ICN Policy Brief

World Health Organization Global Strategy on Human Resources for Health in

the era of the post 2015 Sustainable Development Goals:
Nursing’s Essential Contribution

Author
Prof Jill White, AM RN RM MEd PhD

Purpose
The purpose of the paper is to provide a background for NNAs to have a common
understanding of the current global health agenda and the process for decision making at
what is a most critical time for future direction setting. ICN’s ultimate intention is to assist
NNAs to better contribute to the national and global agenda setting.
This paper should be read in relation to the zero draft of the “WHO Global Strategy on
Human Resources for Health: Workforce 2030” www.who.int/hrh/resources/glob-strat-
hrh_workforce2030.pdf

Background
The Millennium Development Goals (MDGs) with the end-point of 2015 have been a
powerful force in maintaining political support for health development because of the clarity
of the objectives and measurable targets. The post-2015 development agenda has been
driven by the United Nations (UN) High-level Panel of Eminent Persons. This High-level
Panel received a report from a UN System Task Team, which set out a broad framework for
post- 2015, with four pillars: inclusive economic development; environmental sustainability;
inclusive social development - including health; and peace and security, underpinned by
human rights, equality and sustainability.1 Ultimately this work led to the development, and
formal endorsement, at UN meeting on 25 September 2015, of the Sustainable Development
Goals.2 There is no doubt that the SDG agenda will provide the investment framework for
the next 15 years.
The SDG agenda addresses many of the “unfinished business” of the MDGs and takes the
new health landscape into account. While keeping the health MDG targets, the growing
challenge of NCDs and their risk factors have also been included, with clear targets and
indicators being developed.3 With the formal approval of the SDG goals and targets, the
WHO Global Strategy on Human Resources for Health: Workforce 2030 will provide
concrete recommendations and ideas on how to achieve these targets at a more technical
level.

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Sustainable Development Goals (SDGs)
For 15 years, the MDGs became the focus of the funding priorities for work with developing
countries and the targets against which progress in world health was largely measured. They
quickly a major global focus and spawned some very influential and now very large health
care organisations such as GAVI (immunisations), the Global Fund and UNAIDS (HIV/AIDS
and other infectious diseases); and increased prominence for organisations such as UNFPA
(maternal health).
The next 15 year strategy for the UN is embodied in the SDGs and is well underway, having
commenced in Rio in 2012, and formally adopted in 2015.2 The goals and targets will be
followed-up and reviewed using a set of global indicators. These will be complemented by
indicators at the regional and national levels which will be developed by member states, in
addition to the outcomes of work undertaken for the development of the baselines for those
targets where national and global baseline data does not yet exist. The global indicator
framework, to be developed by the Inter Agency and Expert Group on SDG Indicators, will
be agreed by the UN Statistical Commission by March 2016 and adopted thereafter by the
Economic and Social Council and the General Assembly, in line with existing mandates. This
framework will be simple yet robust, address all SDGs and targets including for means of
implementation, and preserve the political balance, integration and ambition contained
therein.
It is critical that the nursing profession understands the importance and potential impact of
the SDGs and, having already missed the conversations related to the setting of the goals
and targets,3 we must ensure we are in at the beginning of the process of determining the
indicators by which progress will be measured. If the indicators chosen are not sensitive to
nursing’s input and impact then the profession risks invisibility for the 15 years span, 2016-
2030.
There are some very important distinctions between the MDGs and SDGs. There were only
eight MDGs and nursing saw itself as explicitly relevant to three: MDGs 4 Reduce Child
Mortality; MDG 5 Improve Maternal Health; and MDG 6 Combat HIV/AIDS, Malaria and
other diseases. The focus of the MDGs was explicitly on developing countries.
The SDGs are quite different. ALL countries, irrespective of their income status, are to be
involved, as it is acknowledged that even in the high income countries there are great areas
of inequality and the actions of high income countries have direct global impact effecting
future sustainability.

The Official Agenda for Sustainable Development adopted on 25 September 20152 has 92
paragraphs, with the main paragraph (51) outlining the 17 Sustainable Development Goals
(Appendix 1) as follows:

1. End poverty in all its forms everywhere

2. End hunger, achieve food security and improved nutrition and promote sustainable
agriculture[
3. Ensure healthy lives and promote well-being for all at all ages
4. Ensure inclusive and equitable quality education and promote lifelong learning
opportunities for all
5. Achieve gender equality and empower all women and girls
6. Ensure availability and sustainable management of water and sanitation for all
7. Ensure access to affordable, reliable, sustainable and modern energy for al
8. Promote sustained, inclusive and sustainable economic growth, full and productive
employment and decent work for all

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 9. Build resilient infrastructure, promote inclusive and sustainable industrialization and
foster innovation
10. Reduce inequality within and among countries
11. Make cities and human settlements inclusive, safe, resilient and sustainable
12. Ensure sustainable consumption and production patterns
13. Take urgent action to combat climate change and its impacts
14. Conserve and sustainably use the oceans, seas and marine resources for
sustainable development
15. Protect, restore and promote sustainable use of terrestrial ecosystems, sustainably
manage forests, combat desertification, and halt and reverse land degradation and
halt biodiversity loss
16. Promote peaceful and inclusive societies for sustainable development, provide
access to justice for all and build effective, accountable and inclusive institutions at
all levels
17. Strengthen the means of implementation and revitalize the global partnership for
sustainable development

As noted above, there is one health related goal: Goal 3 “Good Health and Well-being:
ensure heathy lives and promote well-being at all ages”, and this has nine sub-goals or
targets (See Appendix II). However, as seen above, many of the others SDGs relate to
health, not the least being Goal 6 “clean water and sanitation” which is inherently also linked
to Goal 13 “climate action” particularly for our Island and Delta countries. This underlines the
intent of the SDGs which is that they are deliberately “integrated and indivisible and balance
the three dimensions of sustainable development”: economic, social and environmental.2

Other SDG targets that directly impact health

• Eliminate all forms of violence against all women and girls in the public and private
spheres, including trafficking and sexual and other types of exploitation
• Significantly reduce all forms of violence and related death rates everywhere
• End abuse, exploitation, trafficking and all forms of violence against and torture of
children
• By 2030, end hunger and ensure access by all people, in particular the poor and
people in vulnerable situations, including infants, to safe, nutritious and sufficient food
all year round
• By 2030, end all forms of malnutrition, including achieving, by 2025, the internationally
agreed targets on stunting and wasting in children under 5 years of age, and address
the nutritional needs of adolescent girls, pregnant and lactating women and older
persons
• By 2030, achieve access to adequate and equitable sanitation and hygiene for all and
end open defecation, paying special attention to the needs of women and girls and
those in vulnerable situations
The infrastructure is well is in place to tackle the first three goals as they were carried over
from the MDGs. However, nursing’s potential role with NCDs, with substance abuse, with
traffic accidents and injuries, sexual and reproductive health services, affordable, accessible
models of care, and environmental safety are to be convincingly made to our governments
and our impact accounted for explicitly in the indictors for each of these areas. We have
evidence and must therefore produce it in a compelling locally relevant story. Each country is
to develop their own exact accountable target so the opportunity for local influence exists.

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As of August 2015, there were 169 proposed targets for these goals and 304 proposed
indicators to show compliance. 3

For further information on the SDGs, click on this link - a one hour briefing for journalists on
the SDGs.

http://kff.org/global-health-policy/event/web-briefing-for-media-what-do-the-
sustainable-development-goals-mean-for-global-health/

WHO Global Strategy on Human Resources for Health: Workforce 20304

The Global Strategy was developed in response to a resolution passed at the 2014 World
Health Assembly (WHA) which recognised the development of the SDGs and the importance
of a global HRH strategy to support this work. The draft strategy builds upon global evidence
and experience, as well as broad-based consultation in the period 2013-2015 with experts at
the global, regional and national level, and has been informed by thematic papers, related
global guidelines, policy commitments, regional strategies and initiatives. ICN was actively
involved throughout this process, participating in the thematic work groups and commenting
throughout the drafting of the Strategy.
ICN encourages NNAs to become familiar with the document given its future relevance to
the SDGs and the development agenda for the next 15 years.
As noted, the document starts with a “Vision” statement of the Global Strategy on HRH
which states that it seeks to:
“Accelerate progress towards Universal Health Coverage and the Sustainable Development
Goals by ensuring equitable access to skilled and motivated health worker within a
performing health system.”4
The supporting overall goal further elaborates this statement by identifying that, “ensure(ing)
availability, accessibility, acceptability and quality of the health workforce through adequate
investments and the implementation of effective policies at national, regional and global
levels, for ensuring healthy lives for all at all ages, and promoting equitable socio-economic
development through decent employment opportunities.” This section is followed by a series
of supporting principle statements.

Equitable access, skilled and motivated health worker, and a performing health system are
easily understood as essential building blocks for achieving improved health outcomes,
despite the difficulties in achieving these. As well it is important to reflect upon what the
meaning and significance of the words Universal Health Coverage and Sustainable
Development Goals.

Universal Health Coverage (UHC): The WHO definition of UHC is “to ensure that all people
obtain the health services they need without suffering financial hardship when paying for
them. This requires:
• a strong, efficient, well-run health system;
• a system for financing health services;
• access to essential medicines and technologies;
• a sufficient capacity of well-trained, motivated health workers.”6,7

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There is now international agreement that not only are catastrophic healthcare costs
devastating for individuals and families but that they have a highly negative impact on
country level productivity and economics. There are many different ways in which countries
are seeking to provide a form of safety net for people, but, whatever the strategy, the goal is
the prevention of the health related financial hardship.
The next sections of the Global HRH Strategy identify four objectives with targets and
supporting policies. Reading this section of the Global Strategy document carefully, it is
important to consider how this relates to your country and your countries specific positioning.

How can nursing assist its government to determine its targets and then to meet
them?
The objectives are:
1. Optimize the existing workforce in pursuit of the SDGs and UHC (e.g. education,
employment, retention)
2. Anticipate future workforce requirements by 2030 and plan the necessary changes (e.g.
a fit for purpose, needs-based workforce)
3. Strengthen individual and institutional capacity to manage HRH policy, planning and
implementation (e.g. migration and regulation)
4. Strengthen the data, evidence and knowledge for cost-effective policy decisions (e.g.
Minimum Data Set + National Health Workforce Accounts)

The Strategy ends with two sections that identify the roles for both the WHO Director
General and NGO and other stakeholders to support the work. Again, it is important for
NNAs to reflect upon what this means to your country and what role you could play.

Steps in Formal Adoption of WHO Global Strategy on HRH: Workforce 2030

The consultation process by WHO on the Global Strategy has followed their normal
governance process: online public consultations were held in July-August 2015; Member
States consultation at WHO Regional Committee meetings in Sept-Nov 2015; EB discussion
in January 2016; and WHA formal adoption in May 2016.
The first two steps in this process have been completed. ICN submitted an online
commentary on the strategy. This was shared with all NNAs who were encouraged to
participate. As well, ICN co-hosted with WHO, a formal consultation as part of the CNR in
Korea in June 2015.
WHO staff are currently redrafting the document based upon these consultations. A revised
version of the Global Strategy for HRH: Workforce 2030 will be discussed by the EB of the
WHO at its January 2016 meeting and considered at the WHA in May 2016.
As noted above, the input to WHO at this stage is through the country and regional meetings
and representations, hence the importance for all national nursing associations to be
knowledgeable about the process and informed about the evidence which demonstrates
nursing’s contribution to meeting the vision and goals of the WHO and making this
information available to their country representatives, where possible urging participation of
senior nurses with country delegations to WHA in May 2016.

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Role of NNAs and Nursing
The role of nursing in such a strategy is of utmost importance to ICN and the more than 16
million nurses practicing worldwide.8 As noted throughout this document, ICN has been
actively involved with WHO throughout the development process of this Strategy. However
ICN members have an important role to play in ensuring that nursing voices are heard
throughout the development process. It is their Ministries of Health who participate as
members of WHO and have the opportunity to comment at the WHO Executive Board
meeting in January 2016, and the WHA in May when the strategy will be brought for final
endorsement.
As the face and national voice of nursing in the country, NNAs have a tremendous
opportunity to advocate and reinforce the critical role of nurses in the development of quality
health policy and the effective and efficient redesign of health systems that increase access
and deliver effective health interventions. As such, NNAs are the conscience and moral
compass of the profession to whom individual nurses and the public looks to for guidance
and leadership on vital health issues and policies. These issues and policies include access
to care, quality of care, patient safety, and safe working environments. Healthcare financing
underpins all these issues.8,9

ICN Support for NNAs

The WHO under the current Director General, Dr Margaret Chan, has become very focused
on evidence based policy. Being abreast of the evidence in relation to human resources for
health and its impact on patient and population outcomes will enable NNAs to assist your
government in meeting its targets through nursing. This is a leadership opportunity that is
important not to miss.
With this in mind, ICN is preparing a series of policy briefs, using nursing evidence, which
NNAs and ICN would use to brief their governments and other stakeholders about the
essential contribution of nursing to the global HRH strategy succeeding and to achieving the
SDGs for our collective sustainable development.

About ICN
The International Council of Nurses (ICN) is a federation of more than 130 national nurses
associations representing the millions of nurses worldwide. Operated by nurses and leading
nursing internationally, ICN works to ensure quality nursing care for all and sound health
policies globally.

About the Author

Professor Jill White, Dean Emerita, Professor of Nursing and Midwifery, Faculty of Nursing
and Midwifery, University of Sydney, Australia. Senior Fulbright Scholar 2015, School of
Nursing, University of Pennsylvania. Senior Scholar in Residence ICN, May-June 2015,
Geneva. Professor White has extensive international experience, most recently in Tonga
and Vietnam. She was the founder of the UTS WHO Collaborating Centre and facilitated the
formation of the South Pacific Chief Nursing and Midwifery Officers Alliance.

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References

1. World Health Organization (2013). World Health Report. Research for Universal
Health Coverage. Retrieved from:
http://apps.who.int/iris/bitstream/10665/85761/2/9789240690837_eng.pdf

2. United Nations General Assembly (2015) Transforming our world: the 2030 agenda
for sustainable development. A/70/L.1, 18 September.

3. World Health Organization (2012). Health Indicators for Sustainable Development

Goals. Geneva: WHO. Retrieved from: www.who.int/hia/health_indicators/en/.

4. Global Health Workforce Alliance & WHO (2015) Health Workforce 2030 Towards a
global strategy on human resources for health: a synthesis paper of the thematic
working groups. Geneva: GHWA/WHO.

5. World Health Organization (2014). Global Coalition Calls for Acceleration of UHC.
Geneva: WHO. December 12. Retrieved at:
www.who.int/universal_health_coverage/en

6. ICN/World Bank (2014) Strengthening Community and Frontline Health Workers for
universal Health Coverage: Event Summary. July. Geneva. Retrieved at:
www.nurse.or.jp/nursing/international/icn/report/pdf/2014m/08-06.pdf.

7. Institute of Medicine (2011) The Future of Nursing: leading change, advancing

health. Washington, DC: The National Academic Press.

8. ICN (2015) Nursing a Force for Change: Care effective, cost effective. Geneva: ICN.

9. World Health Organization (2003) Investing in Health: a summary of the findings of

the Commission on Macroeconomics and Health. Geneva: WHO CMH Support Unit.

10. World Health Organization (2011) Strategic Directions for Strengthening Nursing and
Midwifery Services 2011-2015. Geneva: WHO.

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 APPENDIX I

SUSTAINABLE DEVELOPMENT GOALS:

http://www.un.org/sustainabledevelopment/sustainable-development-goals/

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 APPENDIX II
Goal 3. Targets.
Ensure healthy lives and promote well-being for all at all ages

3.1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live
births
3.2 By 2030, end preventable deaths of newborns and children under 5 years of age,
with all countries aiming to reduce neonatal mortality to at least as low as 12 per
1,000 live births and under 5 mortality to at least as low as 25 per 1,000 live births
3.3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical
diseases and combat hepatitis, water-borne diseases and other communicable
diseases
3.4 By 2030, reduce by one third premature mortality from non-communicable diseases
through prevention and treatment and promote mental health and well-being
3.5 Strengthen the prevention and treatment of substance abuse, including narcotic drug
abuse and harmful use of alcohol
3.6 By 2020, halve the number of global deaths and injuries from road traffic accidents
3.7 By 2030, ensure universal access to sexual and reproductive healthcare services,
including for family planning, information and education, and the integration of
reproductive health into national strategies and programmes
3.8 Achieve universal health coverage, including financial risk protection, access to
quality essential healthcare services and access to safe, effective, quality and
affordable essential medicines and vaccines for all
3.9 By 2030, substantially reduce the number of deaths and illnesses from hazardous
chemicals and air, water and soil pollution and contamination

3a Strengthen the implementation of the World Health Organization Framework

Convention on Tobacco Control in all countries, as appropriate
3b Support the research and development of vaccines and medicines for the
communicable and non-communicable diseases that primarily affect developing
countries, provide access to affordable essential medicines and vaccines, in
accordance with the Doha Declaration on the TRIPS Agreement and Public Health,
which affirms the right of developing countries to use to the full the provisions in the
Agreement on Trade-Related Aspects of Intellectual Property Rights regarding
flexibilities to protect public health, and, in particular, provide access to medicines for
all
3c Substantially increase health financing and the recruitment, development, training
and retention of the health workforce in developing countries, especially in least
developed countries and small island developing States
3d Strengthen the capacity of all countries, in particular developing countries, for early
warning, risk reduction and management of national and global health risks
http://www.un.org/ga/search/view_doc.asp?symbol=A/70/L.1&Lang=E

UN General Assembly, 18 September 2015.

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