1. McSpedon, Corinne Senior Editor


Elizabeth Iro assumes a key decision-making role at the WHO.


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For nearly a decade, the international nursing community has called for greater nursing representation and leadership at the World Health Organization (WHO). Last fall, however, WHO director-general Tedros Adhanom Ghebreyesus named Elizabeth Iro to the newly created position of chief nursing officer (CNO). Her appointment, which includes a role on the WHO Headquarters Leadership Team, has been a welcome sign of the public health agency's commitment to nurses, those working both in the community and at the policymaking table.

Figure. Elizabeth Ir... - Click to enlarge in new window Elizabeth Iro, MHSc, MBA, RN, RM. Photo courtesy of Elizabeth Iro.

Iro's public health experience spans three decades and includes work as a nurse and midwife in the Cook Islands and New Zealand. Prior to joining the WHO, she was most recently the Cook Islands' secretary of health. She assumed this role in 2012, becoming the first nurse to hold the position. "It was quite a big change for the Cook Islands to look beyond a medical doctor to fill that role," Iro says. Her responsibilities included advising the minister of health on budgetary and policy issues and implementing legislative reforms of the country's national health system. Before this, she was the CNO and acting director of hospital health services for the Cook Islands. This followed 25 years as a staff nurse, midwife, and supervisor of the nation's main hospital maternity ward.


Midwifery was not Iro's original career choice. She entered school interested in surgical nursing. But after finishing her undergraduate nurse training in New Zealand and returning to the Cook Islands, Iro found that her nursing responsibilities included caring for women during pregnancy, birth, and the postnatal period. Approximately 10,000 people live in the Cook Islands, which are in the South Pacific, midway between Hawaii and New Zealand; the nation comprises 15 islands spread across 90 square miles. Believing her skill set inadequate given these care expectations and the country's geography, Iro returned to New Zealand for midwifery training. A hospital sponsorship enabled her to complete this training before she moved back to the Cook Islands to provide essential quality care to women, newborns, and their families.



Iro's interest in public health policy developed "as I became more and more frustrated with the system," she says. "When that happens, you tend to look outside for positive alternatives." An example of such frustration was when she suggested "extended outreach health services for pregnant women and their partners to be provided by public health nurses. This would have allowed for continuity of care; but this model was frowned upon." Thus, while working as a nurse and midwife, Iro recognized the need for additional education and training that would complement her nursing experience and help her play a larger role in policy decisions. She enrolled in introductory and certification courses in civil law and in management classes, which she describes as being "very informative. They have guided my work in nursing and midwifery, especially when I was in a regulatory role as the registrar of the Cook Islands Nursing Council and later as president of the Cook Islands Nurses Association." Her clinical experience, in turn, has driven her policy work, in which she always keeps the nursing perspective at the forefront.


Nowhere is this clearer than in her position at the WHO, where Iro officially began working in January. As the agency's CNO, she focuses on building up nursing's voice globally. "One of the things I've done is to meet with the nurses and midwives at WHO-both those at headquarters and those working in the regional offices," she says. (The WHO has 150 offices throughout the world and six regional offices-in Africa, the Americas, Southeast Asia, Europe, the Eastern Mediterranean, and the Western Pacific-in addition to its headquarters in Geneva, Switzerland.) "We're building a team, a task force on nursing and midwifery. This means providing an interdisciplinary platform to strengthen, mainstream, and make visible the contributions of nurses and midwives at WHO headquarters and in regional and country offices. Membership is open to nurses and midwives as well as representatives or champions of nursing and midwifery from the different departments or programs within WHO. This does not replace the Global Advisory Group on Nursing and Midwifery," she says, which was formed within the WHO in 1992 to highlight the importance of nurses and midwives' work and to provide policy advice to the director-general and other senior WHO leaders.


Highlighting the views and perspectives of nurses and midwives is essential, Iro says. "Making a change and an impact at the country level is important and a greater investment in the health workforce. Nurses and midwives especially are critical to the achievement of universal health coverage and health for all."



The creation of the WHO CNO position and appointment of Iro fulfilled Director-General Ghebreyesus's promise to include a nurse on his senior leadership team. "This is the first time a CNO has been named," notes Iro, who points out that the director-general's support has been vital to her work. "His vision and commitment are based on his background and the work he's done in his own country [Ethiopia]. He recognizes the importance of nurses within the health care system." In appointing Iro to this position, Ghebreyesus stated, "Nurses are central to achieving universal health coverage and the Sustainable Development Goals. Ms. Iro will keep that perspective front and centre at WHO."


This emphasis on the role of nurses in attaining universal health care is echoed in the work of global nursing organizations such as the International Council of Nurses (ICN) and International Confederation of Midwives (ICM), as well as in the ICN's recently launched Nursing Now campaign, which seeks to improve global health by raising the profile and status of nurses worldwide. Therefore, in addition to focusing on how she can best manage from within the WHO, Iro is also building networks among nursing and midwifery experts and advisers in global institutions. Forging such connections, she says, "allows us to see how we can better coordinate our efforts, because we're all working toward the same goals."


In fact, Iro describes the ICN and ICM as "two of my key links." She notes that the WHO's agenda is very well aligned with the Nursing Now campaign, and with the work of the ICN and ICM. "We're collaborating to make sure we're going in the same direction as we work to ensure nurses and midwives are more visible and valued for their contributions to health care services. This is an exciting time."-Corinne McSpedon, senior editor