Nurses and Midwives: Now more than Ever for - What is GIS - World ...

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Nurses and Midwives: Now more than Ever for - What is GIS - World ...

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Nurses and Midwives: Now more

than Ever for Global Health

an Yan

ief scientist Nursing and Midwifery

orld Health Organization

neva

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20

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Our world, Our health…

health


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The Goal

… the attainment by all peoples

of the highest possible level of health

Health is not a commodity that is given, it must be generated from within

WHO Constitution 1948

Health action should not be imposed from outside, foreign to people, it must be a response of

communities to problems they perceive, supported by adequate resources

Mahler 1998


Millennium Development Goals (1990 – 2015)

Goal 4 reduce child mortality

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Target: reduce by 2/3rds (under-five mortality rate)

Goal 5 improve Maternal Health

Target: reduce by ¾, the maternal mortality ratio

Goal 6 combat HIV/AIDS, malaria and other diseases

Target: halt by 2015 and begin to reverse spread

of HIV/AIDS, malaria and other major diseases

Primary Health Care – the key to attaining acceptable level of

health for all people

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The Essence of Primary Health Care

"health is not a commodity that is given,

within".

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it must be generated from

"health action should not be imposed from

outside, foreign to the people,

it must be a response of the

communities to

by an

problems they perceive, supported

adequate infrastructure" (Mahler, 1998)


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The Health Situation

Inequities in access to care and health

outcomes

Impoverishing costs

Erosion of trust in health care

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Access to health care

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Inequities

1.3 Billion individuals globally with no access to health care

58 million of women ( out of 136M) who will give birth in a year, will receive no

medical assistance during childbirth and postpartum period – endangering lives of

mothers and babies

Health outcomes

Life expectancy : 40 years difference between the riches and poorest countries

Child health (under 5 mortality rate) : vast difference exist within countries and individual cities - e.g

. Nairobi)

- below 15/1000 in high income group,

- 254/1000 in slums in the same city

- Norway : 12 years difference in life expectancy within country, between cities

In many cases – people who are well-off are generally healthier , have best access to the

best care while the poor are left to take care of themselves


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Impoverishing Costs

Annual government health

$20 per person in low income

$6,000 per person in high income countries

Out of pocket health expenditures

40% in low income countries ( 5.6 billion)

20% in high income countries

Result: 100M people below the poverty line each year ( due to

rising HC costs , system for financial protection in disarray)

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Erosion of trust in health care:

health as a commodity and care driven by profitability

HC often delivered according to a disease model , high technology, specialist care and the

power of prevention ignored

unnecessary tests and procedures, frequent and longer hospitalization

higher overall costs, exclusion of people who can't pay

fragmented health care focused on national disease and projects with little attention to

coherence, decrease investment in infrastructures , services and staff

People reduced to program targets

Health workforce deployment: ½ of physicians and ¾ of nurses and midwives working in

hospitals

Specialist perform tasks that are better managed by general practitioners, family doctors

and nurses – leading to inefficiency, limited access to comprehensive health care.

Health care failing to respond to expectations of the public –

patient-centered, fair, affordable and efficient

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Towards a health system that …

Guarantees social protection in health for all citizens

Contributes to the elimination of inequities in access to

health services

Guarantees quality health services

Assures excluded social groups equal opportunity to

receive integral health care

Satisfies the population’s health needs, demands &

expectations

Eliminates the inability to pay as a barrier to access to

health care

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PAHO/WHO XLIII Directing Council, Washington DC 2002


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The Health Workforce

Nurses and midwives : The main providers of health care , urban and

rural (improved access and coverage)

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Source: Australia's Health Workforce. Productivity Commission Position

Paper. Canberra, 2005.


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Distribution of Human Resources in 2005

Argentina

Belice

Bolivia

Brasil

Chile

Colombia

Costa Rica

Cuba

Ecuador

El Salvador

Guatemala

Honduras

México

Nicaragua

Panamá

Paraguay

Perú

Puerto Rico

República Dominicana

Uruguay

Venezuela

Latin América

Enfermeras

Médicos

0 10 20 30 40 50 60 70 80

Fuente: Fuente:

Organización Organizaci n Panamericana de la Salud.

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Área rea de Análisis An lisis de Salud y Sistemas de Información Informaci n Sanitaria.

December 28, 2008

2001-2005. 2001 2005. Washington DC, 2005


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Nursing and Midwifery : a Valuable

Resource for Global Health

Nursing and midwifery , a solution to today's increasingly

complex needs in health care delivery and PHC provision

Nation of Healthy People Healthy World (MDGs)

Nursing and Midwifery Practitioners: 16 million nurses and

midwives, 60% of health care providers

Better trained member of the team, coordinate and manage health

services, support and supervise other team members, well trusted

by the community, delivers services with scarce resources.

Shown rapid transformation of nursing practice and the reorientation

of professional training to support PHC.

( made possible by their versatility , numbers and capacity )

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ontributions of Nursing and Midwifery to

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Primary Health Care ( improved health outcomes)

illed attendant at birth saves

others and babies

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Trained N& M can deliver approximately 80% of

the health care and up to 90% of the

pediatric care currently provided by primary

care physicians at equal or better quality and

lower costs

Under utilization of nurse practitioners in the

US – cost the country as much as $ 8.7 B

annually (Tournquist ' 97)

Health Prevention and promotion– better use

of existing preventive measures reduces the

global health burden of disease by 70%

Nurses – a valuable resource for global health


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Nursing and Midwifery Service

Messages from the Director Generals- WHO

Nurses Lead the Way …that nursing could serve as a powerhouse

of leadership in making PHC a reality. ( Mahler, 1985)

Nurses form the backbone of health systems around the globe and

provide a platform for efforts to address the MDGs and achieve its

targets. If we are to succeed in achieving the MDG targets and

improving health systems performance, urgent action is needed to

overcome the problems that seriously undermine the contributions

nursing and midwifery services can make to the vision for better

health for all communities. ( Director- General 2002)

Towards the achievement of MDGs 4 and 5 , WHO's strategy is the

use of skilled birth attendants , who are nurses, midwives and

doctors. ( Director- General 2008)

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The renewed PHC : 4 reform areas

Universal

Coverage

Leadership

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(WHR 2008)

Service

Delivery

Public

Policy


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Now More than Ever : Nursing and

Midwifery Contributing to PHC

Source: Compendium of PHC studies : 38 teams from 29 countries across 6 regions

Universal Coverage: rural and remote

areas

- Korea : utilization of nurses as community health practitioners

(CHP) – a total of 1850 , each responsible for 1500 – 2000

population. High satisfaction level from clients, improved health

status and decreased risk behaviors ( smoking and drinking

alcohol)

- Belize : Community – based psychiatric/mental health program

by trained nurse practitioners ( 10 months). National program

staffed by nurse practitioners, only two psychiatrist needed at

national level.. Beds in acute mental health hospitals – reduced

by 40%.

- Bahrain – Adequate number of nurses and midwives trained to

work in the 4 tiered health system. Results: 22 health centers

opened through out the kingdom providing 12-24 hours of care.

2.8 million visits to health centers, increased diabetic visits,

children screening and immunizations

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Service delivery

- Yemen . Use of community midwives , increase in clinic attendance

- Botswana : nurses providing family health . Sustained intervention

for care of stroke patients resulting in families assuming

responsibility for own health

- Brazil : nurse – led care during deliveries … no maternal deaths

from pregnancy or childbirth

- Australia : Renal replacement therapy provided by nurse

practitioners, no medical officers needed

- Denmark : Care of the elderly provided by nurses . Health

assessment, activities of daily living higher, average bed days

lower, running costs for care- lower and life expectancy

increased by 30%


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Now More than Ever : Nursing and

Midwifery Contributing to PHC

Source: Compendium of PHC studies : 38 teams from 29 countries across 6 regions

Leadership

- Haiti – nurse –led care in ambulatory and clinic

care , resulted in gains in controlling malnutrition,

malaria and TB

- China – nurse –led innovation in community health

( rehab and palliative care) : Nurse coordinated the

care provided by multi-disciplinary teams –

physiotherapists, nutritionists, optometrist,

psychologist, music therapist , Results : improved aged

persons ability to manage own well –being, decrease in

hospitalization

- Canada – nurse-managed care for medically

deprived communities. Nurses coordinate and

supervise the work of volunteers, community partners,

town councils, business organizations , referrals to

physicians. . 16 sites, 24 nurse managers, 18,500

clients( 1 nurse per 800 clients, average of 8-25 clients

per day)

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Public Policy

- Oman : government commitment to increase access

to basic health care brings long-term improvements.

Includes use of 1400 nurses, resulting in high

immunizations coverage, fall in infant mortality rate (

from 170/1000 in 1970 to 16/1000 in 2006)


Investment in Nursing and Midwifery for

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Improved Global Health

AMRO HRH target for 2015

India

1 : 1 ratio ( physicians and nurses)

Argentina, Nurse Emergency Act – 8M

National Rural Health Initiative ( development of centers of excellence, use of

advanced practice nurses)

Zambia

nation-wide opening-up schools of N&M

Government's investment and continued support for the profession are

Vital in making PHC a reality

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World of Global Health : Nursing and

Good

Midwifery Services

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Leadership

Innovation

Action (partnerships

and team work )

highest possible level of health

Great

Policymakers' continued investment and support for N&M are vital

In making PHC a reality


Good it is

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A Message

To receive peace from the World

Better it is

To give peace to the world

Best, by far the best , it is

To become the peace of the World

Sri Chinmoy


Good it is

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A Final Message for PHC

To receive ( health ) from the World - HFA

Better it is

To give (health) to the world

Best, by far the best , it is

To become the healthy people for the Healthy World

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Sri Chinmoy


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All TOGETHER


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