Nursing Education in the WHO South-

East Asia Region during the

COVID-19 Pandemic
23 February 2022

Ai Tanimizu,
Technical Officer – Nursing & Midwifery
Office for the WHO South-East Asia Region
 Agenda
• Health Workforce and Universal Health
Coverage/SDG
• WHO South East Asia Region
• Impact on Nursing Education in SEAR
during COVID-19 Pandemic (country
examples)
• Challenges to achieving UHC
• WHO’s work to strengthen Nursing
Education
 Universal Health Coverage (UHC)
Health workforce is vital to achieving UHC
• UHC means that all individuals and
communities regardless of where they are,
receive quality health services when in
need, without suffering financial hardship.
• It includes the full spectrum of essential,
quality health services, from health promotion
to prevention, treatment, rehabilitation, and
palliative care.
https://www.who.int/en/news-room/fact-sheets/detail/universal-health-coverage-(uhc)
Universal Health Coverage (UHC) in SDG3

UHC

R. Bitran for 2nd Bangladesh Flagship

Health Labour Market Framework for UHC
 WHO SEA Region Context
• 11 Member States, 2 billion people (1/4 of
world’s population)
• On average, the lowest public expenditure
on health and highest out-of-pocket
expenditure of any WHO region
• Over 300 million people experience
catastrophic health spending each year
• Health inequities prominent
– Children U5 from poorest households
2-4 times more likely to die from
preventable causes than richest.
 Decade of Health Workforce Strengthening
2015-2024
SEAR HRH policy
priority areas:
– Transformative
education
– Rural retention
– HRH governance
– HRH data and
information

https://apps.who.int/iris/handle/10665/334226
WHO resources
 WHO SEAR &COVID-19
• Economic impact
– Estimated economic contraction of -5.4% in the region.
– WB estimated that in 2020 60% of the 120 million people
pushed into extreme poverty resided in South Asia
• Direct Morbidity and Mortality
– Third most affected region in terms of infections and deaths
• Disruption to Essential Health Services
– 18 months following start of the pandemic 8/9 reporting
countries identify disruption in essential health services
(with disruption to approx. a third of tracer services)
• COVID Vaccine
– As of 17 February 2022, more than 1 billion (52%) persons
are fully vaccinated in SEAR out of its total population.
 Nursing Education in SEAR
during COVID-19
Data collection methods: Disruptions in Midwifery
- Direct communications with Education Due to Covid-19
WHO Country Office focal Questionnaire
points
- Information collected by
- Disruptions in Midwifery sending questionnaire to
Education Due to Covid-19
Questionnaire* WHO Country Office focal
points for midwifery/nursing
(Q2 2020) in Q2-2020
- Nursing Workforce in South-
East Asia Region 2021
Questionnaire
*(note: Some midwifery education sites are
also nursing educational institutions)
 Nursing Workforce in South-East Asia
Region 2021 Questionnaire
Methods:
- Letter sent to Ministry of Health for nominating focal point
(March 2021)
- Questionnaire distributed to focal point after receiving
nominations
- Nominated government focal point to fill in data
- Contracted partner and WHO SEARO review data
- Virtual meeting scheduled to validate data and collect
qualitative data regarding country context. Focal point invited
other relevant stakeholders including Government Chief
Nurse Officer, regulatory body and professional association
(within two months of receiving filled questionnaire)
Challenges due to uprising of Delta variant in South-East Asia
Region
 Nursing Workforce in South-East Asia
Region 2021 Questionnaire

• Institutional/Questionnaire Respondent
Background
• Regulation of the Nursing Profession
• Nursing Workforce Education and Training
• Nursing Roles and Scope of Practice
• Impact of COVID-19 on Nursing
 Nursing Education in SEAR
during COVID-19
Examples from:
• Bangladesh
• Bhutan
• Indonesia
• Maldives
• Sri Lanka
• Thailand
 Bangladesh
• Theory classes – some
institutions established their
own web-based classes
• Broadcasted on gov TV
• Linked with ICT Ministry and
their a2i project → made
classes more accessible
with less bandwidth
• Telecommunications
company provided internet
packages for students at a
low affordable price

*Information received from WHO Bangladesh country office focal point in Q2-2020
 Bhutan
• Few non-core course
requirements reduced
• Clinical practice:
during regional
lockdowns, students
were moved to areas
that were not affected
by lockdowns to
continue practice
*Information received from data validation meeting of the Nursing Workforce in
South-East Asia Region 2021 Questionnaire, June 2021
 Indonesia
• Nursing students could • Nursing specialty
volunteer their time to students – worked with
respond to COVID-19 family and patients and
pandemic connected with their
• Students who faculty advisor remotely
volunteered to assist
with Covid response
could count these
hours toward clinical
hour requirements
*For Indonesia, a university was contacted to fill out the questionnaire as nomination was not received
**Information received from data validation meeting of the Nursing Workforce in South-East Asia Region 2021
Questionnaire, February 2022
 Maldives
• No clinical practice • Increased simulation
course during severe labs for students with
COVID period. less students per
• Delayed clinical session
practice to next
semester and had to
choose new sites

*Information received from data validation meeting of the Nursing Workforce in

South-East Asia Region 2021 Questionnaire, May 2021
Maldives (continued)
 Sri Lanka
• No reduction but • Demonstrations and
educational period return demonstrations
was extended to in Skills Labs
compensate (eg 3
year diploma may • Implemented case
take 3.5 years to based discussions
complete)

*Information received from data validation meeting of the Nursing Workforce in

South-East Asia Region 2021 Questionnaire, December 2021
 Thailand
Shortened licensing exam
- Test items reduced to reduce duration of
time in sitting in exam room

*Information received from data validation meeting of the Nursing Workforce in

South-East Asia Region 2021 Questionnaire, November 2021
Challenges to progressing toward UHC
Health Labour Market Framework for UHC
SEAR HWF Situation – Production
 SEAR HWF Situation - Availability
• Density of doctors, nurses and
midwives increased from 21.5 to
26.0 per 10,000 population
• Projections to 2030 suggest gap
of 1.6 million doctors and
nurses/midwives in the Region
(may be exacerbated by the
ongoing Pandemic)
• Mix of doctors and
nurses/midwives varies by
country
• Medical assistants, CHWs, TCM
practitioners, paramedical staff
and informal workers are
prominent, especially at PHC
level
Global Strategic Directions for Nursing
and Midwifery (SDNM)
 Development and Adoption
Draft dissemination WHO Regional Office-
Prioritization exercise with coordinated consultations WHO Member States
GCNMO Forum/Triad 30 November 2020
Global stakeholder Consultation
participants
All WHO official languages consultations March 2021
June 2020 + Portuguese Dec. 2020-Jan 2021

Submission to the 74th Member States interest to

World Health Assembly
documents (A74/13)
Resolution drafting, review Adoption of SDNM 2021-
sponsor and co-sponsor a
and revisions by Member 2025 via WHA74.15
World Health Assembly
States
Resolution

.
Within the Global Strategy for Human Resources for Health
context of
Global Strategy for Women’s, Children’s, and Adolescent’s Health
Working for Health and Growth Action Plan
Using
evidence
from
Strategic Directions for Nursing and
Midwifery 2021-2025
Four policy priority areas

https://www.who.int/publications/i/item/9789240033863
Evidence
• Various levels of
EDUCATION
programmes
• Varying quality
• Unaligned
competencies
• Insufficient
number of
graduates
• Insufficient
number and
preparation of
faculty
• Limited data
reporting
SoWN and SoWMy Theory of Change

For any given SDNM policy priority:

Intersectoral policy
dialogue. POLICY
Addressing key
questions with the DECISION ACTION
data and analysis
MAKING
Identification of
DIALOGUE
key stakeholders to
engage at various DATA
levels for various
purposes Evidence-informed decision-making
Agreement on the way forward
BROAD Commitments to actions
ENGAGME Familiarization with indicators
Status of reporting
NT Sources of data (if outside MOH)
Collation of data; use for analysis
Reporting via NHWA platform

SDNM Implementation Paradigm

 Engagement by Partners and Stakeholders
NHWA Indicators for 2 Education Policy
Priorities
Ensure education programmes are competency-
based, apply effective learning design, meet
quality standards, and align with population
health needs.
• Accreditation mechanisms for education and
training institutions and programmes (NHWA 3-
02)
• Standards for social accountability (NHWA 3-03)
• Standards for social accountability effectively
implemented (NHWA 3-04)
• Standards for interprofessional education (NHWA
3-06)
• Agreement on accreditation standards (NHWA 3-
07)
• Education plans aligned with national health plan
(NHWA 9-04)
Ensure domestic production is optimized to
meet or surpass health system demand
• Ratio of applications for health workforce education
and training to training places (NHWA 2-03)
• Ratio of admissions to available places (NHWA 2-04)
• Ratio of students to qualified educators in a given
year (NHWA 2-05)
• Graduation rate from education and training
programmes (NHWA 2-07)
• Total expenditure on health workforce education
(NHWA 4-02)
• Education plans aligned with national health plan
(NHWA 9-04)
• HRHIS for reporting on outputs from education and
training institutions (NHWA 10-04)
 Engagement by Partners and Stakeholders

• Policy-specific (examples)
– Education
– Jobs
– Leadership
– Service delivery—Regulation and Working environment
• Data
– NHWA indicators
• Many essential ones are also the most challenging
• Dialogue
– Supporting government efforts to engage and organize
• SoWN policy dialogue toolkit
 Discussion – Building Back Better for UHC
• Does the current education program meet
quality standards and align with population
needs?
• How do we ensure ‘nobody is left behind’?
(accessibility of the Internet, mental health and motivation issues
addressed, etc)

• Which innovations introduced during

COVID-19 should be maintained? How do
we sustain them?
 Thank you

tanimizua@who.int