Massive acceleration needed to fill sanctioned nursing positions in India

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Nurses and midwives form the cornerstone of healthcare delivery in India and are the unflinching pillars on which our healthcare system rests. The WHO Global Strategic Directions for Nursing and Midwifery 2021-2025 presents evidence-based practices and an interrelated set of policy priorities that can help countries ensure that midwives and nurses contribute optimally to achieving universal health coverage and other population health goals. The contribution of the cadre to the overall health of the country demands more intervention and visibility today.

While nurses enjoy a majority in the health task force, they remain starkly absent from leadership roles in the healthcare sector. They continue to be missing from key leadership bodies either due to non-sanctioning of the nursing positions or non-filling of the positions even when they are sanctioned. Additionally, the limited involvement of nurses and midwives in the policy making and decision-making levels has deterred the formulation of equitable and fair policies to reduce policy-practice gaps in the healthcare system. Hence, a much-needed representation of the nursing workforce in leadership roles is required across India, including setting up of fully-functional Nursing Directorates.

The Directorate of Nursing is the central body from which all activities relating to Nursing are managed. This includes all involving nursing and midwifery practices, providing Primary Health Care as well as fulfilment of the third Sustainable Development Goal in order to achieve reduction in maternal and child mortality, besides other specialities targeted at achieving good health and well-being.

Today, while there are nursing directorates across states, there is an urgent need to strengthen them to increase the representation from the Nursing and Midwifery cadre. In states, where there is neither a fully functional Nursing Directorate nor the post of Director Nursing, the final decision-making powers rest with non-nursing personnel. Hence, the involvement of nurses and midwives are limited in health and nursing related policy and decision making. There is an urgent need to adapt to the WHO norms as outlined in the Global Strategic Direction for Nursing & Midwifery (SDNM) 2021-2025 recently adopted at the World Health Assembly 2021. The SDNM focuses on investment in nursing education, jobs, leadership and service delivery.

Today, India has over three million registered nurses and midwives, who are responsible for the country’s 1.3 billion population – a grossly inadequate ratio. This is less than the WHO norm of three nurses per 1000 population. To meet the prescribed WHO norm, India needs to add more than 4.3 million nurses by 2024.

The lack of nursing reforms has translated in shortage of nursing human power in both teaching as well as service delivery setups. Creating more administrative and leadership positions with decision-making powers by placing more nurses and midwives in leadership positions will have a strong influence on the creation and strengthening of the cadre.

Madhabi Das, Ex-Joint Director of Health Services (Nursing), Government of West Bengal, said, “To strengthen nursing and midwifery as a profession and for facilitating our growth and development, we need representation of our cadre. In West Bengal, we have been able to bring about faster reforms and changes by setting up a strong nursing cell, which looks after education, practice, career development and positive working environment, among others.”

West Bengal is currently the only state in India where there are about 17 Nursing Officers dedicatedly looking after the administration of nursing education, practice, career path and working conditions. As a result, the workforce has increased from 3,000 nurses in 1957 to 66,983 in 2022. The success of West Bengal nursing cell has made it evident that creation of separate nursing directorates led by nursing leaders across India can go a long way in raising the status of nursing profession in India.

Presently, the nursing cell plays an important role in looking after not just the development of 66,983 nursing personnel, but also their recruitment, appointment and posting, as well as monitoring the Nursing educational institutes, pay scale, pay anomalies, and public health nursing.

The setting up of a separate nursing directorate is imperative to bring the much-needed focus on nurses and midwives as the backbone/foundation of India’s healthcare system, showing them in their true light as leaders, mentors, collaborators, educators and innovators.

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