Geneva
27 November 2001

Global Advisory Group on Nursing and Midwifery

Dr Gumbi,

Dr Thompson,

Colleagues,

It is my pleasure to be able to join you today at the seventh meeting of this very important Advisory Group.

I know you have been examining the role of nursing and midwifery skills within the different health systems of our world. You have examined ways in which nurses and midwives can contribute to health outcomes and health system performance. You have identified issues that must be addressed if this contribution is to increase. You have proposed Strategic Directions and a Plan of Action for the WHO secretariat and its Member States.

You have responded to Member States' concerns about their nursing and midwifery services. These have been expressed forcefully on several occasions, most recently during May's World Health Assembly. As they developed their resolution, delegates were explicit about the substantial contribution that both nurses and midwives can make to health outcomes. They saw them to be at the core of any health system. The Assembly wanted to see further efforts to maximize this contribution. They were extremely concerned about global nurse and midwife shortages. They called for action.

In the resolution on "Strengthening Nursing and Midwifery", the 54^th Assembly wanted an enquiry into the global shortage of nurses and midwives, including the impact of migration. They also wanted to see a greater involvement of persons with nursing and midwifery skills in health planning, in health worker training, and in service provision. They wanted a global action plan for increased investment in nursing and midwifery. They asked the WHO secretariat to spearhead decisive action - develop the plan, encourage its implementation and monitor progress.

You have advised on the development of this plan. Now you are going to review it.

You will examine whether it makes the right diagnoses and proposes correct solutions. Indeed, your task this week is vital for the future of health systems. They fail if they are not fuelled by the best nursing and midwifery skills. They fail if they are not staffed by sufficient nurses and midwives.

All of us in this room know that nurses and midwives are essential for good health care. We want to be sure that this reality is acknowledged by those who make critical health policy decisions. They need to appreciate that nursing and midwifery skill development, the organization of the nursing and midwifery professions and a focus on health service quality, all make a real difference. They need to access the data and analyses which examine the case.

We are working to develop the necessary analyses, best practice guidance and technical support. The plan you are to discuss this week sets out what is required; now we need the will and resources to make it happen, and that calls for effective advocacy and focused action.

Qualified nurses and midwives in many developed and developing countries are leaving these professions and new recruits are insufficient to replace them. Current efforts to encourage the training, recruitment and retention of a skilled nursing and midwifery workforce, and of ensuring their motivation, are not working well enough.

Low pay rates and hazardous working conditions are real barriers to retention. As are the lack of career development, professional status and autonomy. Severe shortages of nursing staff has led to the closure of essential health care facilities, including emergency rooms. Shortages make those who are working more likely to be affected by ill health.

We know what needs to be done. How can we, together, make more of a difference?

On 20 December, I will receive the Report of the Commission on Macroeconomics and Health. Commissioners have confirmed the strong link between ill health and poverty, particularly among the 2.5 billion people who live on less than US$ 2 per day. The Report will make a powerful case for a dramatic scale-up in health investment. It will spell out the equation - starkly. To get fair globalization, equitable development and human security, we must invest more in health. That means more resources and better services.

At this year's World Health Assembly, at the UN General Assembly Special Session on HIV/AIDS, and at the G8 Summit in Genoa, Member States committed to provide an increase in the level of resources available for global health. By doing so, the international community pro-actively recognized that good health - and accessible health care - are vital for peace and security.

Some new funds have been pledged to the innovative Global Fund to Fight AIDS, Tuberculosis and Malaria. The Fund will help us all work together with a focus on the rapid delivery of proven and effective health interventions to those who need them most, and on the achievement of real results.

We know that nursing and midwifery play a key role in practical efforts to respond to the millions of deaths each year from infectious and noncommunicable diseases and injuries. This means that nurses and midwives are key to the sustained success of the new public-private partnerships for health.

We should show how nurses and midwives are at the forefront of the collective global response. They are committed to the delivery of first class health care for all, regardless of ethnicity or gender, in a manner that is both effective and efficient. Their leaders contribute through their involvement in human resource planning; in pursuing optimal working conditions; and in promoting equitable health outcomes.

We are also getting to know the statistics about nursing workforce shortages, and their determinants. We must work for a real increase in nurse and midwife numbers where the shortages are most acute, and in the extent and use of their skills - everywhere.

They will help Member States to improve the overall coverage and effectiveness of health systems.

We know that nurses and midwives are best placed to link between people and health systems, and to make the systems responsive to the needs of those who are poor and marginalized. We know that nurses and midwives play a key role in reducing risk factors for disease and disability - such as unsafe sex, tobacco use or unwillingness to exercise.

I hope that - in taking forward the action plan, nurse and midwife groups will focus on the value of their contribution to personal and public health, and quantify it where possible. This matters at a time when policymakers are considering how best to spend very scarce resources for health, and seeking straightforward protocols for public health action. Nurses are well placed to deliver the majority of interventions required to tackle the diseases of poverty.

Colleagues,

Within WHO we will continue to promote to importance of human resources for health as intensively as we can, within available resources. We will offer help with strategies that underpin focused action at the national and intergovernmental levels.

We have a strong and committed alliance, held together by common purpose. The International Council of Nurses, the International Council of Midwives and the Global Network of WHO Collaborating Centers for Nursing and Midwifery Development play an active role, alongside WHO staff, in the development of the Strategic Directions and Plan of Action for Nursing and Midwifery.

We value your expertise and contribution to achieving our common vision of better health for all people, especially the poor and vulnerable, through strengthening the contribution of nursing and midwifery services in health policies and systems.

By continuing together, within this alliance, we will contribute to the improvement of health systems, of nursing and midwifery services and of people's well-being the world over. This is real health sector reform.

I wish you well in your deliberations.