Nursing and Health Policy Perspectives

Abstract

I chose ‘access’ as my watchword for this ICN Quadrennium. By this I mean access by populations to health care, including primary health care (PHC), access by nurses to contemporary education programs, and access by governments and policy makers to nursing advice. The last notion is my focus for this column. More than ever before nurses are crucial to building and strengthening the health care systems within which they work. Nurses are the principal providers of PHC in the developing nations of the world. Their role will inevitably be enhanced as demographics change due to ageing populations and the increased incidence of chronic disease. Thus nurses must be central to the process of building and strengthening health systems. Whilst it may seem to be a ‘no brainer’ for governments to engage nurses in decision-making for health, the reality is often very different. In some situations nurses and their associations cannot gain access to the policy debate on which decision-making is predicated without forming partnerships with other groups. These groups may be other nursing bodies, consumer or employer groups, or organisations representing other health professionals with similar interests in the specific issue. Collaborating with other groups is not without risk as there may only be a narrow convergence of goals and lobbying activity will need to be contained. On the other hand, a consortium can often exert more power than a single group acting alone. Nurses and consumers are a formidable alliance and too often this potential grouping is overlooked. For such an alliance to be effective, both groups need well-articulated and congruent goals. Nurses can provide valuable perspectives on the population health needs of communities as well as on wider health system design. The International Council of Nurses (ICN) through contact with its more than 130 members is aware of many examples of nurses influencing access by consumers to health care at the country level. Let me illustrate the breadth of nurses’ influence by offering a few examples of lobbying and engagement efforts that resulted in enhanced health systems for consumers. In Denmark, nurses providing care for patients with back problems maintained regular contact with them by telephone, which had the effect of reducing hospital admissions by half. This program both increased access by patients to health care and reduced inpatient costs. In the area of tuberculosis care, nurses in Lesotho and the Philippines have led their countries in the prevention, care and treatment of tuberculosis, thus facilitating access by their populations to health care. An outstanding example of nurses’ power can be seen today in the United States. The American Nurses Association lobbied long and hard along with others to achieve passage of the Affordable Care Act, which contains provisions for extended health insurance coverage for people who were previously uninsured. Nurses’ engagement in this debate was critical since they understood the health system from a consumer perspective and saw how it needed to be changed to increase access to care. Another example is the successful campaign for reform of aged-care waged over some years by the Australian Nursing Federation in collaboration with a range of groups with similar goals. The campaign culminated in a significant increase in funding for all aspects of aged care benefiting both the aged population and aged-care nurses. These examples constitute but a snapshot of the power of nurses to influence the policy debate and decisions in health care. Nurses must continue to be engaged even though such involvement takes time and energy and may not always succeed. Because governments change, a key challenge for nursing organisations is to maintain the right level of exposure and interest in the health policy debate so that apolitical nursing advice can be sought. In most countries nurses constitute the largest group of health professionals. We have a unique role to play in health policy development and we must ensure that we fulfil it for the benefit of the populations we serve. It is critical that we share our successes and provide support to our colleagues across the globe.