A group of international experts that met at WHO Headquarters in Geneva recently concluded that nursing and midwifery services are in "crisis". This crisis is mainly a result of poorly planned workforce policies that do not work, fragmented health systems and epidemiological and socioeconomic trends.

The experts met at the Sixth Meeting of the World Health Organization’s (WHO) multi-disciplinary Global Advisory Group for Nursing and Midwifery.

Nurses and midwives around the globe are leaving the health system, driven away by underpay, hazardous working conditions, lack of career development as well as professional status and autonomy. In addition, there is a sharp decline in new recruits to the profession for similar reasons. If the world’s public health community does not correct this trend, the experts agreed, the ability of many health systems to function will be seriously jeopardized.

In countries such as the UK, Canada and USA the average age of nurses was between 43 and 45, indicating that young people were not taking up the profession for exactly the same reasons. "Skills drain", where nurses are recruited into developed countries from developing countries exacerbates the situation. For example, the number of overseas nurses coming to the UK has risen by 48% in 12 months. For the most part, the new recruits are from non-EU countries such as South Africa, Australia, the Philippines, New Zealand and the West Indies.

Speaking to the group, Dr. Gro Harlem Brundtland, Director-General of WHO, said, "Nursing and midwifery services are vital for effective health services. We should better understand the causes of this crisis and encourage Members States to respond."

Participants heard how, in one hospital in Zambia, which need 1,500 nurses to run smoothly, only 500 nurses were currently employed. Ten years ago in Poland, over 10,000 new nurses were being graduated annually from educational courses. That figure number has fallen to 3,000. In Chile, out of 18,000 nurses in the country, only 8,000 are actively working in the field.

In Egypt, for example, most nurses and midwives were trained by and employed in the public sector. Now private sector healthcare providers are luring them away with higher salaries. The result was a shortfall of nurses and midwives in the public sector with some professionals holding two jobs, one in each sector. The overall quality of the nurses’ and midwives’ work suffered, participants heard.

"The poor are always the first to suffer during times of health care crisis. Nurses and midwives play pivotal roles in providing essential services to the poor, marginalized and underserved populations. Effective nurse-midwife service models exist but they are not translated into effective health policy," said Dr Naeema Al-Gasseer, Senior Scientist for Nursing and Midwifery, WHO.

Participants heard, for example, how 94% of "well-baby" clinics in Chile are run by nurses. Since these clinics began in the 1970s, infant mortality in the country has dropped from 110 per 1000 child births to 11 per 1000.

Also, it is most often nurses who work in the local clinics and health stations where most information on prevention and control of diseases such as HIV is disseminated.

The experts agreed that the best remedy for the problems currently facing nursing and midwifery services was to ensure that these concerns were priorities on the public and political agenda. Experts called for more systematic evidence of the impact of inadequate nursing and midwifery services within the health system and urged policy makers to take action.