Strengthening nursing and midwifery: investments in education, jobs

SEVENTY-FOURTH WORLD HEALTH ASSEMBLY WHA74.15

Agenda item 15 31 May 2021

Strengthening nursing and midwifery: investments

in education, jobs, leadership and service delivery

The Seventy-fourth World Health Assembly,

Having considered the Director-General’s report on the global strategic directions for nursing and

midwifery 2021–2025;

Recalling the Seventy-second World Health Assembly decision to designate 2020 as the

International Year of the Nurse and the Midwife to increase appreciation of and investments in the

nursing and midwifery workforces;

Commending the leadership, commitment and professionalism of nurses and midwives, who

continue to provide essential health services and remain on the front line in the fight against the

coronavirus disease (COVID-19) pandemic and in humanitarian emergencies;

Deeply concerned with the COVID-19 pandemic and the detrimental impact that this has had on

health and care workers, including nurses and midwives who account for nearly 50% of the global health

workforce;

Recognizing that protecting, safeguarding and investing in the health and care workforce is

fundamental for building health systems resilience, maintaining essential health services and public

health functions, including in preparing for, implementing and evaluating COVID-19 vaccine rollout,

to enable economic and social recovery;

Recalling resolution WHA64.10 (2011) on strengthening national health emergency and disaster

management capacities and the resilience of health systems, which recognizes the domestic health

workforce as the primary responder in all countries, including those with fragile health systems, and is

key to building resilient health systems that contribute to the achievement of the Sustainable

Development Goals;

Reaffirming resolution WHA69.11 (2016) on health in the 2030 Agenda for Sustainable

Development, which recognizes that health workers and the public health workforce are integral to

building strong and resilient health systems that contribute to the achievement of the Sustainable

Development Goals;

DocumentA74/13.

https://apps.who.int/gb/ebwha/pdf_files/WHA64-REC1/A64_REC1-en.pdf?ua=1.

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Reaffirming resolution WHA69.19 (2016) on the global strategy on human resources for health:

workforce 2030 and the objectives to expand and transform the development, education and training,

distribution and retention of the health and care workforce especially nurses and midwives;

Noting the disruptions to education and life-long learning as a result of the global pandemic and

the increased demand for digital, competency-based education to provide all nurses and midwives with

sufficient access to evidence, quality education and learning;

Taking note of the Director-General’s report detailing the shortage and maldistribution of the

nursing and midwifery workforces, and the prominent inequities that are projected to remain through

2030 unless decisive action is taken to improve education, increase economic demand for the creation

of jobs in particular in rural areas, develop nursing and midwifery leadership, and protect and enable

nurses and midwives in their service delivery environments;

Recognizing that the COVID-19 pandemic has had a disproportionate impact on the poorest and

the most vulnerable populations, with repercussions on health and development gains, in particular in

developing countries, especially least developed countries and small island developing states, thus

hampering the achievement of universal health coverage and the strengthening of primary health care;

Recognizing that primary health care is the corner-stone of a sustainable health system for

universal health coverage, and that the health and care workforce is a fundamental pillar of primary

health care;

Further recognizing the crucial contribution of the nursing and midwifery professions to

strengthening health systems, to increasing access to comprehensive and patient-centred health services

for the people they serve across the lifespan, mindful of cultural contexts, and to the efforts to achieve

the internationally agreed health-related development goals, including the 2030 Agenda for Sustainable

Development and those of WHO’s programmes;

Recognizing the differences between nursing and midwifery and that while the two professions

share many of the same challenges, they maintain their own specific scopes of practice;

Acknowledging that the health, well-being, lives and safety of nurses and midwives, particularly

for those providing front-line services, were already affected by health workforce and skills shortages

in many countries, and that this is further exacerbated by the COVID-19 pandemic, resulting in increased

stress, strain and burn-out and reduced productivity and performance, and impacting workforce retention

and therefore the functioning, efficiency and resilience of health systems;

Further acknowledging the importance shown by the COVID-19 pandemic of strengthening

health worker protection and employees’ well-being, including through tailored approaches for

psychosocial support, additional training and support for new practices for recovery and continuous

monitoring of employee well-being, and ensuring respectful work environments that are free from racial

and all other forms of discrimination;

https://www.who.int/docs/default-source/primary-health/declaration/gcphc-declaration.pdf.

https://apps.who.int/gb/ebwha/pdf_files/WHA72/A72_R2-en.pdf.

https://www.who.int/hrh/resources/A62_12_EN.pdf.

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Concerned at the long-standing shortages and maldistribution of nurses and midwives in many

countries, particularly in rural and remote settings, and the impact of this on health and development

outcomes, which are inextricably linked, and recognizing the need for effective planning of the

education, deployment and retention of health professionals – including through the collaboration of

authorities responsible for health, education and employment – to educate, employ and retain an

additional 5.7 million nurses and 750 000 midwives by the year 2030 in order to realize Sustainable

Development Goal 3 (Ensure healthy lives and promote well-being for all at all ages);

Recalling the 2030 Agenda for Sustainable Development, including Sustainable Development

Goal 3, target 3.8 on achieving universal health coverage and target 3.c to “substantially increase health

financing and the recruitment, development, training and retention of the health workforce in developing

countries, especially in least developed countries and small island developing States”;

Noting also with concern that factors negatively affecting the recruitment and retention of general

and specialized nursing and midwifery personnel persist and have been exacerbated during the

COVID-19 pandemic, thereby hindering the capacity of countries, in particular developing countries,

especially least developed countries and small island developing States, to deliver efficient and effective

quality health care and services;

Reaffirming the continuing importance of resolution WHA63.16 (2010) in applying the WHO

Global Code of Practice on the International Recruitment of Health Personnel and the WHO Global

Code’s recognition that an adequate and accessible health workforce is fundamental to an integrated and

effective health system, and to the provision of health services;

Acknowledging that applying the WHO Global Code of Practice on the International Recruitment

of Health Personnel is crucial to ensuring the proper and ethical management of international

recruitment, and health personnel international migration, and that this can make a contribution to the

development and strengthening of health systems, while bearing in mind the necessity of mitigating their

impact in countries of origin;

Reiterating the importance of continued and concerted efforts, and the provision of development

assistance; and further recognizing with deep concern, the impact of high debt levels on countries’ ability

to withstand the impact of the COVID-19 shock;

Noting the specific needs and special circumstances of developing countries, especially least

developed countries and small island developing States, and those in fragile, conflict-affected and

vulnerable settings, due to their vulnerabilities and capacity constraints, and their need for sustained

technical and financial assistance aimed at strengthening health systems, including nursing and

midwifery workforce development;

Recognizing further the deliberations by Member States at the three High-Level Events on

Financing for Development in the Era of COVID-19 and Beyond and the necessity to expand support

for the most vulnerable, including through social and financial protection, and education and health

systems, so that no one is left behind, as part of economic recovery at all levels;

Acknowledging the importance of initiatives that promote gender equality, such as the Beijing

Platform for Action (Beijing +25), Generation Equality Forum and the Gender Equal Health and Care

Workforce Initiative, bearing in mind that women account for 90% of the global nursing and midwifery

workforce;

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Mindful of previous resolutions to strengthen nursing and midwifery,

as well as previous

global strategic directions on nursing and midwifery, including the most recent iteration for 2016–2020;

Recalling also decision WHA73(30) (2020), which requested the Director-General to update the

Global Strategic Directions for Nursing and Midwifery 2016–2020 and submit the update to the

Seventy-fourth World Health Assembly for its consideration;

Reaffirming Member States’ commitment to strengthen nursing and midwifery by investing in

education, jobs, leadership and service delivery, including the role of nurses and midwives in the health,

social and educational systems,

1. ADOPTS the global strategic directions for nursing and midwifery 2021–2025;

2. CALLS ON Member States

to:

(1) to the extent possible, to implement the policy priorities of the global strategic directions

for nursing and midwifery 2021–2025 related to education, jobs, leadership and service delivery

as relevant to national health and socioeconomic development strategies, aiming to achieve the

four strategic directions and the enabling monitoring mechanisms;

(2) to invest in, inter alia, workplace policies, strategic planning, capacity-building, domestic

resource mobilization, additional budgetary allocation as applicable, with a view to ensuring the

enhanced status of and the protection and welfare of nurses and midwives, taking into account

possible and future emergencies, disasters and conflicts;

(3) to maximize the contributions of nurses and midwives in service delivery environments by

seeking to ensure that practice regulations are up to date in order that nurses and midwives may

practice at the pinnacle of their capability and that workplaces provide decent work, fair

remuneration and working conditions, including appropriate leave entitlements, gender equity

and balance, labour protection and rights, mental health and the prevention of violence and

harassment, including sexual harassment and abuse;

(4) to ensure that nurses and midwives are supported, protected, motivated, sufficiently aided,

trained and equipped to safely and effectively contribute in their practice settings and remove

barriers to their practice, including impediments to gender equality, and mitigate their exposure

to violence and harassment;

https://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_R7-en.pdf.

https://apps.who.int/gb/ebwha/pdf_files/WHA59/A59_R27-en.pdf.

https://www.who.int/hrh/resources/WHA54-12.pdf.

https://www.who.int/hrh/retention/WHA49-1.pdf?ua=1.

https://www.who.int/hrh/resources/WHA45-5.pdf?ua=1.

https://www.who.int/hrh/resources/WHA42-27.pdf?ua=1.

And, where applicable, regional economic integration organizations.

Taking into account the context of federated States where health is a shared responsibility between national and

subnational authorities.

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(5) to equip nurses and midwives with the requisite competencies, and professionalism, aiming

to fully meet health system needs, through a scale-up of education tailored to current and future

population health needs, including, but not limited to, collaborating with the WHO Academy;

(6) to facilitate the practice of nursing and midwifery professionals to the full extent of their

education and training while also providing for sufficient oversight and mentoring and for lifelong

in-service training and further skills development in the workplace;

(7) to enhance the capacity of educational institutions to deliver competency-based clinical and

professional development programmes and develop research capacity, including evidence-based

approaches in partnership with its teaching institutions;

(8) as applicable, to increase access to health services by sustainably creating nursing and

midwifery jobs with fair remuneration, effectively recruiting and retaining nurses and midwives

where they are needed most, and ethically managing international mobility and migration in

accordance with the WHO Global Code of Practice on the International Recruitment of Health

Personnel;

(9) to establish and strengthen national and subnational senior leadership roles for nurses and

midwives with authority and responsibility for management of nursing and midwifery workforces

and input into health decision-making, including as regulators of nursing and midwifery education

and practice;

(10) to consider appointing government chief nursing and midwifery officers as per the

recommendations in the global strategic directions for nursing and midwifery 2021–2025

and

aligned, where appropriate, with the WHO guidance on their roles and responsibilities;

(11) as applicable, to strengthen institutional mechanisms for country coordination among

senior nursing and midwifery leaders and their counterparts in academia, professional

associations and regulatory bodies; and foster future generations of nursing and midwifery leaders

through supported leadership skills development programmes;

(12) to facilitate the monitoring of implementation of the global strategic directions for nursing

and midwifery 2021–2025 via, inter alia, the annual reporting through national health workforce

accounts (resolution WHA69.19 (2016)) and the biennial WHO Global Forum for Government

Chief Nursing and Midwifery Officers;

(13) to provide, to the extent possible, technical and financial assistance to developing countries,

especially least developed countries and the small island developing States and humanitarian

settings, aimed at strengthening health systems health personnel development, including

specialized training on nursing and midwifery and investments in information systems, to assist

with addressing workforce shortages and/or capacity-related challenges;

(14) as applicable, to align official development assistance for nursing and midwifery education

and employment with national health workforce and health sector development strategies;

https://www.who.int/publications/m/item/global-strategic-directions-for-nursing-and-midwifery-2021–2025.

https://www.who.int/hrh/nursing_midwifery/cnow/en/.

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(15) to provide, to the extent possible, appropriate financial and technical support related to

nursing and midwifery workforce capacities to developing countries with special circumstances,

including fragile health systems that are also battling the COVID-19 pandemic;

(16) to aim to complete the commemorative activities under the International Year of the Nurse

and the Midwife, which would have been disrupted due to the COVID-19 pandemic and cooperate

with national nurses and midwives associations to plan and execute commemorative activities to

end the International Year of the Nurse and the Midwife in 2021;

(17) to continue to implement the WHO Global Code of Practice on the International

Recruitment of Health Personnel and the latest recommendations of the WHO Expert Advisory

Group on the Relevance and Effectiveness of the WHO Global Code of Practice on the

International Recruitment of Health Personnel to equitably strengthen health systems worldwide,

to mitigate the negative effects of health personnel migration on the health systems of countries

and to report to the WHO Secretariat on the implementation of the WHO Global Code of Practice

on the International Recruitment of Health Personnel, including data on international health

workforce migration, data from health personnel information systems, and measures taken, results

achieved and difficulties encountered in implementation;

(18) to encourage and facilitate, as appropriate, the establishment and strengthening of

professional councils for nursing and midwifery as relevant to context;

(19) to take part in the Gender Equal Health and Care Workforce Initiative;

3. CALLS ON international, regional, national and local partners and stakeholders from within the

health sector and beyond to engage in and support implementation of the global strategic directions for

nursing and midwifery 2021–2025, specifically calling for:

(1) to the extent possible, educational and other institutions within and outside the health

systems to adapt their programmes and instructional modalities aiming at providing

competency-based education and learning inclusive of appropriate technology, interprofessional

learning and culturally competent care; to work in synergy with accrediting bodies to address

capacity gaps and faculty development needs; and to collect and share institutional data essential

for national health labour market analyses and informed health workforce planning;

(2) professional councils and regulatory bodies to update and strengthen professional nursing

and midwifery policies, regulations and standards, as applicable, and enhance regulatory capacity,

including through the collaboration of authorities responsible for health, education and

employment, where indicated; modernize registries and information systems, as applicable, to

enable the sharing of updated and accurate data on nurses and midwives and facilitate safe and

efficient mobility across jurisdictions;

(3) private recruitment agencies and other relevant actors to employ ethical recruitment

practices, as well as assist in addressing maltreatment of migrant health workers in the recruitment

process and strengthening the relevance, effectiveness and implementation of the WHO Global

Code of Practice on the International Recruitment of Health Personnel;

(4) professional associations and trade unions to mobilize collective action and advocacy for

investments in nursing and midwifery education, jobs, leadership and service delivery; to engage

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in data, dialogue and decision-making forums; and advance the ILO’s Decent Work Agenda for

safe and equitable workplaces;

(5) donors and development partners, along with international financing institutions, regional

development banks, and other public and private financing and lending institutions, to prioritize

sustainable and scalable investments in education, jobs, leadership and quality service delivery in

the health and care sectors, including the nursing and midwifery workforce;

(6) private sector entities to support investments in competency-based education, scholarships

and training, and upgrading qualifications, in order to meet changing health system demands and

population health needs;

(7) partners to continue to support initiatives and campaigns such as the Nursing Now

Challenge and the Young Midwifery Leaders Programme, which raise the status and profile of

nursing and midwifery in order to, inter alia, achieve greater investment in improving education,

professional development and employment conditions, as well as to enhance the influence of

nurses and midwives on global and national health policy, as supported by the International Year

of the Nurse and the Midwife;

(8) all partners to support WHO’s efforts on the International Year of Health and Care Workers

for 2021, and to join its campaign to: #Protect, #Invest, #Together;

(9) partners to take part in the Gender Equal Health and Care Workforce Initiative;

4. REQUESTS the Director-General:

(1) to provide support to Member States, upon request, to optimize the contributions of nursing

and midwifery towards national health policies and the Sustainable Development Goals,

including implementing and monitoring the global strategic directions for nursing and midwifery

2021–2025;

(2) to strengthen the progressive development and implementation of national health

workforce accounts to improve the availability, quality and completeness of health workforce

data as the basis for evidence-informed policy dialogue and decision-making;

(3) to mainstream in WHO, new support initiatives implemented as a result of the COVID-19

pandemic, and which have had a positive impact on nursing and midwifery services and health

care services delivery generally in Member States;

(4) to develop technical guidelines and global policy recommendations related to nursing and

midwifery, including on rural retention and managing migration, taking into account lessons

learned and experience sharing from the COVID-19 pandemic;

(5) to scale up assistance to developing countries especially least developed countries and

small island developing States, and in humanitarian settings that face particular difficulties in

educating, and developing the nursing and midwifery sector, and retaining nurses and midwives,

through, inter alia, advocacy, evidence-based studies and data reporting;

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(6) to engage Member States and all relevant stakeholders to develop, in consultation with

Member States, a succinct compilation document under the name of “global health and care

worker compact”, following up on resolution WHA73.1 (2020) and decision WHA73(30) (2020),

based on already existing documents of relevant international organizations (in any case WHO

and ILO), which aims at providing Member States, stakeholders and other relevant organizations

with technical guidance on how to protect health and care workers, safeguard their rights, and to

promote and ensure decent work, safe and enabling practice environments free from racial and all

other forms of discrimination, particularly in respect of the equity and gender-based challenges

faced by the global nursing and midwifery workforce, in line with the WHO Global Code of

Practice on the International Recruitment of Health Personnel;

(7) to support Member States, and senior government nursing and midwifery leaders in

particular, to leverage the national nursing and midwifery workforce data for intersectoral policy

dialogue and evidence-based decision-making on how to strengthen nursing and midwifery

towards population health goals, including participating in the biennial WHO Global Forum for

Government Chief Nursing and Midwifery Officers;

(8) with their prior consent, to publish the list of government chief nursing and midwifery

officers on the WHO website and take responsibility for its regular updating;

(9) to strengthen the relevance, effectiveness and implementation of the WHO Global Code of

Practice on the International Recruitment of Health Personnel, including by continuously

fostering bilateral and multilateral dialogue and cooperation to promote mutuality of benefits

deriving from the international mobility of health workers, as well as strengthening engagement

with non-State actors, including recruiters;

(10) to encourage and support all Member States to report on the implementation of the WHO

Global Code of Practice on the International Recruitment of Health Personnel, and urge Member

States’ accountability, in accordance with national context and priorities, to their reporting

commitments;

(11) to report regularly to the Health Assembly on the progress made in implementing this

resolution, integrated with reporting on the Global Strategy on Human Resources for Health:

Workforce 2030 and aligned with reporting requirements of the WHO Global Code of Practice

on the International Recruitment of Health Personnel in 2022 and 2025.

Seventh plenary meeting, 31 May 2021

A74/VR/7

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