1.1 Involvement of nurse and midwife in health policy formulation & programme planning1.2 Strategic planning for nursing & midwifery workforce management as an integral part of HRH planning and health system development1.3 Financing

2. EDUCATION ,TRAINING & DEVELOPMENT

3. DEPLOYMENT AND UTILIZATION

3.1 Appropriate skill mix and competencies3.2 Relevant nursing & midwifery infrastructure 3.3 Effective leadership and management3.4 Good working conditions and efficiently organized work3.5 Technical supervision systems 3.6 Career advancement opportunities3.7 Incentive systems3.8 Job satisfaction

2.1 Coordination between education & service2.2 Student recruitment2.3 Competency-based education2.4 Multi disciplinary learning2.5 Life long learning culture2.6 Continuing education system

5. EVIDENCE-BASED DECISION MAKING

COMPETENT AND MOTIVATED NURSING AND MIDWIFERY PERSONNEL

QUALITY NURSING AND MIDWIFERY CARE

QUALITY, EQUITABLE & ACCESSIBLE HEALTH SERVICES

1. POLICY AND PLANNING

4. REGULATION

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In-depth country assessmentsFormulation of Multidisciplinary Advisory Team of WHO-SEARO (2001)Conducted in 2001-2002 in 10 SEAR countriesUsing protocols for in-depth country assessment based on frameworkAnalysis of country assessments

GUIDELINES

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Methods of Data Collection:InterviewsDocument search and reviewFocus group discussionsMultidisciplinary discussionsNurse-specific focus group discussionsSurveysObservation

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SEAR Countries:BangladeshBhutanDPR KoreaIndiaIndonesiaMaldivesMyanmarNepalSri LankaThailand

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Analysis of Country Assessments:Brief Summary of FindingsPolicy and Planning:Inadequate involvement of nurses in policy and planningInadequate capacity and capability of nurses to effectively contributeLimited strategies and opportunities to develop capacity and capability

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Analysis of Country Assessments:Brief Summary of Findings.Education, Training and Development:Absent or weak linkages and interdependency between the education and service sectorsFew current problems with the number of students being recruited but there are issues with the quality and professional potential of those recruited.Achieving competency-based education and modern teaching methodology and skills requires considerable effort.There are few multidisciplinary learning opportunities for nursesDifficulty in encouraging, promoting and achieving a culture of lifelong learningContinuing education other than Thailand, is ad hoc and inadequate.

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Analysis of Country Assessments:Brief Summary of Findings.Deployment and Utilization:Shortage and maldistribution of nursing personnel along with an inappropriate professional skill mixFew initiatives to strengthen the flexibility of nursing workforceRosters are not evidence based and are in need of revisionBasic equipment is lackingSustainable funding is problematic and inequitably distributed, particularly between urban, rural and remote areasNursing professional associations are essential but need to be strengthened as do leadership and management

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Analysis of Country Assessments:Brief Summary of Findings.Deployment and Utilization..:Working conditions need improving: salaries are low, health facilities are poor and unsafe for staff, inappropriate nurse:patient ratios, nurses are subject to physical and verbal abuse, housing and transport are often unsatisfactory, incentives are poor, mutual respect between nurses and with other members of the health team need strengthening.

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Analysis of Country Assessments:Brief Summary of Findings.Technical supervision is poor overall and the approach to continuous quality improvement and encouraging motivation is weakThere are few developmental opportunities for nurses to improve technical supervision skillsCareer advancement opportunities are few and higher-level nurse clinical practitioner training is largely absentEvidence base is inadequate to accurately assess job satisfactionIn Bangladesh, DFID survey showed that 90% of nurses were dissatisfied

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Analysis of Country Assessments:Brief Summary of Findings.Regulation:Most countries have nursing or health council or other regulatory mechanisms in place.Robustness of regulation for nurses is uneven across SEAR, despite the extensive evidence base now available on the impact of strengthened regulation, and best-practice approaches to regulation.

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Analysis of Country Assessments:Brief Summary of Findings.Evidence Base for Decisions:Limited information systems available Limited local researchLimited access to evidence bases being developed in other countries, with financial constraints cited as the most common reason for the weaknessesA center for evidence-based best practice in nursing has been established in Thailand

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GUIDELINES for Member CountriesPurposes:To strengthen the management of nursing workforceTo minimize or avoid the impact of the global crisis in nursing (shortage of nurses, maldistribution of nurses along with an inappropriate skill mix)

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Using GuidelinesA selection of priority actions to effectively develop and manage the nursing workforce To be used by government policy developers & policy managers, clinical multidisciplinary and nurse leaders; to debate, adapt, select, develop new priority actions, and then implement, monitor and evaluateEach country could select priority actions most relevantEach country develop and effectively implement a National Strategic Plan for Nursing Development

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Managing ChangeOperational level (easiest and quickest level to achieve change and focuses on practices and procedures)Strategic level (focuses on mid-to longer-term strategies targeting sustainable system change; e.g. National Strategic Plan Attitudes and behaviors level (targeting individual, group, and organizational attitudes and behaviors-the most complex change to achieve and takes the longest time:3-10 years)

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In-depth Country AnalysisWHO-SEAROGuidelinesCountry Strategic Plan of ActionIn Nursing Workforce Management

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Reminder:Everyone has the right to work, to free choice of employment, to just and favorable conditions of work and to protection against unemployment.:The thought of all human beings are interconnected, affecting each other and in turn affecting the entire universe (Itzhak Bentov)

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