With declining global spending on health, as the world prepares to observe International Nurses Day, Monday 12 May, there is renewed urgency to build health systems that respond to the needs of nurses and the people they serve. 

Investing in nurses yields high returns. It improves maternal and child health, HIV/AIDS prevention, and outbreak response for example, while strengthening primary healthcare systems. 

However, in many under-resourced settings throughout southern Africa health systems rest on the shoulders of an overwhelmed nursing workforce, who in addition to servicing high patient numbers in poorly equipped hospitals and clinics are sometimes forced to operate from churches, schools and other non-traditional settings where they cannot access the tools they need to effectively deliver care. They are often poorly paid, overworked, prone to burnout and constrained by limited opportunities for professional growth, yet they continue to discharge their duties with commitment, delivering much-needed care and saving millions of lives.

Despite the critical role that nurses play in keeping our already overburdened health systems afloat, a sudden decline in global health funding now poses an additional threat to the future of healthcare in Africa, with devastating impacts on health workers and the wellbeing of the communities they serve. 

African countries brace for impacts of cuts 

As countries in the Global North roll back commitments to fund global health institutions and initiatives, African countries must brace for the impacts of these actions on health systems that are already under immense strain. They must also urgently address the need for robust and responsive health systems that safeguard the wellbeing of caregivers while ensuring uninterrupted access to care for those most in need.

When resources meant to sustain health systems dry up, it exacerbates health disparities and increases the burden on already fragile health systems. Nurses, the backbone of healthcare delivery, often bear the brunt of these constraints. For example, the deep funding cuts have not only impacted the livelihoods of frontline health workers—mainly nurses and midwives—they have also deprived remote and marginalised communities of access to essential healthcare. 

Additionally, the cuts have disrupted nurse-led health programs focusing on maternal health, HIV/AIDS, TB, leprosy, and other infectious diseases in many vulnerable countries across Africa, collapsing essential health care services, impacting the quality of care and cutting an already limited health workforce.

Nurses need to be decision-makers as well as implementers  

The WHO predicts a global shortage of 10 million nurses by 2030. Nurses need to be at the heart of global transformation as essential leaders and contributors to the design of healthcare policies, strategic decision-making, and effective implementation at all levels. However, in many countries, nurses are excluded from decision making and health system design. They—especially female nurses—are often seen as implementers rather than strategic thinkers, despite their experience of being on the frontlines and navigating challenging circumstances including disease outbreaks and shortages of essential medical goods. 

It is a fact that while women lead caregiving functions, they are excluded from leadership and hold only a fraction of senior decision-making roles globally, with even fewer of these roles being held by female nurses. Studies have shown that the under-representation of women in senior roles limits the development and implementation of equitable policies.

Building resilient health systems

The solution lies in building resilient health systems that are deliberate in meeting the needs of both providers and patients. Commitments to policy reforms for ensuring protection from workplace hazards and fair remuneration for overtime and high-risk duties should be prioritised. The ambitious, transformative goals of UHC become more achievable when we create clear pathways for nurses to work in environments that enable them to grow further into leadership roles. This also means increased investments in mentorship, training and structural support systems that empower nurses to lead and influence change. Academic institutions and training organisations must embed leadership and governance skills into nursing education, while the public and private sectors collaborate with professional nursing associations to co-create lasting solutions to the systemic barriers that prevent nurses from moving up the ladder.

Applause and praise are not enough

For far too long, nurses have stood on the frontlines of care, keeping clinics running, tending to the needs of their communities, and holding together fragile health systems. They have done so tirelessly, often without adequate recognition, resources, or influence over the decisions that directly impact their daily work and the patients they serve. Applause, while appreciated, will not resolve chronic understaffing. Gratitude cannot cover living expenses or student debt. And praise alone will not promote nurses into the leadership roles most are qualified to hold.

To build robust, inclusive and responsive health systems, governments, the private sector and partners must come together in a unified effort to prioritize building a nursing workforce that is well supported and fit to propel Africa forward in its journey to achieving global health goals.

 Akhona Tshangela is the WomenLift Health Southern Africa Director and a public health professional with over 15 years of service.  She has successfully implemented and led programs at both national and continental levels, demonstrating expertise in dealing with complex public health issues and contextualising these to the African continent.

Felistas Mpachika-Mfipa is the Chief Reproductive Health Officer for the Reproductive Health Directorate, Malawi. With over 15 years’ experience, she has worked as a nurse practitioner and manager, maternal and neonatal health program manager, and researcher.

Image Credits: Raisa Santos , R Santos, © Dominic Chavez/The Global Financing Facility, ICN/Women in Global Health, WHO AFRO, European Union – Louiza Ammi.