Do you sometimes feel, when you’re battling to make positive changes in health care, that you’re banging your head against a brick wall? That it’s not even worth trying, because everything is decided higher up? Or that other priorities, like economics, will come first anyway? You’re not alone.
This is why NZNO representatives meet employers and government, to put the nursing agenda on the table. And it’s why NZNO kaiwhakahaere Kerri Nuku, chief executive (CE) Memo Musa and I went all the way to Geneva last month, to attend meetings organised by the International Council of Nurses (ICN) – the first under the new ICN CE, New Zealand nurse Frances Hughes, and new ICN policy consultant (and former RCN secondee to NZNO) Howard Catton.
As Catton told us in one meeting, “Nurses need to be at the table, not just for discussions on nursing policy, but health policy, social policy, housing, education. We need to be where all the social determinants of health are discussed.”
ICN enables this to happen at the highest level, by working with the labyrinth of specialised agencies that make up the United Nations (UN) system – and particularly with the World Health Organization (WHO), the International Labour Organization and the World Bank.
Feeding into WHA
The meetings we attended in Geneva were timed to feed into the World Health Assembly (WHA), a biennial gathering of the world’s health ministers and officials taking place under the auspices of the UN, the following week.
For the first two days in Geneva, we met more than 100 leaders of national nursing associations (NNAs) from around the world.
Then we all came together with regulators (including our Nursing Council) and government chief nurses in the Triad meeting, to formulate a nursing response to some of today’s key global issues.
The initial discussions revealed a remarkable level of agreement about the health issues facing the various NNAs, and about the necessary responses. The demands of ageing populations, non-communicable diseases and health workforce shortages have resulted in a worldwide shift towards nurse-led health care in the community.
To continue this shift, we discussed implementing the WHO’s Global Strategy on Human Resources for Health: Workforce 2030. This strategy was adopted unanimously by the WHA meeting which followed, in a resolution that also affirmed “the emerging political consensus on the contribution of health workers to improved health outcomes [and] to economic growth” and the “mounting evidence that investments in health workforce . . . are conducive to economic and social development”.
The New Zealand government delegation to the WHA voted in favour, along with all the other countries, but also spoke about a need to ensure the best return on investments.
Meanwhile, the top-level shift away from thinking about health workers as a “cost” to the economy was also apparent during our ICN discussion of the UN Commission on Health Employment and Economic Growth and on the WHO Strategic Directions for Nursing & Midwifery 2016-2020, which was formally launched at the ICN NNA meeting.
Introducing that document, Catton commented that “there’s a healthy scepticism which says, strategies come and strategies go, and nothing changes”.
So NNA leaders were asked to come up with plans on how we could advocate for, influence and support implementation of these strategies back in our home countries, to ensure changes happen this time. A wide range of approaches was presented, including wielding our industrial power as unions and mobilising for political campaigns.
But there’s always a danger that powerful global institutions like the UN, WHO and the World Bank will drive the agendas of NNAs and ICN, rather than the other way around. The way to avoid this danger is the same at the global level as it is within NZNO: the members must be the ones who set the direction.
So the speech from ICN CE Frances Hughes on her transformation and regional engagement plan to ensure “the sanctity of the NNAs” was very reassuring. “Your role is paramount”, she said. “You are our members. You give strategic direction to the ICN board.”
After this, NZNO took the opportunity to convene an impromptu meeting of NNAs from the Asia-Pacific region, to ensure nurses from our region are heard more clearly within ICN in future.
We didn’t achieve all our NZNO goals in Geneva. In particular, more work will be needed to increase global understanding of indigenous nursing issues.
But we did manage to put pay equity for women onto the global agenda, getting the issue into discussion summaries at the NNA meeting and successfully proposing its inclusion in the official communiqué from the Triad meeting to the WHA. And we strengthened the message sent to the WHA about the need to invest more in nursing and midwifery workforces.
But if NZNO representatives are listened to in international forums like this, it is because of the efforts of NZNO members and staff. Your collective actions, in campaigns like “All the Way for Equal Pay” and the new “Speak Up for Health” campaign for better health funding, are what can elevate these issues all the way up to the international level.
So the next time you feel you’ve run up against a brick wall when you’re trying to make change, please take a deep breath and keep on pushing. •
(First published in Kai Tiaki Nursing New Zealand, June 2016. Reposted with permission).