Are the Global Strategic Directions for Strengthening Nursing and Midwifery 2016–2020 being implemented in countries? Findings from a cross-sectional analysis

Abstract

Background Nurses and midwives are the largest component of the health workforce in many countries. The World Health Organization (WHO) together with its partners facilitates the joint development of strategic policy guidance for countries to support the optimization of their nursing and midwifery workforce. The Global Strategic Directions for Strengthening Nursing and Midwifery 2016–2020 (SDNM) is a global policy guidance tool that provides a framework for Member States, the WHO and its partners to adapt, develop, implement and evaluate nursing and midwifery policy interventions in Member States. As part of the broader monitoring and accountability functions of the WHO, assessing the progress of the SDNM implementation at a country level is key to ensuring that countries stay on track towards achieving universal health coverage (UHC) and the sustainable development goals (SDGs). Methods This is a cross-sectional mixed methods study involving the analysis of quantitative and qualitative data on the implementation of country-level interventions in the SDNM. Data was provided by government chief nursing and midwifery officers or their representatives using an online self-reported questionnaire. The quantitative data was assessed using a three-level scale and descriptive statistics while qualitative comments were analysed and presented narratively. Results Thirty-five countries completed the survey. Summing up the implementation frequency of interventions across all thematic areas, 19% of responses were in the category of “completed”; 55% were reportedly “in progress” and 26% indicated a status of “not started”. Findings reveal a stronger level of implementation for areas of nursing and midwifery development related to enhancing regulation and education, creating stronger roles for professional associations and policy strengthening. Leadership and interprofessional collaboration are intervention areas that were less implemented. Conclusion Monitoring and accountability of countries’ commitments towards implementing nursing and midwifery interventions, as outlined in the SDNM, contributes to strengthening the evidence base for policy reforms in countries. This stock-taking can inform policy- and decision-makers’ deliberations on strengthening the contributions of nurses and midwives to achieving UHC and the SDGs. Electronic supplementary material The online version of this article (10.1186/s12960-019-0392-2) contains supplementary material, which is available to authorized users.

A critical interpretive synthesis of the roles of midwives in health systems

“…midwives collecting or sharing data) [ 43 , 65 , 90 ] • Midwives were unable to practice to full scope because of inconsistent standards of education and professional regulation [ 78 , 91 , 106 ] • Globally, there was a general lack of knowledge regarding the International Confederation of Midwives’ Global Standards for Midwifery Education, which was a barrier to the provision of quality midwifery education [ 53 , 66 , 87 , 107 , 108 ] • Midwives were not practicing to their legislated full scope of practice (Canada), barriers included (1) hospitals — scope restrictions; (2) capping of the number of midwives granted hospital privileges; (3) capping the number of births attended by midwives; and (4) inconsistent midwifery policies across hospitals [ 52 , 77 ] • Healthcare reforms increased the centralisation of decision-making, which created barriers to change (Australia) [ 95 ] • Combination of regulatory processes and health systems that promoted birth as a natural process; favoured professional midwifery care (Nordic countries) [ 8 , 62 , 86 , 91 , 99 ] • Accreditation mechanisms supported midwifery education programmes and institutional capacities [ 63 , 70 , 93 , 107 ] • Environments that allowed midwives to practice autonomously and to full scope of practice [ 74 ] • Expanded scope from providing skilled delivery care to include SRHR ranging from abortion, family planning, screening (diabetes and several forms of cancer), immunisations, palliative care, and public health and promotion [ 10 – 13 , 55 , 74 , 94 , 109 – 113 ] • Increased contraceptive prevalence rate (Nigeria) by engaging midwives in provision of family planning services [ 114 ] • Engagement of midwives within broader humanitarian emergency contexts (e.g. conflict, epidemics, and natural disasters) [ 46 ] •...…”

“…• Strong leadership from midwifery professional associations engaged in policy dialogue and decision-making to advance universal health coverage and meeting health-related UN Sustainable Development Goals [ 8 , 63 , 66 , 71 , 90 ]…”

“…• Midwives lacked ownership and leadership to contribute to national accountability through tracking and reporting systems (e.g. midwives collecting or sharing data) [ 43 , 65 , 90 ]…”

“…accreditation requirements, setting standards, policies and guidelines) [ 63 , 68 – 70 ]; (3) capacity-building including midwifery research [ 71 , 72 ]; (4) policy leadership and decision-making [ 43 ]; and (5) lobbying governments and advocacy [ 73 , 74 ]. Strong leadership from midwifery professional associations engaged in policy dialogue and decision-making has helped advance agendas related to universal health coverage and meeting health-related United Nations Sustainable Development Goals [ 8 , 63 , 66 , 71 , 90 ].…”

Correction to: Are the Global Strategic Directions for Strengthening Nursing and Midwifery 2016–2020 being implemented in countries? Findings from a cross-sectional analysis

“…Following publication of the original article [ 1 ], the authors identified an error in Table 2 . The correct table is given below.…”