services.

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6. RECOMMENDATIONS TO THE DG

6.1 Review of draft recommendations

The session began with review of recommendations by Viro J. Tangacharoensathien. The comments on recommendations are listed below:

• Second recommendation on making policy brief is too weak and does not appear to be a recommendation. There requires to be a road map for the HLG.

• There was nothing in the recommendations on Regulatory Bodies. The recommendations are simply echoing what is already in the arena.

• There is need to emphasize strengthening of pre-service education.• The Director General may like to have an opinion on different indicators.

Several countries have plans but how are they implementing them. Last paragraph should be minimized and focus more on what GAGNM is doing rather than amplify what is happening in the regions.

• It is important to indicate that there is work taking place in the regions which needs to be supported.

• Clarity in needed on the role of nurses and midwives• Reference should not only be made to Africa and Asia. There are other

countries in the other regions such as, Western Pacific who are in similar situations.

• Recommendations should indicate the future not in the past. The role of GAGNM in the past has to be highlighted as it is important to send a message on what GAGNM will do to help WHO Director General move the agenda.

• Limit the preamble to the recommendations only to relevant issues. This is an opportunity to emphasize nursing and midwifery. Recommendations have to serve as a reference point for future meetings and be geared towards solving specific identified problems.

6.2 Final Briefing note and recommendations to the DG, 19 March 2010

GAGNM convenes its 13th meeting in Geneva on 18-19 March 2010.

GAGNM recognizes the importance of WHO regional nursing and midwifery programmes that support progress towards the achievement of health-related MDGs, particularly through:

• increasing the capacities and improving the quality of nurse and midwife education both at pre-service and post-qualification level;

• faculty development; and• supporting countries in maximizing/expanding the scope of practice of nurses

and midwives.

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GAGNM is committed to mobilizing the vital and potential role of nursing and midwifery to contribute to national health systems strengthening.

GAGNM stresses the importance of optimizing the deployment of human resources for health and of inter-professional collaboration, as a strategy to enhance the performance of national health systems.

Accordingly, GAGNM will produce an evidence based Policy Summary on “Nurses and Midwives contributions to Primary Health Care” based on the progress report of the High Level Group. The policy summary will include an Agenda for Action for supporting countries in designing and implementing their national health strategy and governance arrangements for system strengthening and redirection in line with the PHC agenda. The Summary will be developed in close consultation with WHO clusters engaged in PHC strategy development. It will serve as a tool for the DG and the organization to take the lead in mobilizing this critical health workforce to make PHC renewal a reality.

GAGNM recommends that:(1) Member States be supported in implementing and monitoring the

“Framework for action on inter-professional education and collaborative practices (WHO, 2010)”, and to develop guidelines and tool-kits which offer guidance on the governance of education and health systems.

(2) Resources be mobilized to support countries and WHO secretariat in scaling up nursing and midwifery education and practice to address national and regional health priorities.

6.3 Feedback from the meeting between the GAGNM and the WHO Director-General

The Director General agreed to all the recommendations, but pointed out the following:

• Country needs must be taken into account. The starting point is the countries for recommendations. Countries should be assisted to produce more health workers based on good plans. In scaling-up different approaches should considered, long term as well as long term especially in the production of health workers.

• There is need to support countries on training of trainers• Current situation is that resources are limited but there should be more

coordination. Once the mission and programme objectives are clear, resources will follow.

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ANNEX 1: LIST OF PARTICIPANTS

GAGNM members

Dr Rowaida Al-Maaitah (Chairperson), Senator, Jordan Nursing Council and the Upper Parliament of Jordan, Member of the Board of Trustees, Jordan Nursing Council, Amman, Jordan

Dr Lu Shek Eric Chan, Executive Manager for Nursing ( Vice Chairperson), Hospital Authority in Hong Kong, Room 518N, Hospital Authority Building, 47B Arglye Street, Knwloom, Hong Kong

Dr Abdoulaye Diallo, Professional Officer - Training, West African Health Organization (WAHO), Chairman of the Anesthesiology Department, Faculty of Medicine, BP: E 2193, Bamako, Mali

Dr T. Dileep Kumar, President of the Indian Nursing Council, Nursing Adviser, Ministry of Health and Family Welfare, Room No 751/A Wing, Nirman Bhavan, New Delhi, India

Ms Maricel Manfredi, Regional Nursing Adviser, AMRO/PAHO WHO Collaborating Centre for Mental Health Nursing, University of Maryland, 14241 Kings Crossing Blvd, Unit 401 Boyds Md 20841, USA

Dr Pelenatete Stowers, Assistant, CEO, Nursing and Midwifery, Health Services Performance & Quality Assurance, Nursing and Midwifery, Private Bag, Ministry of Health, Apia, Samoa

Dr Lis Wagner, Professor, Institute of Clinical Research, Research Unit of Nursing, J.B. Winslows Vej 9, DK-5000 Odense C, Denmark

Dr Nabil Kronfol, Senior Medical Adviser, Health Systems, Health Manpower Development, PO Box 113-7400, Beirut, Lebanon

Dr Viro J. Tangcharoensathien, Director, Ministry of Public Health, International Health Policy Programme, Tiwanon Road, Nonthaburi 11000, Thailand

Prof Sandra MacDonald-Rencz, Executive Director, Office of Nursing Policy, Health Policy Branch, Health Canada, Room B529, 200 Promenade Eglantine, Driveway, PL 1905B, Tunney’s Pasture, Ottawa ON K1A 0K9, Canada

Prof Cheherezade M.K. Ghazi, Director of the Nursing College, Cairo University, 5 Ibrahim Nosseir Street, Seif Plaza Building, Apt 2-Laurent, Alexandria, Egypt

Prof Gilles Dussault, Professor (Catédratico convidado) and Director Health Systems Unit, Instituto de Higiena e Medicina Tropical, Rua da Junqueira, 96, 1349-008 Lisbon, PortugalOfficial observers of GAGNM

Ms Agneta Bridges, Secretary-General, International Confederation of Midwives, Laan van Meerdervoort 70, 2517 AN The Hague, The Netherlands

Dr Isabel Costa Mendes and Ms Carla Ventura, WHO Collaborating Centre, College of Nursing at Ribeirao Preto, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto, Sau Paulo CEP 14040-902, Brazil

ANNEXES

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Mr David Benton, Chief Executive Officer, International Council of Nurses, 3 Place Jean Marteau, 1201 Geneva, Switzerland

Ms Judith Shamian, Vice-President, Victorian Order of Nurses, Ottawa Canada

Regional advisors

Margaret Loma Phiri, Regional Adviser, Human Resources for Nursing/Midwifery (HRN), Division of Health Systems and Services Development (DSD), WHO Regional Office for Africa (AFRO)

Fariba Al-Darazi, Regional Adviser, Nursing and Allied Health Personnel, WHO Regional Office for the Eastern Mediterranean (EMRO)

Bente Sivertsen, Regional Adviser for Nursing and Midwifery, WHO Regional Office for Europe (EURO)

Kathleen Fritsch, Regional Adviser in Nursing, WHO Regional Office for the Western Pacific (WPRO)

Prakin Suchaxaya, Regional Adviser for Nursing and Midwifery, WHO Regional Office for South-East Asia (SEARO)

WHO Headquarters

Jean Yan, Coordinator and Chief Scientist: Nursing and Midwifery, Health Professionals Networks, Nursing and Midwifery, Department of Human Resources for Health

Mwansa Nkowane, Technical Officer, Health Professionals Network, Nursing and Midwifery, Department of Human Resources for Health

Chen Reis, Technical Officer, Strategy, Policy and Technical Development, Health Action in Crisis

Francesca Celletti, Technical Officer, Health Workforce Education and Production, Department of Human resources for Health

Ivan Ivanov, Scientist, Interventions for Healthy Environments, Health Security and Environments

Blerta Maliqi, Technical Officer, Making Pregnancy Safer

Laura Guarenti, Scientist, Promoting Family Planning

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D AY 1 , M A R C H 1 8 , 2 0 1 0 ( T H U R S D AY )

Time (hrs) Agenda item Responsible person08:30–09:00 Registration AdminAssistant09:00–09:10 Welcome GAGNMChair:RowaidaAlMaaitah09:10–09:20 Meetingobjectivesandagenda

ProgressreportHPNCoordinator:JeanYan

09:20–09:30 Presentation:resultsoftheGAGNMquestionnaire NabilKronfol09:30–09:40 MeetingProcedureandProtocol RowaidaAlMaaitah09:40–09:55 WHOInitiativesonHealthSystemStrengthening,PHCandMDGs ADG/HSS:Carissa.Etienne09:55–10:10 HumanResourcesforHealth(HRH)StrategicDirectionsandimplications

forHealthProfessionsNetworkNursingandMidwifery(HPN)HRH Director: Manuel Dayrit

10:10-10:25 BREAK10:25–10:35 AcceleratedHRHresponsetoMDG5 MPS Director: Monir Islam 10:35–11:30 Discussion:Startswithupdateofthesituation,keyissues,discussionand

recommendations)PelenateteStowersTaskforceChair

11:30–11:40 InterprofessionalCollaboration(IPC) C.Wiskow11:40–12:40 Discussion:Startswithupdateofthesituation,keyissues,discussionand

recommendationsSandraMacDonaldRenczTaskforceChair

12:40–14:00 LUNCH14:00–14:10 HighLevelGrouponPHC G.Dussault14:10–15:30 Discussions,keyissues,andrecommendations J.ShamianandR.AlMaaitah15:30–15:45 BREAK15:45–17:00 GAGNM’ssupportfortheregions:

PerresultofGAGNMquestionnaire:AsessionforGAGNMmemberstodiscusswiththeRegionalAdvisersregionon–specificissues,andprogramofworkforstrengtheningnursingandmidwifery;Shareareasofgoodpractice,lessonslearnedandstrategiesutilizedforimprovement

KathyFritsch,RNAs/WPRO

17:00 Adjournment18:00 Reception

D AY 2 , M A R C H 1 9 , 2 0 1 0 ( F R I D AY )

09:00–09:10 Summary:Day1Proceedingsandrecommendations

09:10–09:20 Scaling-upNursingandMidwiferyEducation J.Yan,F.Celletti

09:20–10:30 Issues,discussions,opportunitiesforpartnershipandrecommendations C.Ghazi,TaskforceChair

10:25–10:45 BREAK

10:45–12:00 StrengtheningNursingandMidwifery:EBprogressreport;OptimizingGAGNM’sroleinhealthpolicychangeandHSSstrengtheningatalllevelsofWHO

J.Yan

N.KronfolandR.AlMaaitah

12:00–13:00 TheHaitiCrisisSituation:RecommendationsforimprovedaccesstoNursingandMidwiferyservicesinHumanitarianCrisisandconflictSituation(theplantoincludestrategiesensuringequalityandconstructivecollaboration/integrationwithinthehealthteam)

S.Malvares

13:00-14:00 LUNCH

14:00–15:00 Draftingofrecommendations R.AlMaaitahandrecommendationtaskforce

15:00–16:00 ReviewandAgreementofRecommendations GAGNM

16:00–17:00 ConcurrentSessions:GAGNMMeetingwithWHO/DGUpdatefromWHOpriorityprograms

GAGNMChairandVice-Chair,HRH/DIR,HPNCoordinator,RNAModerator:BenteSivertsen

17:00 ReportonDG’sresponse(andnextsteps)MessagefromtheGAGNMChair

R.AlMaaitah

17:30 Adjournment

ANNEX 2: AGENDA

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ANNEX 3A: QUESTIONNAIRE MAXIMIZING THE CONTRIBUTIONS OF GAGNM TO WHO’S POLICIES AND PROGRAMS FOR IMPROVED HEALTH OUTCOMES

Dear Colleagues,

Strengthening the work of GAGNM and maximizing its contribution to WHO’s policies and programs for improved health outcomes will be an agenda item for the virtual meeting scheduled for November 11, 2009 at 1PM (Geneva time). This short questionnaire seeks your views on a number of issues related to the arrangements of the next face-to-face GAGNM meeting in March 2010. Feedback from the survey will be presented at the meeting to inform the discussion. Please complete and return completed survey form to the Nursing and Midwifery Office at [email protected] by October 29, 2009

Thank you for your assistance.

Rowaida Al Maaitah, Chairperson, GAGNM and Jean Yan Chief Scientist Nursing and Midwifery

Questionnaire

1. Are the GAGNM terms of reference still appropriate (see attached)

❏ YES ❏ NO If NO, please provide comments below on how they should be revised/

updated.

2. GAGNM meetings agendaa. what issues would you like to see addressed at the March 2010 face-to-face

meeting?

b. what involvement should GAGNM members have in setting the agenda for the meeting?

3. Conduct of the meeting On a scale of 1 to 5 – where 1 is totally disagree and 5 fully agree – please rate

the following statements:• GAGNMmemberswillleaddiscussionsandinterventions ;• PermanentobserverswillbeinvitedtocontributeattheChair’sdiscretion ;• Whereappropriate,actionpointswillbeagreedforagendaitems ;• GAGNMrecommendationswillbedraftedbythetaskforcepriortothe

meeting and made available for GAGNM members’review and feedback at end of Day 1 ;

• MeetingbetweenmembersoftheGAGNMandRegionalNursingAdviserswill be scheduled to discuss expectations and opportunities for joint work ;

• TimewillbeallocatedforGAGNMmembers(only)todiscussissuesatthebeginning of the meeting ;

• TimewillbeallocatedforGAGNMmemberstoplanforthenextsteps ;

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If you would like to add comments on the above statements, please do so below.

4. Meeting administrationa. Are you satisfied with the background documents provided by the

Secretariat for meetings ?

❏ YES ❏ NO If NO, how could it be improved?

b. Are you satisfied with the travel itinerary and hotel accommodation?


c. Meeting report Are you satisfied with content?


Are you satisfied with timeline for production/dissemination?


5. If you would like to make other comments about the GAGNM meetings please do so below.

Thank you for taking the time to complete this questionnaire.

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The Global Advisory Group on Nursing and Midwifery (GAGNM) is a multidisciplinary group of professionals who provide the Director General of the World Health Organization (WHO) with policy advice on strengthening nursing and midwifery within the context of WHO’s programs and priorities.

Specific terms of reference include;• ProvidingpolicyadvicetotheDirectorGeneralonhownursingandmidwifery

services can optimize the responsiveness of health systems to people’s needs.• AdvisingtheDirectorGeneralonstrengtheningthenursingandmidwifery

contribution to global health and what is needed to make such contributions possible.

• AdvisingonlongtermstrategicplansfornursingandmidwiferywithinWHO.• Supportingthedevelopmentanduseofnursingandmidwiferyoutcome

indicators globally.• Collaboratinginmonitoringprogressofnursingandmidwiferycontributions

to the health agenda, particularly WHO’s programs and priorities.

ANNEX 3B: GLOBAL ADVISORY GROUP ON NURSING AND MIDWIFERY TERMS OF REFERENCE


NURSING AND MIDWIFERY CAPACITY TO CONTRIBUTE TO HEALTH SYSTEM STRENGTHENING AND THE ACHIEVEMENT OF MDGS

13TH MEETING OF THE GLOBAL ADVISORY GROUP FOR NURSING AND MIDWIFERY DEVELOPMENT18–19 MARCH 2010GENEVA, SWITZERLAND


World Health Organization

Department of Human Resources for Health

20 Avenue Appia

CH–1211 Geneva 27

Switzerland

www.who.int/hrh/nursing_midwifery/en/



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