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A World Health Assembly target to provide universal health coverage to a billion more people cannot be achieved unless nursing and midwifery is rapidly expanded and developed, global health leaders have argued in a new report.

Released earlier this month by the World Innovation Summit for Health (WISH) Nursing and UHC 2020 Forum held at the WISH Conference 2018, the report claims countries that invest and develop their nursing and midwifery workforce can achieve quick, cost-effective expansion of high-quality universal health coverage.

Titled Nursing and Midwifery: The Key to the Rapid and Cost-Effective Expansion of High-Quality Universal Health Coverage, the report was co-authored by Lord Nigel Crisp, Co-Chair of the Nursing Now campaign, and Professor Sharon Brownie, Dean of the School of Nursing at the Aga Khan University.

It includes new data on public perceptions of nurses and midwives across seven countries, with findings revealing strong backing for nurses playing a greater role in health services and reinforcing the view that nurses and midwives are primed to manage the defining health challenges of modern times.

“The world is facing a shortfall of 18 million health workers needed to deliver and sustain universal health coverage by 2030,” says Director-General of the World Health Organization (WHO), Dr Tedros Adhanom Ghebreyesus in the report.

“More than half of that shortfall is nurses and midwives. This report makes a persuasive set of arguments for investing in nursing and midwifery as part of a multidisciplinary, people-centred workforce.”

Building on the success of Nursing Now, a three-year campaign aiming to empower nurses worldwide and lift the profile of the profession, the report proposes a three-pronged approach focusing on rapid, cost-effective and high quality expansion.

It states countries can achieve rapid expansion of universal health coverage by investing in the workforce and making changes to service delivery and practice, thus enabling nurses and midwives to work to their full potential through the creation of more nurse-led clinics and midwifery services.

Similarly, evidence in the report shows cost-effective expansion of universal health coverage will largely depend on enabling and training existing nurses and midwives to work more effectively.

This includes enormous potential for nurses to expand their scope of practice through task sharing, with one study cited in the report estimating an advance practice nurse could complete about 70% of a GP’s workload.

Examining high quality expansion, the report found evidence of the impact that nurses and a patient-centred, holistic approach has on quality, with studies showing physicians and nurses generally achieve equivalent health outcomes for long-term NCD management.

However, nurses often achieve better patient satisfaction and treatment adherence, and provide more health promotion and disease prevention.

Speaking at the launch of the report, Lord Nigel Crisp said previous discussions regarding the delivery of universal health coverage have unduly focused on financing and access to service without sufficient investment in the health workforce.

“Our report shows that by redesigning health services at a national level to make better use of nurses and midwives, countries can achieve high quality, cost effective universal health coverage.”