Five Questions With….Elizabeth Iro

Why is your appointment so significant for the WHO and the position and influence of nurses and midwives worldwide?

Women make up 75% of the global healthcare workforce, they contribute nearly $3 trillion to the industry and nurses and midwives (90% of which are female) make up over 50% of this. In my home region, the western pacific region, nurses and midwives are 70% of the health workforce.

So it is disheartening to see that women continue to represent most of the health workforce worldwide yet remain the minority in global health leadership. But I have to commend my boss the Director General of WHO Dr Tedros – not only for his appointment of a strong leadership team, but for the first time, achieving gender parity in WHO’s top ranks, with women outnumbering men, and with more geographical diversity than ever before. This is very historic.

His appointment of me in the role as Chief Nursing Officer of WHO in his leadership team has signaled another strong message to the international, regional and national level of the importance of nurses and midwives to health care.

This is an exciting time for nurses and midwives as we all come to align our efforts for better and optimised health outcomes for both those receiving care and those providing the care.

What are the main challenges which affect the nursing and midwifery profession and what impact do you think the Nursing Now campaign may have on this?

We know that investing in nurses and midwives brings more women into the workforce and thereby contributes to greater equity between men and women in employment and financial independence.

However, I agree that too often women’s contributions go unpaid and unrecognized – and their stories of impact go untold. I would also add women’s hard work ‘done well’ is often invisible, maybe we pride ourselves in being humble and achieving success without a fuss.

We need to navigate the political, policy and economic field in order to articulate and reposition nursing and midwifery so it is truly valued for what it can contribute to achieving the SDGs and Universal health coverage. The priority of WHO.

We know that only 35% of participants in cardiovascular research trials are women. A review of Australia’s Medical Research grants showed nearly all the grants went to male led teams and we are also not very good at leveraging the success of our champions for example, Mary Renfrew, who led the Lancet report on Midwifery received a prestigious award elected as a Fellow of the Royal Society of Edinburgh (FRSE) – the first midwife or nurse to receive that honour alongside the likes of Benjamin Franklin!

So we have a long way to go to ensure women’s and relevant health professionals’ voice is heard on many committees and high level commissions.

I am aware that integrating and scaling up our efforts to strengthen the nursing and midwifery agenda will require greater political will, effective leadership, long-term commitment and predictable, sustained financing. Part of the solution lies with strengthening capacity for nursing leadership and policy engagement in national level policy and decision-making processes and this is where the strength of the Nursing Now campaign, which I know THET is an avid supporter of, lies.

How will the WHO look to address these challenges?

For too long and in too many countries nursing and midwifery leaders have been absent from the policy dialogue and decision making – that is beginning to change. Work is already in action to review nursing and midwifery education and WHO will continue to work with partners, academic institutions, ICM, ICN to ensure quality education and educators.

This will all be organized to ensure that the following priorities are kept at the centre of building a quality nursing and midwifery workforce:

• Quality education
• Nursing and midwifery competencies
• Regulation and professional standards
• Support behavior change that leads to quality nursing and midwifery
• Respectful care

Beyond this and to help us move faster, We (nurses and midwives within headquarters at WHO working across different departments) have established a WHO Taskforce for Nursing and Midwifery. This is more than a group of nurses and midwives, it will be a cross-cutting multi-disciplinary Task Force of champions across HQ, regions and countries to address leadership, collaboration, coordination, partnership and research. It provides an interdisciplinary platform to strengthen, mainstream and make visible the contributions of WHO nurses and midwives at HQ, regional and country offices, to deliver  on the priorities of WHO with a focus on Universal Health Coverage.

We know that nurses and midwives are key members of any health interdisciplinary team, they are at most times the first and only person patients see, and sometimes may be the only health professional a person sees.

A fit for purpose workforce in specific country context will be critical and a multidisciplinary approach to healthcare at global, regional and country level will be required, recognising that impact must be within countries.

But I want to ensure that nursing and midwifery is at the heart of all that we do in WHO, so that all women and newborns, children, men  and their families everywhere really can get the best quality of care and ensure they are all treated with the dignity they deserve.

In addition capitalising on global and regional events is important to leverage the enhancement of the contribution that nurses and midwives make to achieving universal health coverage and why investing in nurses and midwives is a very good option.

What are your ambitions for the UK contribution towards improving the nursing and midwifery professions (and what do you think the role of health partnerships is in this)?

The Government needs to ensure quality midwifery and nursing education is a priority and are delivered by competent educators. There needs to be more investment in education and training.  According to Jane Cummings England’s Chief Nursing Officer the “NHS is built on the backs of people from overseas.”

In this regard establishing twinning programmes to support LMIC countries could contribute to strengthening nursing and midwifery globally. Health partnerships can support this endeavour with sponsorship for such programmes.

What was your highlight of the WHA?

It was a fantastic Assembly this year. I have so many highlights but certainly bringing together the WHO Nursing and Midwifery Taskforce to highlight the nursing campaign at WHO was up there. It was also fantastic to take part in meetings where I was able to continuously impress the importance of nursing to WHA attendees. I think the next year ahead is certainly going to be a busy but exciting one and I look forward to seeing the fruits of our labours in the months and years to come!