One week prior to the World Health Assembly in May, the government chief nurse and midwifery officers (GCNMOs) from the World Health Organization (WHO) member nations met in Geneva, Switzerland. Among the 193 member countries, 80 have a designated GCNMO. (The United States does not have a GCNMO; traditionally, the chief nurse of the U.S. Public Health Service sits as the GCNMO representative. Currently that person is Assistant Surgeon General Rear Admiral Carol Romano.)
The GCNMOs meet every two years. Their current focus is how to strengthen nursing and midwifery to improve access to primary health care and to achieve the United Nations Millennium Development Goals (MDGs, see http://www.un.org/millenniumgoals).
Carissa Etienne, assistant director general for Health Systems Services at the WHO, said that if nurses and midwives are not involved in the discussions of how a nation will meet the MDGs, "a whole body of knowledge and experience will be missing." However, Pauline Tan, the GCNMO of Singapore, said she participates in the minister of health's bimonthly meeting. "Nursing has a big voice," she says.
Shortages and maldistribution of health care workers. Jean Yan, chief scientist and coordinator of the WHO Office of Nursing and Midwifery, noted that, "there are 57 countries with critical shortages; 37 are in sub-Saharan Africa." Dorica Sakala Mwewa, chief policy analyst for nursing services at the Ministry of Health, Zambia, said that her country has only 50% of the health workers it needs. Eileen Petit-Mshana, a WHO medical officer, reported that between 1999 and 2005 17% of Botswana's health workforce died of AIDS or were incapacitated because of it.
For many countries, task-shifting, where health care practices that might normally be done by a physician or nurse are being shifted to less-qualified health care workers, may be the only way for people in remote areas to receive health care. However, there often is little training and oversight of these workers and patient safety is a concern.
The WHO is emphasizing collaboration and creating partnerships to achieve goals. Assia Essman Ahmmed reported that in Somalia, because of recent conflict, "the health system was gone and people went back to traditional methods." There were no nursing graduates from 1998 to 2002. With help from the WHO, Somalia has opened three schools of nursing and 150 nurses graduated this year. Conference participants were also introduced to the Global Community of Practice, a network of 180 countries that meets online using the Implementing Best Practices Knowledge Gateway to discuss issues and share ideas and resources. (For information, go to http://www.ibpinitiative.org.)
In a closing statement, the GCNMO forum agreed on actions to improve the ability of nursing and midwifery to help achieve the MDGs, including increased collaboration and partnerships, active participation and leadership of GCNMOs within countries, and establishment of a GCNMO in each WHO member country.
Maureen Shawn Kennedy, MA, RN
editorial director (and WHO Nurse Scholar)