Nurses and midwives: More needs to be done for India’s foot soldiers

Nursing and midwifery are witnessing a brain drain due to poor salaries and working conditions in the private sector, and the absence of proper careers in the government sector
While nurses enjoy a majority in the health workforce, they remain starkly absent from leadership roles (AP) PREMIUM
While nurses enjoy a majority in the health workforce, they remain starkly absent from leadership roles (AP)
Updated on Jan 12, 2022 07:39 PM IST
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ByT Dileep Kumar

Nurses and midwives form the linchpin of health care delivery across the world. The Covid-19 pandemic highlighted how the absence of an optimal number of nurses and midwives can debilitate the health care sector. In India, nurses, midwives and other nursing professionals make up 47% of the health workforce and carry out 80% of patient care responsibilities.

During the second wave of the pandemic, nurses, alongside doctors, helped thousands to recover from the deadly virus. With a fresh surge in cases, nurses are at the centre of managing the health crisis, and yet, the recognition of nurses and midwives in the country remains largely wanting.

There are 3.3 million nursing and midwifery professionals registered since 1947. India has 1.7 nurses per 1,000 people, less than the World Health Organization’s norm of three per 1,000. India has the capacity to train 0.28 million nursing and midwifery professionals a year.

While a lot has been done, nurses in India still face multiple challenges. One, the recognition of qualification, code of ethics, professional conduct (and misconduct) continues under the Indian Nursing Council Act, 1947, but this law, limited in power, has not seen significant revisions for 69 years. Nursing education is also being impacted by increasing privatisation, with the private health sector providing almost 88% of this education. Along with soft skills development, these institutions need to improve the quality of education.

Nursing and midwifery are witnessing a brain drain due to poor salaries and working conditions in the private sector, and the absence of proper careers in the government sector. This migration is also encouraged by the lack of infrastructure. Structural challenges such as long working hours, short-staffing, workplace violence, and pay disparity also plague the field.

While nurses enjoy a majority in the health workforce, they remain starkly absent from leadership roles. Additionally, the limited involvement of nurses and midwives in policymaking and decision-making has deterred equitable and fair policies to reduce policy-practice gaps.

However, there has been progress in improving nursing education by the Government of India and the Indian Nursing Council (INC) through initiatives such as a nurse practitioners programme and a national nursing & midwifery commission bill (NMMC) draft. Residency programmes have also been added to allow nurses to start specialising beyond general nursing skill sets.

Under the midwifery initiative in the guidelines on midwifery services, 2018, the government aims to create a cohort of nurse practitioners in midwifery, capable of providing positive birth experiences to women by promoting physiologic birth, respectful maternity care, and decongesting higher-level health facilities.

The nursing registration and tracking system, developed by INC, is one approach to maintaining records and providing benefits to nurses across the country. A live register of this kind can be integrated into central and state-level planning. Further, filling the nursing and midwifery leadership positions that are lying vacant can give them a well-deserved seat at the table of policymaking and decision-making at the national level. Similarly, nursing directorates at the state level will also be essential in promoting nursing and midwifery across various states.

As per the National Health Policy, 2017, phasing out the General Nursing and Midwifery (GNM) programmes into a Bachelor of Science (Nursing) programme will ensure the quality of nursing education. While this progress in elevating nursing education is commendable, steps towards increasing nursing leadership and addressing the nursing migration remain to be seen.

India has developed its health services and workforce planning, yet there remains room for improvement. Setting up a systemic basis for monitoring and evaluation to enable periodic reviewing and upgradation of systems can be a cohesive way ahead. This step can effectively set the country on the right path to realising its universal health care coverage goals, with nurses and midwives becoming the foot soldiers of a healthier India.

Dr T Dileep Kumar is president, Indian Nursing Council

The views expressed are personal

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Tuesday, January 25, 2022