Nurses' collaboration for policy development: equity and access to health care


Nurses from around the globe will gather in May at the ICN 25th Quadrennial Congress in Melbourne, Australia to explore the theme of equity and access to health care. In the March issue, four articles illustrate this theme in terms of collaboration in policy research and development between nurses from more and less developed countries. International collaboration is also the theme of this issue's guest editorial.

Collaboration in international partnerships as a means to achieve improved health access and health outcomes in less developed countries is the concern of three articles in this issue. First, a literature review (Searching for collaboration in international nursing partnerships, pages 31–36) involves a policy analysis using the DeSantis conceptual structure.1 The authors strongly advise that the inclusion of nurses from less developed countries be mandatory when funders approve studies of international partnerships promoted from the developed world.

The above literature review is followed by two accounts of just such collaboration between nurses. One account describes Brazilian nurses' contribution to Angola's potential future health care development (Healthcare context and nursing workforce in a main city in Angola, pages 37–44). The authors refer to the paradox not only of the two countries sharing a common language, Portuguese, but also of both having enormous potential in terms of human and natural resources, and vast inequalities in health. They develop their situational analysis of staffing in the Angolan health system whilst mindful of Brazil's own progress over the past 25 years in developing nursing within a national government policy that reflected the values of Health for All and Primary Health Care.

During the 1990s I was privileged to visit Brazil on several occasions. I witnessed nurses' valiant efforts in developing health services collaboratively with other health professionals to meet the needs of some of the poorest in their society. The contribution of government support through national policy guidelines should not be underestimated. It is enormously encouraging to see not only what has been achieved, but also that Brazilian nurses are now stretching out to colleagues in a less developed country to develop nursing and to help achieve greater equity in health care access.

A second account discusses the collaboration between Darwin in Australia's Northern Territory and Bali in Indonesia (International partnerships and the development of a Sister Hospital Programme, pages 45–51). The collaboration to improve clinical practice was conceptualised as a ‘Sister Hospital Programme’ and again involved government support. The initiative arose from the devastating consequences for both hospitals following their involvement in the care of victims from the Bali terrorist bombings in 2002. The authors use a theoretical framework2 derived from a model for health program planning, as a structure for behavioural change, identifying the detailed steps followed as well as discussing organisational and policy issues. They conclude: ‘Nurses in Australia and other developed countries have an opportunity to look internationally and to assist others in improving the quality of health care in systems that are not so well funded or developed’ (page 50).

Another article presents collaboration between a group of 20 researchers and research users from six countries. Nurses' engagement in AIDS policy development (pages 52–58) explores the influence of workplace policies on the ability of nurses to provide care for individuals and families living with HIV, and where necessary to access treatment for themselves.

Data collection took place in Kenya, Jamaica, South Africa and Uganda, and the findings identified a crucial need for nurses' working at different levels of their respective health care systems to be involved in policy development in the field of HIV/AIDS care and prevention. Too often nurses were either not allowed to participate in policy development, or were subject to ‘top down’ policies that did not address their fundamental concerns. The participation of front-line nursing staff was found to be essential in shaping effective health policy, particularly in sharing research results that ‘serve as a sound basis for decision-making and the allocation of resources’ (page 57).

The articles I have referred to exemplify what is meant in practice by INR's Aims and Scope as ‘developing a global intelligence on nursing and exploring beyond local or national interests to the more general, global application of the principles underlying their work’.3 As Editor of INR for ten years, I commend these authors' commitment to helping others who are less advantaged by developing nursing and improving access to health care. Above all I applaud nurses who put pen to paper and tell their colleagues what they have achieved.

  1. 1

    DeSantis, L. (1995) A model for counterparts in international nursing. International Journal of Nursing Studies, 12 (2), 198209 .

  2. 2

    Green, L.W. & Kreuter, M. (2005) Health Program Planning: An Educational and Ecological Approach, 4th edn. McGraw-Hill, New York .

  3. 3

    INR, Inside front cover, also Author Guidelines.