Primary Health Care & Universal Health Coverage 2024

Posted on December 17, 2024 by nora

The International Council of Nurses (ICN) released an important discussion paper in September 2024. Nursing and Primary Health Care: Towards the Realization of Universal Health Coverage authored by David Stewart, Madrean Schober, and Howard Catton.

As I write this blog just after December 12 – Universal Health Coverage Day – it is an opportune time to reflect on the topic of the paper and its recommendations. The paper is well organized making it easy to work through its main body and appendices. Brief case studies are interspersed showcasing nursing leadership and innovations in different health systems and contexts.

In the introduction, the authors point out many of the current realities that stand in the way of achieving universal health coverage: resource constraints, fragmented care, underutilization of nurses, and lack of teamwork. They trace key developments in the PHC movement referring to the major global conferences and declarations – Alma-Ata (1978) and Astana (2018) – emphasizing foundational principles of primary health care. I was glad to see the sidebar quotation (page 8) on the difference between PHC and primary care, often a source of confusion.

Chapter 1: The case for change reviews the challenges and documented gaps. The value of PHC in improving population health outcomes is highlighted here. The focus on patients and a greater orientation to community control are highlighted throughout the discussion as is the case for funding. The key role of PHC in public health emergencies is illustrated by the COVID-19 pandemic. This chapter ends with a timely reminder about the vital aspect of PHC in delivering vaccination programs. Nurses have a key role in managing and delivering immunizations to all age groups and in a multitude of community settings.

Chapter 2: Reimaging the possibilities of nurses in primary health care. This chapter focuses on roles including advanced practice and documents how countries are promoting team-based models. Details are provided in tables and illustrations as well as in the case studies. The authors note that digital health is becoming more relevant to PHC education and practice and encourage innovation by nurses in design of appropriate digital tools.

Finally, it’s worth reading the conclusion; I find myself in complete agreement with the points offered including this statement: “PHC should be at the highest priority for governments because it is the cornerstone of a sustainable health system.” (page 51).

Appendix 1 offers a summary of ICN’s recent work on PHC highlighting papers, position statements, media initiatives, and ongoing partnerships.

The summary of the authors’ recommendations found in Appendix 2 is a useful tool organized into four groupings:

Care coordination
Integrated and team-based PHC
Advanced practice nurses
PHC nursing workforce

The recommendations encompass ideas for health system change, advocacy, interdisciplinary education, and action by professional associations. One of the many nursing workforce recommendations is to “increase the voice of PHC nurses in policy development and high-level decision making” (page 55).

Reading this rich discussion paper and reflecting on the interesting case studies reminded me of visits to primary health care centres in past travels to Aotearoa/New Zealand, Australia, Nepal, India, and at home in Canada. I wrote about experiences in Japan in my August 2024 blog Public Health Nursing in Japan: Then and Now reflecting on strengths of their system as it has developed. My appreciation of the reality of PHC is rooted also in early career experiences in a community health centre in rural Manitoba and at the Alexandra PHC Clinic in urban South Africa. In my home province of British Columbia, I worked with a coalition that promoted the CHC model and development of a network leading to the establishment of the British Columbia Association of Community Health Centres. Sometimes I wonder why we haven’t made greater progress when so many well-established centres exist as models in many countries including Canada.

An excellent resource in Canada is the Canadian Association of Community Health Centres with member CHCs across the country. As highlighted on its website CACHC is “the federal voice for Community Health Centres and community-oriented, people-centred primary health care across Canada.” Recent announcements following provincial elections in New Brunswick and British Columbia provide optimism for new centres on the horizon in 2025.

It has been a turbulent year in geopolitics including concerns about the interconnected issues of conflicts, environmental crises, and global health. The positive messages of the 2024 ICN discussion paper do offer us hope for a time when universal health coverage is realized.

By Nora Whyte – December 17, 2024

I acknowledge with respect that I live and work on the Unceded traditional territory of the K’òmoks First Nation.

Highlights of 2023

Posted on January 5, 2024 by nora

My professional highlight of 2023 was attending the International Council of Nurses (ICN) Congress in Montreal in July. I wrote about the experience in my summer post on the ICN Congress and have been reflecting on both the content and organization of the event since then. I was glad to meet new people and also to renew acquaintances with colleagues, some of whom I am connected with on social media and enjoy following their updates and commentary.

The ICN Congress provided opportunities to hear from people I follow such as James Buchan and Howard Catton who discussed their report published by ICN Recover to Rebuild: Investing in the Health Workforce for Health System Effectiveness. Their key message is “that without sufficient investment in well-supported nurses there can be no effective healthcare system recovery and rebuild” (Buchan & Catton, 2023, p. 4).

The experience in Montreal alerted me to watch for and share statements from Dr. Pamela Cipriano, ICN President, and Howard Catton, CEO, in the latter half of the year during the UN General Assembly and other global meetings. Continuing on its important ‘Nurses for Peace’ campaign, the ICN Board issued a strong statement in November on the Israel-Gaza conflict and maintains a dynamic presence on social media. See links below to recent statements:

UN Declaration on Universal Health Care

Universal Healthcare Day Statement

Climate and Health Declaration at COP28

Statement on the Israel-Gaza Conflict

In addition to the experience of the sessions at the ICN Congress, I participated in several webinars offered throughout the year including events hosted by the Canadian Nurses Association: the annual meeting in June and a town hall in September. A notable webinar at the end of the year was a highly informative session with Natalie Bryant from Australia featuring her current work on ‘Indigenist Critical Policy Analysis’. Grounded in the United Nations Declaration on the Rights of Indigenous Peoples, it is a framework for assessing organizational policies to determine whether they uphold Indigenous rights and address issues in their policy processes. I look forward to learning more about using the framework. Thanks to the BC Indigenous Health Nursing Research Program and the Nuu-chah-nulth Tribal Council Nursing Services Department for hosting this session.

My consulting focused on work with the Nuu-chah-nulth Tribal Council as we concluded a community-based research project last year. As a team member, it was satisfying to have our article published in the Canadian Journal of Nursing Leadership:

Watts. J., Bourque Bearskin, L. Blackstone, D. Christiansen, S. Young, K., Charleson, J., Charleson, R., Fraser, J., Sangster-Gormley, E., Dick, V., Duncan, S., & Whyte, N. (2023). Nursing the Nuu-chah-nulth Way: Communities driving nursing policy priorities. Canadian Journal of Nursing Leadership, 35(4), 55–67. doi:10.12927/cjnl.2023.27073

Another major highlight was the 50th Reunion of our UBC School of Nursing Class (BSN 1973) in May. It was a great, happy time of reminiscing and also gave us a chance to have conversations with classmates about our careers, families, and current interests. We spent time on the UBC campus and had a lovely evening at the Vancouver home of a classmate, Sherri Adams. The reunion committee did a fantastic job of arranging this milestone celebration!

My personal and professional worlds are intertwined in multiple ways. I think back on discussions this past year with a core group of friends and colleagues where the topics have covered writing and reading, conferences, career and retirement decisions, personal changes, the state of the world, travel, and gardening. Supportive friends, family, and close colleagues make it all worthwhile as the years go by.

By Nora Whyte – January 5, 2024

I acknowledge with respect that I live and work on the Unceded traditional territory of the K’òmoks First Nation.

Universal Health Coverage: New Political Declaration

Posted on September 27, 2023 by nora

Earlier this year I wrote about Universal Health Coverage (UHC) being on the agenda for 2023 in anticipation of the United Nations High-Level Meeting on UHC. The meeting took place in New York this September during the 78th Session of the United Nations General Assembly (UNGA). The resulting political declaration adopted on September 21 is entitled “Universal Health Coverage: expanding our ambition for health and well-being in a post-COVID world.”

The Political Declaration has 109 points beginning with background on past agreements and UNGA resolutions and moving into our current global context including urgent action needed to achieve the Sustainable Development Goals (SDGs).

The World Health Organization issued a media release on September 21 celebrating the approved declaration with its strong focus on primary health care:

“In the Political Declaration, Heads of State and world leaders committed to take key national actions, make essential investments, strengthen international cooperation and global solidarity at the highest political level to accelerate progress towards UHC by 2030, using a primary health care (PHC) approach.

For health care to be truly universal, it requires a shift from health systems designed around diseases to systems designed for people. PHC, an approach to strengthening health systems centred on people’s needs, is one of the most effective areas for investment to accelerate progress towards UHC.”

Further, as stated in the declaration , political leaders are called to recognize and act upon the health inequities that exist within and among countries. Throughout the document there is a call for greater political commitment along with global solidarity and cooperation to tackle “social, economic, environmental and other determinants of health” and to eliminate barriers to health care access. There are numerous points on Health Human Resources highlighting the need for national governments to invest in their health workforce and to attend to issues of migration.

UHC2030 Coalition

The UHC2030 Coalition continues its excellent advocacy as well as its educational work on UHC. The Action Agenda serves as a clear framework: Action Agenda from the UHC Movement – UHC2030

International Council of Nurses

The International Council of Nurses (ICN) was represented at the UNGA by President Dr. Pam Cipriano who gave presentations during the High-Level Meetings on Health. It was great to know that ICN brought strong global nursing expertise and presence to the deliberations. ICN had contributed to the Action Agenda as a member of UN High-Level Meeting Task Force. As Dr. Cipriano stated:

“The political declaration gives governments an opportunity to make a clearsighted and enduring change that will make a real difference by giving everyone equitable access to the health care that they need. Governments must not only make these commitments; They must follow through with the necessary investment to make these historic changes a reality that will benefit many millions of people who currently have little or no access to basic health care.”

ICN’s coverage included these media releases:

https://www.icn.ch/news/icn-president-says-universal-health-coverage-will-only-be-achieved-2030-if-there-dramatic

https://www.icn.ch/news/icn-president-calls-resilient-health-systems-un-high-level-meeting-pandemic-prevention

Much more will be written about the UHC movement, the SDGs and the UHC 2030 action agenda. We need to ensure that the momentum is sustained along with the renewed enthusiasm for primary health care.

By Nora Whyte – September 27, 2023

I acknowledge with respect that I live and work on the Unceded traditional territory of the K’òmoks First Nation.

Updates on Nursing Associations 2022

Posted on June 27, 2022 by nora

I’m writing this update at the end of June in advance of our summer break in Canada. World events in the first half of 2022 have left us shaken and concerned about the future as we grapple with climate issues, global conflicts, food security, and population health. As I follow the daily news, I also turn my attention to developments in nursing and look for statements and opportunities for advocacy.

ICN Updates

The 75^th World Health Assembly took place in May. It was interesting to follow on social media as it generated considerable attention this year. The International Council of Nurses (ICN) was active in presenting ‘Interventions’ on specific resolutions. See ICN’s summary here.

ICN along with the International Confederation of Midwives and the WHO met for their 9^th Triad meeting in May. The representatives issued the 2022 Triad Statement focusing on health care workforce issues and reporting on what countries are doing in response to the Global Strategic Directions for Nursing and Midwifery 2021-2025. Howard Catton, ICN CEO, has been interviewed by many news media this year speaking about the war in Ukraine and related humanitarian crises and on the scale of the nursing shortfall globally.

Annual Meetings

The Canadian Nurses Association (CNA) and the Association of Nurses and Nurse Practitioners of BC (NNPBC) held their annual meetings in June. Both were open to all members and observers in a virtual format. The CNA Meeting of Members was noteworthy because it marked the first time that individual members could vote to elect candidates for the Board of Directors and vote on AGM motions. The previous federation model of territorial and provincial member associations carrying votes has ended. As a member who is following these changes, it will be interesting to see how the new membership structure will work and how the new Board will communicate with members throughout the country.

After both meetings, I was left somewhat disappointed that there wasn’t more substance presented on what our associations are doing to demonstrate leadership during the current health care staffing crisis and other major issues in 2022 (I receive newsletters and view social media updates but others may not). I do recognize that annual meetings present highlights and financial statements on the previous year and are always six months out of date for the current year’s activities. It makes me wonder if members would be interested in (and commit to attending) an organizational update given in the autumn each year. We could meet the new Board members, hear their priorities for the current year, and ask questions – all through a virtual format, and in a less formal manner than at an annual meeting.

Annual meetings and major events aside, I do appreciate the ongoing work of our professional associations at all levels to bring a nursing perspective to provincial, national, and global health challenges and policy change.

By Nora Whyte – June 27, 2022

I acknowledge with respect that I live on the Unceded traditional territory of the K’òmoks First Nation.

Public Health and Climate Change

Posted on October 24, 2021 by nora

The COP26 conference opens in Glasgow on October 31, 2021 and is generating considerable interest in the weeks leading up to the event. Officially known as the 2021 United Nations Climate Change Conference, it is the 26th UN Climate Change conference. As explained on the COP26 website, “COP stands for Conference of the Parties – the signatories of the United Nations Framework Convention on Climate Change (UNFCCC) – a treaty agreed in 1994 which has 197 Parties (196 countries and the EU).”

Telegraph Cove, Vancouver Island, BC – August 2021

It is heartening to see the growing public awareness of climate change impacts and the sense of urgency being expressed this year. Leading health organizations have formed coalitions to advocate for climate action. A recent open letter – Healthy Climate Prescription – issued by the Global Climate and Health Alliance (a coalition of organizations representing 45 million health professionals) is a good example of this important collaboration. Describing the climate crisis as “the single biggest health threat facing humanity” the authors of the letter call on world leaders to deliver on climate action. Among the key demands listed are: “a rapid and just transition away from fossil fuels; for high income countries to provide the promised transfer of climate funds; and for pandemic recovery investments to support climate action and reduce social and health inequities.” Likewise, leading international health journals have published a strong editorial that appeared in multiple journals in September with a vital message: “Reflecting the severity of the moment, this editorial appears in health journals across the world. We are united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory.”

The annual Lancet Countdown: Tracking Progress on Health and Climate Change report was released on October 21, 2021. Key findings are presented in five domains: 1) climate change impacts, exposures, and vulnerabilities; 2) adaptation, planning, and resilience for health; 3) mitigation actions and health co-benefits; 4) economics and finance; and 5) public and political engagement. Indicators are provided under each of the domains to give a quick view of changes since the previous report.

In Canada, the Canadian Association of Nurses for the Environment (CANE-AIIE) has been active since 2009. Their website features articles, presentations, and campaigns. CANE was among the Canadian signatories to the Healthy Climate Prescription letter, along with the Canadian Nurses Association, Canadian Medical Association, Canadian Public Health Association, and other organizations. I found CANE’s definition of planetary health quite helpful in thinking about the health of populations and the natural world:

Planetary health is a recognition of the fact that human health depends on healthy natural environments/ecosystems, and moreover, that we as a civilization find ourselves at a tipping point. We have depended on our natural systems to promote human health to the point where the human population is healthier than ever before, but to achieve this, we have exploited the planet at an unprecedented rate. If we want to continue to safeguard human health, we also need to maintain the health of the planet and its natural systems on which we depend (CANE website, n.d.).

Nurses are being called upon to use our individual and collective influence. Writing in the International Nursing Review, Dr. Pamela Mitchell (2021) offers a thoughtful piece on Nursing’s mandate in climate change. She notes that nurses have written about climate change in the context of the UN Sustainable Development Goals, and now urges collective advocacy to move our focus to climate justice and equity.

Dr. Sally Thorne’s recent editorial in Nursing Inquiry, Awakening to the climate emergency, is a fitting reminder to nurses to pay attention to planetary health. As Editor-in Chief, she anticipates an increase in manuscripts on “a nursing response to the climate crisis” as we take up a shared goal (Thorne, 2021).

I believe that events of recent years are awakening us to the urgency to act as part of our organizations, coalitions, and nations in the quest for climate justice.

Post COP26 Update: The Global Climate and Health Alliance provided an assessment of what was achieved and what work remains. There is positive news in COP26’s Glasgow Climate Pact “that re-commits governments to limiting temperature rise to 1.5C, in line with the most recent science” with concern about the lack of substance in the countries’ commitments. Read more in the media release from Glasgow dated November 13, 2021.

The International Council of Nurses issued a strong statement on the final day of COP26: “ICN is calling for nurses and other healthcare workers to be included at the centre of climate change policymaking, underscoring that climate change is a health issue. As COP26 closes and leaders look ahead to COP27 next year, ICN says it is more important than ever that the voice of health professionals is heard on the climate change debate because if nothing changes nurses and health systems will suffer the consequences.” See full media release (November 12, 2021).

By Nora Whyte – October 24, 2021 (Updated November 22, 2021)

I acknowledge with respect that I live on the Unceded traditional territory of the K’òmoks First Nation.

References:

Mitchell, P.H. (2021). Nursing’s mandate in climate change. International NursingReview, 68, 279– 280. https://doi.org/10.1111/inr.12704

Thorne, S. (2021). Awakening to the climate emergency. Nursing Inquiry, 28: e12459. https://doi.org/10.1111/nin.12459

The Privilege of Membership

Posted on January 19, 2021 by nora

This is the time of year when membership fees are due and the reminders start rolling in. It is a time when I consider whether or not to renew my membership in various organizations and what commitments I’ll make in the year ahead. In particular at the start of 2021, I have been thinking about the privilege of membership in the Canadian Nurses Association.

As noted on its website, the Canadian Nurses Association (CNA) is “the national and global voice of Canadian nursing, working with nurses in all 13 jurisdictions across Canada to bring essential and meaningful change to health care and nursing in the country.” Membership is open to all regulated nurses who may join as individuals or through their membership in provincial and territorial associations in jurisdictions that are CNA members. Major changes in jurisdictional nursing organizations across Canada will continue to have an impact on national membership. For the first time, I will be taking out an individual membership because the annual membership fee in my provincial association, the Nurses and Nurse Practitioners of British Columbia (NNPBC), no longer includes CNA membership. I remain supportive of NNPBC and CNA and hope that we’ll see new membership models and fee structures in the coming years. Membership in CNA is a vital link to our dynamic global nursing body, the International Council of Nurses.

During the summer and fall of 2020, CNA conducted a member survey to build on dialogue and engagement sessions conducted in 2019 & 2020. For a good overview of survey results, see Your Voice, Your Association.

Survey respondents viewed CNA in a favourable way with 81% noting that a national professional association is essential. Communication is key to engagement and three preferred methods are: direct email, social media & webinars. Ideas for building a strong and effective association include:

Engage with membership on a grassroots level
Offer more mental health resources
Offer more continuing education opportunities
Forge strong partnerships with provincial and territorial associations

Highlights of the past year – shaped so dramatically and sadly by the pandemic – were linked to my longtime interest in professional associations and their role in policy advocacy clearly in evidence during 2020. It was satisfying to be a co-author with stellar colleagues, Patrick Chiu and Susan Duncan, on an article published in the Canadian Journal of Nursing Research:

Charting a Research Agenda for the Advancement of Nursing Organizations’ Influence on Health Systems and Policy – Patrick Chiu, Susan Duncan, Nora Whyte, 2020 (sagepub.com)

In our abstract we indicate how we drew on “recent key national and global events including our systematic inquiry into Canada’s 2019 federal election, the Year of the Nurse and Midwife, and the Coronavirus pandemic to examine how Canadian nursing organizations respond in highly complex and evolving contexts.” Further, we used our observations to offer a vision and chart a research agenda for the advancement of nursing organizations’ influence on health systems and policy.

Another highlight that took place at the end of 2020 was receiving a Lifetime Achievement Award from NNPBC at a wonderful virtual 2020 Nursing Awards of Excellence Ceremony featuring music, dance, videos, and special messages from CNA and others. It was an emotional and proud moment to be among the group of BC nurses recognized for contributions to the profession in our province.

I look forward to staying connected to nursing’s collective presence and voice provincially, nationally, and globally in 2021.

By Nora Whyte – January 19, 2021

I acknowledge with respect that I live on the Unceded traditional territory of the K’òmoks First Nation.

Postscript: February 21, 2021

For nurses from BC, the process of membership renewal in CNA was delayed at the start of this year. I was unable to renew in January as planned. Glad to see that the membership portal is working now and that we can renew or rejoin as BC registrants or retired members. Annual membership gives us access to the Canadian Nurse and opportunities to participate in our national association and the ICN. In fact, to submit an abstract (as first author) for the ICN Congress in November, one must belong to a National Nursing Association. I’m thankful that CNA is a member of ICN and that’s one of my primary reasons for renewing my CNA membership.

Nursing the World to Health

Posted on May 15, 2020 by nora

I am writing this post as National Nursing Week in Canada draws to a close. It has been a strange time of celebration mixed with sadness at the losses experienced globally and the ongoing concern about the health of populations and the long road to recovery.

During this Nursing Week, I found that our Canadian nursing leaders reflected what many of us have been thinking about our profession during the time of COVID. I greatly appreciated reading CNA President Claire Betker’s editorial in the Canadian Nurse: On the importance of nurses in 2020. Claire highlighted the opportunity to raise the profile of the profession during the International Year of the Nurse and the Midwife and demonstrated the many ways in which Canadian nurses have made an impact.

International Nurses Day was celebrated globally on May 12, the 200th anniversary of Florence Nightingale’s birth. This year’s theme, Nurses: A Voice to Lead – Nursing the World to Health captured both the spirit and the urgency of nursing’s vital global role. The International Council of Nurses provided excellent resources on its International Nurses Day site and was highly visible in media interviews and in generating social media energy. ICN’s CEO Howard Catton tweeted: “Let our celebrations be a clarion call for real commitments to actions and investments to support nurses to do the work that the world desperately needs them to do.” Annette Kennedy, ICN President, expressed her appreciation to the global nursing community and held a great video conversation with Dr. Tedros on May 12. It’s worth viewing and reflecting on their messages!

This week also provided opportunities to profile the State of the World’s Nursing 2020 Report, released in April 2020 and now gaining attention. This landmark publication has highlighted the urgent need for acceleration of nursing education, job creation and leadership. The report’s call to strengthen nursing leadership is “to ensure that nurses have an influential role in health policy formulation and decision-making, and contribute to the effectiveness of health and social care systems” (WHO, 2020).

Nursing Week 2020 has played out in a vastly different way than anticipated; however, there is no doubt that the theme of “Nursing the World to Health” is more important than ever as we face the remainder of 2020 using a professional, powerful and collective voice to lead.

By Nora Whyte – May 15, 2020

Nursing Now: Ready for 2020

Posted on November 21, 2019 by nora

Nursing Now launched in 2018 as a global collaboration among the Burdett Trust for Nursing, the International Council of Nurses (ICN) and the World Health Organization (WHO). I have been following developments and have used this Blog to share highlights and links to updates from time to time.

On the cusp of 2020, Nursing Now is perfectly positioned to play a leadership role during the 2020 Year of the Nurse and the Midwife. Events and celebrations are planned throughout the year. In their most recent update (November 2019), the Nursing Now campaign team stated: “During 2020, we are united in our ambition to propel nursing and midwifery into the spotlight and onto the agenda of governments, with the ultimate goal of improving health globally.”

As Nursing Now has gained momentum, I have been pleased to note the connection to the Sustainable Development Goals (SDGs). There’s increasing recognition that nurses and midwives are contributing to the SDGs and are absolutely vital to delivering Universal Health Coverage by 2030.

A new aspect of Nursing Now announced during the ICN Congress in Singapore in June is the Nightingale Challenge currently being promoted as a key leadership development strategy for 2020 and beyond:

The Challenge is asking every health employer around the world to provide leadership and development training for a group of their young nurses and midwives during 2020, the Year of the Nurse and the Midwife, to support them as practitioners, and enhance their skills as advocates and leaders in health.

Nursing Now Canada launched in 2019 with plans for national initiatives in three ‘pillars’ as outlined in its June 3, 2019 media release:

Nursing Leadership pillar – to establish a hub to educate, empower and support regulated nurses to lead, advocate, innovate, influence public policy and create sustainable change in health.
Chief Nursing Officer pillar – to establish federal, provincial and territorial chief nursing officers in leadership positions within ministries of health.
Indigenous pillar – to support nurses and midwives in providing culturally safe care and to strengthen the power of Indigenous nurses.

The Canadian Nurses Association is the official link for Canadian nurses to the global Nursing Now campaign and is carrying out this three-point action plan in partnership with the Canadian Indigenous Nurses Association and Indigenous Services Canada.

From here at home to events on the world stage, communities of nurses and midwives will be joining their colleagues and supporters in celebrating the Year of the Nurse and the Midwife in 2020.

Update November 23, 2019

It was a delight to read an editorial published in The Lancet today (Volume 394) entitled 2020: unleashing the full potential of nursing and drawing attention to Nursing Now and the Nightingale Challenge. The editorial makes the case for enhancing nursing to enhance health and looks to the opportunity of 2020 “to showcase the evidence and impact of what nurses and midwives do, and to ensure that they are enabled, resources and supported to meet the world’s health needs.” Thanks to The Lancet for this timely editorial and the social media interest it is generating.

By Nora Whyte – November 21, 2019

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