A cost effective solution to today’s challenges?
The context of health care is being transformed, and governments are looking for cost effective solutions
to challenges such as:
■ Decentralization and privatization involving changes to traditional patterns of work, to health
system governance and to financing;
■ Globalization and technological advances creating new opportunities and tensions;
■ Socio-demographic changes bringing additional pressure, in particular the stresses caused by
handling increasing HIV/AIDS related illness and death;
■ Rising health care costs and higher public expectations making increased demands on resources. 1
The ability of health systems to respond to these evolving challenges is dependent on the availability of
appropriately trained and supported health professionals where and when they are needed. In this
context, nursing and midwifery services have a major contribution to make in meeting national
Contribution undermined 2
Nursing and midwifery services form an integral part of the care delivered by a team of health providers.
From the care and comfort of individual patients to the promotion of community health through
education, from the assessment of individual needs to the identification of gaps in health care provision,
nurses and midwives have an essential role to play within the health system. But their contribution is
being undermined by a variety of issues, including:
■ Migration and shortage of nursing and midwifery personnel
■ Poor working conditions
■ Inappropriate utilization
Failure to address these issues will have increasingly serious implications on the accessibility and
quality of health care, the well-being of health practitioners and the ability to achieve global and
national health priorities. 3
Governments are aware of the need to find solutions to strengthen service delivery if they are to improve
health system performance and meet public demand for access to quality and cost-effective health care.
Moving the health agenda forward will involve:
■ Civil society
■ Professional associations
■ Educational institutions 4
■ International and bilateral organizations
In May 2001, the World Health Assembly adopted a resolution 1 requesting the Director-General to
“rapidly prepare a plan of action for strengthening nursing and midwifery.” The resulting Strategic
Directions for Strengthening Nursing and Midwifery Services 2 was achieved through a
collaborative process with partners 3 based on principles of:
■ Partnership: Working together on common objectives, acting collaboratively and supporting each
others’ efforts; 5
■ Relevance: Developing health services and systems guided by health needs, evidence and strategic
■ Ownership: Adopting a flexible approach that can guide action at global and national levels and be
implemented with local involvement;
■ Ethical Action: Planning and providing health care services based on equity and fairness and respect
for gender and human rights.
These principles will also inform future action taken by the WHO and partners. The Strategic Directions
provides both a framework for WHO action to support countries in improving the quality of nursing and
midwifery services, and a possible guide for action at national levels.
KEY RESULT AREAS Future Directions
The Strategic Directions will support efforts to scale up the
capacity of national health systems to meet health goals set
HEALTH PLANNING, by Member States, while also contributing to the achievement of
WHO’s four strategic directions:
ADVOCACY AND POLITICAL
■ Reducing excess mortality, morbidity and disability,
COMMITMENT especially in poor and marginalized populations.
National development and health plans ■ Promoting healthy lifestyles and reducing risk factors to
provide for adequate nursing and
human health that arise from environmental, economic,
midwifery services and expertise.
social and behavioural causes.
■ Developing health systems that equitably improve health
MANAGEMENT OF HEALTH outcomes, respond to people’s demands, and are financially
PERSONNEL FOR NURSING fair.
AND MIDWIFERY SERVICES ■ Framing an enabling policy and creating an institutional
National employment policies are environment for the health sector, and promoting an
implemented for the nursing and effective health dimension for social, economic,
midwifery workforce that are gender environmental and development policy.
sensitive, based on healthy and safe
work environments and conditions, Improving the quality of and access to health care through
provide for equitable rewards and strengthening nursing and midwifery services will also
recognition of competencies, and are contribute to achieving the Millennium Development Goals in
linked to a transparent career structure. the specific areas of:
■ Reducing Child Mortality
■ Improving Maternal Health
■ Combating HIV/AIDS, Malaria, and Other Diseases
Five Key Result Areas (KRAs) have been identified as being
Nursing and midwifery expertise is fully
crucial to the process of strengthening nursing and midwifery
integrated into decision-making
services, as shown in the panel at left.
processes at all levels, and health
systems utilize best available practices
for the care of individuals, families and Implementation
A more detailed plan of action for implementing and monitoring
EDUCATION OF HEALTH the KRAs is now in place. A communications strategy as well as
a resource mobilization plan has been developed to facilitate
PERSONNEL FOR NURSING implementation. As noted above, implementation of the plan
AND MIDWIFERY SERVICES of action is a collaborative effort between WHO and partners
Competent practitioners with appropriate guided by the four principles of partnership, relevance,
skill mix are available to deal effectively ownership and ethical action.
with the current and future challenges of It is recognized that KRAs will be implemented according to
practice. country priorities and adapted to the needs and contexts of
developing and developed nations. To support implementation
STEWARDSHIP at national level, technical advice and support will be
AND GOVERNANCE provided to countries requesting assistance and relevant
indicators are being put into place for monitoring progress.
Stewardship and governance of nursing
and midwifery services involves the Core performance indicators for each KRA will be identified
government, civil society and the and data collection systems are being initiated at global,
professions to ensure the quality of care. regional and national levels to monitor and measure progress.
This document is a background brief and summary of the Strategic Directions for Strengthening
Nursing and Midwifery Services 2002-2008, published by WHO, 2002.
Brief Editor: Naeema Al-Gasseer, RN, PhD
Brief Publisher: Rita M. Carty, DNSc, RN, FAAN, Secretary General, Global Network, 2000-2004
For more information, please contact:
Dr. Jean Yan, Chief Scientist for Nursing and Midwifery
World Health Organization
20, Avenue Appia
1211 Geneva 27
Fax: + 41 22 791 47 47
1. World Health Assembly Resolution 55.18, 18 May 2002. WHO, Geneva, Switzerland (retrieved from:
2. World Health Organization (2002). Strategic Directions for Strengthening Nursing and Midwifery
Services 2002-2008. Geneva, WHO.
3. WHO partners endorsing the Strategic Directions for Strengthening Nursing & Midwifery Services:
Global Network of WHO Collaborating Centres for Nursing and Midwifery Development
International Labour Organization
International Confederation of Midwives
International Council of Nurses
International Federation of Nurse Anesthetists
International Society of Nurses in Cancer Care
Sigma Theta Tau International Honor Society of Nursing
UNFPA – United Nations Population Fund
UNICEF – United Nations Children’s Fund
© World Health Organization, 2003