Midwives and nurses are critical to improve life expectancy

Midwives and nurses played a key role in the dramatic rise in global life expectancy that occurred during the 20th century, and have continued to contribute enormously to the improvement of the health in most parts of the world.

Midwives and nurses are the backbone of every health system, as they facilitate the smooth implementation of health programs and policies for sustainable development, towards increased maternal and child health and in reducing maternal and infant mortality and morbidity

It has been proven beyond reasonable doubt that the density of the health workforce is directly correlated with positive health outcomes. In other words, health workers save lives and improve health. However, enormous gaps remain between the potential of health systems and their actual performance, and there are far too many inequities in the distribution of health workers between countries and within countries.

In most developing countries, the health workforce is concentrated in the major towns and cities, while rural areas only have approximately 25 % of the country’s doctors and nurses and midwives respectively. The imbalances exist not only in the total numbers and geographical distribution of health workers, but also in the skill level of available health workers.

WHO estimates that 57 countries world wide have a critical shortage of health workers, equivalent to a global deficit of about 2.4 million doctors, nurses and midwives. Thirty-six of these countries are in sub-Saharan Africa. They would need to increase their health workforce by about 140% to achieve enough coverage for essential health interventions to make a positive difference in the health and life expectancy of their populations. The extent, causes and consequences of the health workforce crisis in the world and the various factors that influence and are related to it are well known and described.

The global health workforce crisis can be tackled if there is global responsibility, political will, financial commitment and public-private partnership for country-led and country-specific interventions that seek solutions. Only when enough health workers can be trained and sustained there is hope for a significant reduction in maternal and child mortality.

What needs to be done in relation to maternal and neonatal mortality is to strengthening midwifery education in many countries in the world. It is also necessary to strengthening regulatory mechanisms and promoting the role of midwives associations because they will carry the development of the profession in the future, in their own country.

Professional associations can and should participate in collaborative partnerships with each other. The axiom that two heads are better than one really is true when it comes to strengthening professional associations. By thinking, planning, and working together, the associations can accomplish goals that neither could achieve alone.

The process of building a collaborative partnership is multidimensional. It involves recognizing opportunities for change, mobilizing people and resources to create changes, developing a vision of long-term change and sustainability. It also involves choosing an effective group structure and building trust among collaborators. It is also an opportunity to learn for both partners. The role off the association is to promote and support the profession and protection of the public interests.

Ingela Wiklund

President, The Swedish Association of Midwives
Expert at the World Bank’s Civil Society Consultative Group for Health, Nutrition and Population