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Keywords:

  • Child Mortality;
  • Maternal Mortality;
  • Millennium Development Goal 4;
  • Millennium Development Goal 5;
  • Nursing

Abstract

  1. Top of page
  2. Abstract
  3. Background
  4. Strategic action 1: partner with midwives and local community health workers (CHWs)
  5. Strategic action 2: ensure equity in achieving the UN's MDGs
  6. Strategic action 3: help close research gaps
  7. Strategic action 4: be active in policy advocacy
  8. Conclusion: looking forward
  9. Author contributions
  10. References

AMIEVA S. & FERGUSON S. (2011) Moving forward: nurses are key to achieving the United Nations Development Program's Millennium Development Goals. International Nursing Review59, 55–58

Aim:  This article highlights the role of nurses in achieving the Millennium Development Goals (MDGs) 4 and 5 (reducing child and maternal mortality) and proposes actions for nurses that stream into the strategic frameworks of the World Health Organization and the United Nations.

Background:  The least amount of progress has been made with MDG 5 and failing to achieve MDG 5 jeopardizes the progress of MDG 4.

Conclusion:  This article makes the following recommendations to nurses: partner with local healthcare leaders, ensure equitable access to health services, collect health data to close research gaps and take on policy making responsibilities.


Background

  1. Top of page
  2. Abstract
  3. Background
  4. Strategic action 1: partner with midwives and local community health workers (CHWs)
  5. Strategic action 2: ensure equity in achieving the UN's MDGs
  6. Strategic action 3: help close research gaps
  7. Strategic action 4: be active in policy advocacy
  8. Conclusion: looking forward
  9. Author contributions
  10. References

The United Nations (UN) reports that every year, over 350 000 women die from pregnancy or childbirth complications, and there are still over 215 million women with an unmet need for contraception, even though satisfying this need could reduce, by almost a third, the number of maternal deaths (UN 2010a, pp.1–2). The rate of progress for the UN Development Program's (UNDP) Millennium Development Goals (MDGs) has not been uniform and has been particularly slow for MDG 5: reduce maternal mortality ratio by two-thirds and provide universal access to reproductive health by 2015 (UN 2010b). Failing to achieve MDG 5 has dire implications for MDG 4 (reduce by two-thirds between 1990 and 2015 the under age 5 mortality rate) because ‘motherless newborns are three to ten times more likely to die than others’[United Nations Population Fund (UNFPA) 2005, p. 3]. Significant progress has been made on MDG 4, but it is still far from being achieved; only 10 of the 67 countries identified by the UN as having high child mortality rates are likely to achieve MDG 4 by 2015 (UN 2010b, p. 28). Annually, for every 1000 live births, 60 children die annually (UN 2011, p. 24). Therefore, to sustainably propel the progress of these two MDGs, nurses need to focus on them simultaneously.

To avoid duplicative efforts and ensure sustainability of current progress, nurses need to align their strategies with the existing frameworks created by multilaterals such as the World Health Organization (WHO) and the UN. Two documents key to this endeavour are the UN's Global Strategy for Women's and Children's Health and the WHO's Strategic Directions for Strengthening Nursing and Midwifery Services (2011–2015). The UN's Global Strategy specifies strategies for healthcare workers; at its core is a call to action ensuring universal access to quality care, identifying opportunities for innovation in service delivery, providing services in a manner that does not reduce the dignity and agency of women and children, advocating for the development and strengthening of one's healthcare workforce, continuing education and training, and tracking progress to improve accountability. The WHO recently released the Strategic Directions for Strengthening Nursing and Midwifery Services (2011–2015), which ‘provides a framework for stakeholders on effective collaboration with nurses and midwives and emphasizes the role of nurses in strengthening health systems and achieving the MDGs’ (WHO 2010, p. 2).

This article highlights the role of nurses globally in accelerating the achievement of the UN's MDGs 4 and 5 and recommends the four following strategic actions for nurses that stream into the strategies and frameworks proposed in the WHO's Strategic Directions for Strengthening Nursing and Midwifery Services (2011–2015) and the UN's Global Strategy for Women's and Children's Health.

Strategic action 1: partner with midwives and local community health workers (CHWs)

  1. Top of page
  2. Abstract
  3. Background
  4. Strategic action 1: partner with midwives and local community health workers (CHWs)
  5. Strategic action 2: ensure equity in achieving the UN's MDGs
  6. Strategic action 3: help close research gaps
  7. Strategic action 4: be active in policy advocacy
  8. Conclusion: looking forward
  9. Author contributions
  10. References

To provide life-saving care to the greatest number of women and children, reduce duplicative efforts, and promote comprehensive country ownership and community empowerment, nurses should partner with midwives and local CHWs. The WHO's Nursing and Midwifery Services Strategic Directions (2011–2015) emphasizes the opportunities that arise from the complementary nature of nursing and midwifery: ‘Nursing and midwifery share a number of characteristics and issues that enhance their potential contributions within the health system, although, they are distinct professions with overlapping but complementary roles and scopes of practice. Each profession should have established standards and appropriate regulations to support high-quality evidence-based practice to contribute effectively to quality health outcomes. Implementation of strategies to strengthen nursing and midwifery services must therefore take into account the realities, and priorities and needs in each country’ (WHO 2010, p. 5). Partnering with midwives is necessary to achieve MDG 4 because neonatal-related causes accounted for 41% of mortality among children under age 5 in 2008 (UN 2010b, p. 27).

It is also critical that local leadership not be bypassed or underutilized: ‘A growing body of evidence shows that CHWs can effectively reach the poorest, sickest children, with the potential to save millions of lives by providing care when and where it's needed most . . . two areas where CHWs have especially great potential to save lives and reduce overall rates of child mortality around the world: the diagnosis and treatment of childhood pneumonia and the provision of home-based newborn care’ (Black & Perry 2011). CHWs are necessary but not sufficient to achieve MDGs 4 and 5. Quality of care and patient safety are at the core of nursing principles, and by working closely with CHWs, nurses can share their knowledge and provide technical clinical guidance. Sri Lanka managed to reduce ‘maternal mortality by 87% in the past 40 years by ensuring that 99% of pregnant women receive four antenatal visits and give birth in a health facility’ (UN Secretary General Ban Kin-moon 2010, p. 7). Various strategies enabled this success, one of them being that ‘initial reliance on midwives, supervised by public-health nurses rather than physicians, enabled the development of affordable primary health care-systems’ (Ekman et al. 2008). Collaborating with CHWs is an important means for helping strengthen local capacity and the healthcare workforce of developing countries.

Strategic action 2: ensure equity in achieving the UN's MDGs

  1. Top of page
  2. Abstract
  3. Background
  4. Strategic action 1: partner with midwives and local community health workers (CHWs)
  5. Strategic action 2: ensure equity in achieving the UN's MDGs
  6. Strategic action 3: help close research gaps
  7. Strategic action 4: be active in policy advocacy
  8. Conclusion: looking forward
  9. Author contributions
  10. References

A lack of equity in the achievement of the UN's MDGs is also exacerbating the slow rate of progress in reducing child and maternal deaths. International Save the Children Alliance (2010, p. 7) warns that ‘Global figures on progress towards achieving MDG 4 mask significant disparities between and within countries and regions’. A report by International Save the Children Alliance (2010, p. 7) concludes, ‘While there has been some progress towards MDG 4, this has often been concentrated in the wealthiest fifth of the population (the top quintile), in some cases leaving the poorest fifth of the population (the bottom quintile) no better or even worse off’. A recent UN Children's Fund (UNICEF) study revealed the following: ‘an equity-based strategy can move us more quickly and cost-effectively towards meeting Millennium Development Goals 4 and 5 – reduce child mortality and improve maternal health – than our current path . . .’ (UNICEF 2010, p. 1). Therefore, not only are equity-based strategies a moral imperative but they can also be a cost-effective strategy. It is important for nurses to ensure that all portions of a country's population have access to the available and relevant healthcare services and facilities for children and mothers. Nurses can help ensure that the UN's MDGs are achieved within a human rights framework by promoting equity in access to health services.

Strategic action 3: help close research gaps

  1. Top of page
  2. Abstract
  3. Background
  4. Strategic action 1: partner with midwives and local community health workers (CHWs)
  5. Strategic action 2: ensure equity in achieving the UN's MDGs
  6. Strategic action 3: help close research gaps
  7. Strategic action 4: be active in policy advocacy
  8. Conclusion: looking forward
  9. Author contributions
  10. References

As the global effort to achieve the UN's MDGs has unfolded, charting progress across disparate regions and populations has proven an immense challenge. Indeed, reporting on the UN's MDGs 4 and 5 in particular has varied considerably, and the discrepancies in the data diminish understanding of both the needs of target communities and the effectiveness of the strategies deployed.

Nurses usually are the first line of contact with the mothers and children whose lives MDGs 4 and 5 are hoping to save. As ‘frontline service providers’, nurses represent an invaluable resource in providing accurate tracking and reporting on MDG progress. Nurses have the skills and motivation to develop the databases necessary to map progress and chart the way forward. Recording accurate data on MDG success indicators will not only help inform programme implementation and best practices but it will also strengthen the evidence base needed for advocacy efforts.

The WHO's Strategic Directions for Strengthening Nursing and Midwifery Services (2011–2015) reports that ‘special attention must be paid to the need to build an evidence base of reliable data on the healthcare workforce, especially nurses and midwives’ (WHO 2010, p. 4). Therefore, in addition to keeping accurate records of MDG indicators, nurses must play an important role in informing the WHO and its partners on the state and needs of a country's healthcare workforce. As leaders in health care and invaluable members of the interdisciplinary teams that implement MDG strategies, nurses are highly effective as coordinators, linking efforts across regions, optimizing the deployment of resources and discerning new trends requiring attention.

Strategic action 4: be active in policy advocacy

  1. Top of page
  2. Abstract
  3. Background
  4. Strategic action 1: partner with midwives and local community health workers (CHWs)
  5. Strategic action 2: ensure equity in achieving the UN's MDGs
  6. Strategic action 3: help close research gaps
  7. Strategic action 4: be active in policy advocacy
  8. Conclusion: looking forward
  9. Author contributions
  10. References

The UN's MDGs are an opportunity for nurses to bring their skills and experience to defining the scope and focus of health care in the 21st century. Nurses are core actors in delivering health care globally and essential participants in building stable, prosperous and healthy societies. Nurses have a stake in the policy-making processes orienting global humanitarian efforts and pushing forward improvements in quality of life. Yet as the WHO reports, ‘In spite of their contribution, nurses and midwives are not often identified as key stakeholders at the health policy table’ (WHO 2010, p. 3). Nurse participation in political advocacy and fulfilling responsibilities as policymakers is an essential and necessary step forward in bringing experience and best practices to strategies in global health. Political advocacy is also necessary for creating an environment that enables healthcare workers to act upon their knowledge of best practices.

Conclusion: looking forward

  1. Top of page
  2. Abstract
  3. Background
  4. Strategic action 1: partner with midwives and local community health workers (CHWs)
  5. Strategic action 2: ensure equity in achieving the UN's MDGs
  6. Strategic action 3: help close research gaps
  7. Strategic action 4: be active in policy advocacy
  8. Conclusion: looking forward
  9. Author contributions
  10. References

Urgency has always been an essential component of the UN's MDGs, as progress towards their achievement is measured in lives saved, suffering averted and communities prospering. Today, time is of the essence, not only in light of the fast approaching 2015 deadline, but also because we realize more than ever that we have the means at our disposal to achieve the UN's MDGs and pursue longer term and increasingly ambitious development goals. It is incumbent on nurses to recognize the life-saving and game-changing role that is theirs to play, whether in delivering care or in policy participation to unite behind a common global vision for better health for women and children worldwide.

Key policy messages:

  • 1
    Design health system reform policies that facilitate and maximize collaboration among nurses, midwives and CHWs.
  • 2
    Create concrete institutional platforms that allow nurses to voice their experiences and recommendations to policy makers and professional health organizations.
  • 3
    Utilize long-term partnerships between academic institutions and nurses working in the field as venues for nurses to disseminate the data needed to more accurately track progress of the UN's MDGs and other health policy initiatives.
  • 4
    Take advantage of the momentum created by the UN's MDGs to push forward a comprehensive and human rights-based approach to health and development.

Implications for practice:

  • 1
    Establish lasting intersectoral and multidisciplinary partnerships and collaborations to sustain current achievements and propel action beyond the MDGs' 2015 timeline
  • 2
    Broaden the scope of nursing services to maximize their professional expertise in the policy and research arenas.
  • 3
    Continue to foster a synergistic approach to achieving the health-related UN's MDGs as prototypes of the important contributions of nurses to the healthcare arena worldwide.

Author contributions

  1. Top of page
  2. Abstract
  3. Background
  4. Strategic action 1: partner with midwives and local community health workers (CHWs)
  5. Strategic action 2: ensure equity in achieving the UN's MDGs
  6. Strategic action 3: help close research gaps
  7. Strategic action 4: be active in policy advocacy
  8. Conclusion: looking forward
  9. Author contributions
  10. References

S. Amieva is the lead author. S. Amieva and S. Ferguson collaborated on article conception and drafting of manuscript. S. Ferguson provided critical revisions for important intellectual content, supervision and technical support.

References

  1. Top of page
  2. Abstract
  3. Background
  4. Strategic action 1: partner with midwives and local community health workers (CHWs)
  5. Strategic action 2: ensure equity in achieving the UN's MDGs
  6. Strategic action 3: help close research gaps
  7. Strategic action 4: be active in policy advocacy
  8. Conclusion: looking forward
  9. Author contributions
  10. References