Contribution of Nursing and Midwifery to Health System Performance and Goals

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Introduction

Across countries health care systems have been transformed during the last ten years (Alliance for Health Policy and Systems Research, 2000) responding to the need for more equitable, efficient and sustainable health systems. This reorganization of the health systems has increased the need for generation of knowledge about the role and the contributions made by health care professionals to health system performance and goals.

Nursing and midwifery practitioners comprise the largest health service providers and have been affected health system changes in different ways. There are profound changes affecting nurses and midwives work environment, scope of practice, and their relationship with other health care professionals and clients, which may impact their performance and the service they provide.

Within this framework, the World Health Organization developed a case study protocol to obtain and analyze information regarding nursing and midwifery contributions to health systems performance and also the goals and the effects of health system changes on the effectiveness of nursing and midwifery interventions in three countries of the Pan American Region, Belize, Colombia, and Mexico.

The respective nurse consultant in Belize, Colombia, and Mexico organized national working groups of nurses and midwives. Nurse consultants in each country were responsible for administering a 40-item questionnaire to nurses and midwives from different health institutions in each one of the participating countries. In addition, these consultants obtained key information from secondary sources to support findings and complete data analysis. This paper presents an analysis of case study results in the three participating countries.

The case studies show mixed results regarding the nursing situation in the three countries. The differences in the social and developmental contexts of the countries represent the existing diversity in the PAHO region. The countries not only differ in size and population characteristics but also in the advancement of the implementation of the health sector reform. Mexico has a geographic area of 1,972,550 square kilometers (CIA, 1999a) and 91,145,000 inhabitants (PAHO, 1996). Colombia has a geographic area of 1,138910 square kilometers (CIA, 1999b), and an estimated population of 42,299,301 inhabitants (Garzón, 2000). Belize has a geographic area of 22,960 sq. Kilometers (CIA, 1999c) and an estimated population of 222,000 in 1996 (PAHO, 1998).

Because nursing status varies according to contextual characteristics and advancement in the implementation of health sector reform, a brief comparison of the contextual characteristics of the three countries will precede the discussion of health care reform and nursing situation.