IF you pay attention to recent discussions about Pakistan’s nursing sector, you’re likely to come away feeling pessimistic.
Pakistan continues to have one of the world’s lowest ratios of nurses to population and the phenomenon of ‘brain drain’ means that we continue to lose some of our best nurses to the West. Steps to enhance nursing education, research and services are crucial to the government’s aspirations of achieving universal health coverage by 2030 and the good news is that a strategic shift is under way that suggests that there’s never been a better time to be a nurse in Pakistan.
Local, national and global nursing stakeholders are now coming together with one voice on one platform: a harbinger of systemic change. The first-ever Pakistan Nursing and Midwifery Summit saw the government align its vision with the global Nursing Now campaign goals, a campaign uniting the World Health Organisation, International Council of Nurses, several NGOs as well as nurses from around the world.
Those at the grass-roots level will bring about change.
At the summit, President Arif Alvi declared 2019 the year of nursing, highlighted six areas of focus spanning the spheres of academia, healthcare and employee relations. These included steps to ensure more nurses are available for each patient, to replace diploma programmes with degrees, to provide scholarships to enhance access to education and to provide a harassment-free environment to women. Plans to set up a new nursing university at the National Institute of Health and to double the size of the nursing workforce over the next two years are also laudable goals.
Pakistan has also joined 70 countries as part of the international Nursing Now campaign. This has defined three-year targets that empower nurses to take up leadership roles to address Universal Health Coverage and the implementation of SDGs.
I’m pleased to see Pakistan’s Ministry of National Health Services, Regulation and Coordination taking steps to address the problems. The ministry is looking into obstacles such as growing neonatal and maternal mortality, weak standards of education in many nursing schools, unavailability of community nursing care in the rural areas, lack of qualified midwives and the flawed bureaucratic processes.
We have government and non-government direction, but it’s participants at the grass-roots level who will bring about change. Nurses in Pakistan are asking for new leadership, fairer treatment from government bodies, representation on decision and policymaking boards and equality with other healthcare professions. How can we accelerate the pace of change?
We, as nurses, need to change our behaviour, individually and collectively to welcome colleagues from the global community to help make healthy decisions. We need strong leadership that is open, transparent and consultative and we need organisations that are led in line with these principles. While global initiatives are encouraging, we need to understand that being global means more than just going overseas and coming back with new knowledge. It means opening the doors of our profession to the world to allow change.
Achieving these goals will require a significant effort of all involved and maintaining quality and excellence will challenge existing resources. Nevertheless, the alignment of local, national and global forces will help.
We have success stories from other parts of the world. I would like to share a case study of Australian College of Mental Health Nurses (ACMHN), a nursing organisation which started in 1979 in Australia by holding a national congress.
At that Congress, nurses began to realise that change was imminent and that nursing as a profession was undergoing change. The congress was preceded by the government’s decision of transforming nursing into a university-based model and its ideas on nurses taking a stronger role in community health.
Today, ACMHN is a strong national body representing mental health nurses at the government and policy level. It has produced numerous policy documents, guidelines and competency standards for practice, holds internationally renowned conferences and has a well-respected international journal.
How did this all happen? The timing was right! The government was pushing, global and local professional change was pulling, other professions were needing professional support not servitude, and nurses began to believe in themselves.
In this Year of Nursing and Midwifery, nurses in Pakistan can start to believe in themselves, and welcome the offer of support from our global colleagues, our advisory bodies, inviting them to sit at our meetings.
We need to come forward as one strong team with a clear message: “nothing about us, without us” when decisions about nursing and healthcare are made.
The writer is a professor and dean at the Aga Khan University’s School of Nursing and Midwifery, and a representative of Nursing Now in Pakistan.
Published in Dawn, March 24th, 2019