Promoting access to health care: a nursing role and responsibility

Abstract

Worldwide, a range of complex and interconnected factors impact on the capacity of health systems to provide safe and effective health care. One key determinant is access. Often those with the greatest need for health care are those least likely to gain access to it (Balarajan et al. 2011). Seeking to increase and improve access to health care is a vital consideration in addressing the major health status inequities that exist between population groups, between men and women, and between developed and developing nations (International Council of Nurses 2011). The International Council of Nurses (ICN) acknowledges that health outcomes are principally socially determined and the ability to gain access to health care services is key to addressing gaps in health status and to achieving the Millennium Development Goals (ICN 2011). The social determinants of health include access to well-resourced health care and the importance of this aspect cannot be overstated. I chose ‘access’ as the watchword for my ICN presidency as access by the community to sufficient and well-allocated health care is essential to achieving greater equity in health outcomes. Given the central role of nurses in health systems across the world, it is our responsibility to play an active role in facilitating and improving access to health care particularly where it is hardest to reach and needed the most. In recognising this need, ICN selected as the theme for International Nurses Day 2011, Closing the gap: increasing access and equity. Using this theme, we have sought to communicate to nurses that they have an essential role in the provision of equitable, accessible health care. In describing what is meant by ‘access,’ ICN referred to Chapman et al. (2004) noting ‘good access exists when patients can get the right services at the right time in the right place’. In promoting access, we also are seeking to engender equity within our health systems to reduce barriers to access to health care. Access barriers vary widely. They may be geographic, structural, socio-economic, gender-based, cultural, or related to a lack of expenditure and service availability within health systems. Awareness of such barriers is the first step in overcoming them. Nurses play a vital role in ameliorating inequities of access in all aspects of health care including prevention, education and the delivery of health care. The ICN Code of Ethics for Nurses (2006) reminds us that we have a professional obligation to advocate for development and change that seeks to improve health outcomes. The strategic strengthening of primary health care systems must be a central component of any reform processes aiming to overcome obstacles to increase access to health care (Balarajan et al. 2011). This position is firmly supported by the World Health Organization (WHO) resolution WHA62.12 Primary health care, including health systems strengthening (WHO 2009). The resolution strongly urges governments to strengthen health systems based on a primary health care approach and emphasises the need to train and retain health workers including primary health care nurses. As a key pillar for the promotion of access to primary health care, governments must strategically invest to support their primary health care nursing workforce and increase its nursing services. Nurses are the principal providers of primary health care in many of the nations of the world. This fact places us in a prime position to support and, where possible, drive efforts to address inequalities in access to health care faced by our communities and by disadvantaged population groups.