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Nurses: A best buy

Stock Photo - Indian nurses at road. Street photo, Shot at Gandhi Maidan, Patna, Bihar, India on 25.02.15 at afternoon hours.
Nurses pictured in Patna, Bihar in 2015. Image credit: UPA GHOSH / 123RF

In April of last year, I authored a piece for Health Issues India referring to nurses as “healthcare’s front line.” The COVID-19 pandemic was then in a relatively nascent stage for India. Over the course of the following year, the situation has considerably changed. India is presently the country second worst-affected by COVID-19 in terms of confirmed cases thus far and currently faces a vicious second wave which only continues to explode. At the time of writing, India is embattled by more than three million active cases and has lost well in excess of 250,000 lives. The role of nurses in combating the pandemic cannot be understated – but as with many facets of the healthcare system, there is a gap when it comes to the profession. 

As Quartz reports, “since June 2020, the Central government claims it has hired 2,206 specialist doctors, 4,685 medical officers and 25,593 staff nurses in public hospitals across the country, through recruitments under the National Health Mission. But these recruitments have fallen short of the level the country needs.” The country, as the article outlines, is not in a surprising predicament. “The recruitment delays are hardly surprising in a country that allocated just 0.34 percent of its GDP towards healthcare in the middle of a pandemic,” it notes.

International Nurses Day, observed today, serves as a reminder of the deficit in nursing capacity in India and why it desperately needs to be addressed. As I summarised in last year’s piece, citing multiple sources

“COVID-19 is highlighting how nurses, midwives, and other health workers are the saviours of the health system, with India being no exception to this reality. Writing in The Asian Age, journalist Sunanda K. Datta Ray emphasised that “India desperately needs its doctors and nurses.” Of nurses, Ray wrote “we can’t do without them.”

“Ray pointed to the ratio of nurses to the population, noting that the country has only 1.7 nurses per thousand people, well short of the [World Health Organization]-recommended three-per-thousand.” At the global level, the world is short of the nurses it needs to – as the WHO writes in its report – “deliver on the promise of “leaving no one behind” and the global effort to achieve the Sustainable Development Goals (SDGs).” Nurses, the WHO notes, “make a central contribution to national and global targets related to a range of health priorities, including universal health coverage, mental health and noncommunicable diseases, emergency preparedness and response, patient safety, and the delivery of integrated, people-centred care.” 

“With this in mind, the WHO’s pronouncement that “no global health agenda can be realised without concerted and sustained efforts to maximise the contributions of the nursing workforce” seems patent. Yet, the world does come up short on a number of factors.

“Even as the world is home to a nursing workforce of 27.9 million, this is “not…commensurate with the universal health coverage and SDG targets.” The WHO report identifies a global shortage of nurses posited at an estimated 5.9 million in 2018 – a gap partially plugged since the 2016 shortage of 6.6 million but still one that presents a major obstacle. Low- and lower middle-income countries bear the brunt of nursing shortages worldwide, accounting for 89 percent of the gap – translating to a personnel shortage of 5.3 million approximately.”

In the more than a year since, the global need to invest more heavily in nursing has become only more apparent. A Lancet study published earlier this week established clearly how “more nurses lead to fewer patient deaths and readmissions, shorter hospital stays, and cost-savings for hospitals.” 

“Part of the reluctance to bring in a minimum nurse-patient ratio mandate from some policy-makers is the expected rise in costs from increased staffing,” said Professor Patsy Yates of the Queensland University of Technology School of Nursing. “Our findings suggest that this is short-sighted and that the savings created by preventing readmissions and reducing length of stay were more than twice the cost of employing the additional nurses needed to meet the required staffing levels — a clear return on investment. Often, policy-makers are concerned about whether they can afford to implement such a policy. We would encourage governments to look at these figures and consider if they can afford not to.” 

Fundamentally, nursing is a best buy – an investment which yields great returns in terms of how it benefits public health. But appreciation too is key. We must invest in nurses, their welfare, and their training. The pandemic has underscored this, but a deficit of nurses is not a new problem – and without action, it will continue to be at the detriment of our healthcare systems and those who depend upon them.

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