2020 World Health Day on April 7 passed with a whimper, dwarfed as it were, by the continuing focus globally on the war against COVID-19. Its theme, supporting nurses and midwives is incorporated in the worldwide recognition given to health care workers and others on the frontline of the fight. The annual day, inaugurated in 1950, aims at raising awareness of important health issues, including mental health, maternal and child care, NCDs, food safety, climate change and most recently, in 2018 and 2019, “universal health coverage everyone everywhere”.
This year’s World Health Day should jolt us more than ever in celebrating the work of nurses and midwives among other health workers. We are reminded of the critical role they play in keeping the world healthy. Nurses and other health workers are at the forefront of COVID-19 response - providing high quality, respectful treatment and care, leading community dialogue to address fears and questions and, in some instances, collecting data for clinical studies. Quite simply, without nurses, there would be no response. Over these seventy years of celebrating World Health Day there has been no greater disruption to the health systems and no greater challenge to health workers globally.
All over the world, nurses are foremost among health workers fighting day and night not only to keep us safe from coronavirus, but also to provide the essential services we need to keep healthy in other ways. In his statement to mark this significant day, WHO Director General, Dr. Tedros Adhanom Ghebreyesus recognizes the vital role played by nurses and midwives. “These are the people who devote their lives to caring for mothers and children; giving lifesaving immunizations and health advice; looking after older people and generally meeting everyday essential health needs”. Indeed, they are often, the first and only point of care in their communities. And, more so, in these devastating times of death during social distance, they act as surrogate family to many, giving comfort and support to those who would otherwise expire in utter loneliness. At the same time, shortages of the most basic protective equipment leave doctors, nurses and other frontline workers dangerously vulnerable as they care for COVID-19 patients.
State of the World’s Nursing Report 2020
It is fitting that in commemoration of World Health Day, WHO launched the first ever report, The State of the World’s Nursing 2020. It provides an in-depth look at the largest component of the health workforce. It reflects a global picture of the nursing workforce and supports evidence-based planning to optimize their contributions to improve health and wellbeing for all. The report sets the agenda for data collection, policy dialogue, research and advocacy, and investment in the health workforce for generations to come.
Although the number of nurses globally increased by 4.7 million between 2013 and 2018, the world is facing a global shortfall of 5.9 million nurses, especially in Africa, South East Asia, the Eastern Mediterranean and some parts of Latin America. The report predicts that the current shortage of some 5.9 million nurses will increase, as 1 in 6 nurses worldwide is projected to retire within the next 10 years.
The State of the world’s nursing 2020 report provides the latest, most up-to-date evidence on and policy options for the global nursing workforce. It also presents a compelling case for considerable – yet feasible – investment in nursing education, jobs, and leadership. A similar report on the Midwifery workforce is to be launched in 2021.
Bridging the nursing gap in the Americas
The Report documents that the Region of the Americas is home to 30% of the world’s nurses, or some 8.4 million people, of whom 87% are female. On average, the Region has 83.4 nurses per 10,000 population, more than twice the global average of 36.9 per 10,000. The figure, however, masks extreme disparities in the availability of nurses in different countries. Fully 87% of all nurses in the Americas are concentrated in just three countries: Brazil, Canada, and the United States, which account for 57% of the Region’s total population. That translates into a density of 80 nurses per 10,000 population in those three countries but contrasts starkly with the less than 10 nurses per 10,000 population in Haiti, Bolivia, and the Dominican Republic.
In the Americas, some 30% of the nursing workforce is aged 55 or older, with nearly a quarter of nurses expected to retire over the next 10 years. While there are currently 1.2 young nurses available to replace each retiree, that replacement rate will be insufficient to keep pace with population growth. This is happening at a time when there continues to be a hemorrhaging of the nursing pool in the Caribbean due to migration and the proposals from CARICOM for managed migration have not yield beneficial results.
The Americas Region also has major disparities in the distribution of nurses within countries. In the 35 PAHO Member States that have reported data on distribution, only 36% of nurses are located in rural areas, even though 50% of the population resides there. The availability of nursing personnel is also complicated by the fact that a number of countries, especially in the Caribbean, are net exporters of nurses.
Commenting on the status of the situation in the Americas, Dr. Carissa Etienne, PAHO Director said in a press briefing on World Health Day that through April 6, 384,435 confirmed cases of COVID-19 were reported in the Americas, and 11,270 people have lost their lives. “In just seven days, we witnessed cases and deaths more than double in our region. The pandemic is accelerating rapidly, and I urge governments to prepare and respond at the same speed,” she said.
Cuba's Health Brigade must be Celebrated
COVID-19 has placed a strain on the healthcare system in various Caribbean countries as more resources are funneled toward caring for coronavirus patients. The mammoth effort by Cuba in sending aid in the form of doctors and nurses to Italy and other hard-hit territories cannot go unnoticed. Cuba has been exporting doctors and nurses throughout the Caribbean as COVID-19 cases began to pop up in the region and governments reached out for help. As of 2020 World Health Day, Cuban health professionals are being or have already been deployed to: St Kitts and Nevis (30); Barbados (101); Antigua and Barbuda (29); St Vincent and the Grenadines (16); Jamaica (140); St Lucia (120); Dominica (34); and Belize (58).
To bridge the nursing gap by 2030, the WHO report says countries will need to increase the number of nursing graduates by an average of 8% every year and ensure they can find jobs and be retained by health systems. This will require investments to expand educational and training opportunities, increase nurses’ remuneration and improve their working conditions to ensure better retention. Funding these measures would cost roughly US$10 per capita (overall population) per year, the report says.
Addressing Health Disparities
COVID -19 has demonstrated the worst-case scenario involved in the spread of an epidemic into the developing-world where huge numbers of people live, where health care facilities are poor and where millions lack the money to afford whatever care is available. There are also larger emerging-market countries that will take a huge economic hit as a result of lost tourism, and basic commercial and agricultural activity. But there are more specific and immediate areas to be addressed.
Speaking yesterday (March 8) to Ms. Peggy DaSilva, Coordinator of the CARICOM Regional Nursing Body from her base in St Vincent and the Grenadines, reinforced some concerns of that regional organization about the special plight of the differently abled that was brought to the attention CARICOM Heads of Government. Among them, the need for sign language accompanying health briefings to ensure this demographic has greater access to public education; statutory mandates for construction of ramps to facilitate access to public and other buildings; and special support to care givers and care giving institutions. At the same time a release from UNAIDS (March 7) draws attention to the particular hardships facing sex workers globally, and calls on countries to ensure the respect, protection and fulfilment of sex workers’ human rights. The case of prisoners in cramped cells has led to a rapid spiraling of the coronavirus in those institutions, in most cases without adequate plans for effective preventive and remedial action. In the USA, the Chicago jail for example has the highest concentration of deaths.
While all levels of society are being affected by COVID-19, the impact of this pandemic is particularly hurting schools and places of worship, and disproportionately impacting the underrepresented communities, the sick, the elderly and the lower income groups. In the USA, statistics reveal the enormity of the disparity afflicting the black and brown communities, with Black Americans at overwhelmingly higher risks of infection and deaths. As a result, it is vitally important that organizations delivering critical social services and meeting community needs remain viable, particularly during this economically challenging time. Consideration may be given to including places of worship as recipients of support in the category of small businesses.
During this weekend’s celebrations of Easter, Christians may wish to reflect on the fact that Jesus’ crucifixion and resurrection were indeed instigated by the betrayal of ‘Judas’. The Washington DC National Cathedral Lenten Medication by The Rev. Canon Leonard Hamlin (March 8) is a fitting preview of life beyond COVID -19. "Today, what does betrayal to His teachings look like when we see the hoarding and cleaning of shelves, communities disproportionately affected because of economic, environmental, political and racial factors? When we are able to reach a point of looking back, will anything be different because of what we have been through? Will the change be limited to our habits or will change truly be in our hearts? I am praying that the change begins with me and together, we will see a different world on the other side of this moment”
For believers as well as non-believers, this sacred pledge is a truly respectful tribute to those, the focus of our celebration of World Health Day.
Edward and Auriol Greene Directors, GOFAD.