× Nursing
Chief Nursing Officer Marc Julmisse leads nursing rounds inside the neonatal intensive care unit of University Hospital in Mirebalais, Haiti.
Photo: Rebecca E. Rollins/Partners In Health

Nurses play an enormous role in delivering health care and strengthening health systems around the world. At 35 million strong, nurses and midwives make up the large majority of the global health care workforce and deliver the bulk of all health care services.

But the distribution of nurses is far from equitable. According to the World Health Organization, five times more nurses work in high-income countries than in low-income ones, despite the higher burden of disease in poor countries. As a result, clinics and hospitals around the world are overwhelmed by patients and grossly understaffed. Nurses often shoulder this burden with low pay, few or poor educational opportunities, and inadequate resources to care for their patients.

PIH’s approach

For a mother in labor in the mountains of Lesotho or a child suffering from cholera in Haiti, access to PIH’s qualified nurses and midwives—who comprise 51 percent of our clinical workforce—often means the difference between life and death.

PIH promotes nursing as an integral part of delivering comprehensive, high-quality, and patient-centered care. At our sites around the world, we foster a culture of team-based care among nurses, physicians, and allied health professionals. This requires investing in nurses and midwives, improving the settings in which they work, and accompanying national Ministries of Health to do the same for nurses in the countries in which we work.

PIH’s nursing program aims to:
• Develop best practices of global nursing care in resource-limited settings by integrating service delivery, training, and research.
• Strengthen nursing education and specialty expertise, which also provide professional development opportunities.
• Identify and support nursing leaders to improve training and enhance patient care.

In Haiti and Rwanda, PIH’s nurse educators and mentors work alongside our nursing staff to improve patient care. These educators and mentors provide instruction but also an instant feedback loop and support system for staff nurses as they learn new skills and apply new knowledge.

In Haiti, some of our nurse educators focus on key specialties—such as maternal health, pediatrics, mental health, and surgery—which allows us to expand the capacity of our workforce and respond to more of our patients’ needs.

PIH and its Haitian sister organization, Zanmi Lasante, also recently established a Nursing Center of Excellence, based at University Hospital in Mirebalais, that will support nurses throughout the PIH/ZL health care system. The Center’s aim is to codify nursing practices, build the capacity of the health care workforce, and meet the region’s urgent needs for specialized care.

In Rwanda, PIH launched a program in 2010 called MESH—short for Mentoring and Enhanced Supervision at Health Centers—in collaboration with Rwanda’s Ministry of Health. The program connects experienced nurse mentors to staff nurses in rural health centers. Based on its initial success, the Rwandan government plans to expand the HIV portion of MESH throughout the country.

In Lesotho, nurses have driven the integration of maternal and child health services in our clinics, creating a strong platform of primary care. Their success allowed them to implement the innovative Maternal Mortality Reduction Program (MMRP) in a country with one of the highest maternal mortality ratios in the world.

The program, piloted in 2009 at Bobete Health Center, has had a tremendous effect on the lives of mothers and children. The year before the MMRP launched, only 46 women delivered at the facility. In the program’s second year, 216 women safely delivered their babies. Since then, PIH/Lesotho has strengthened its efforts in Bobete and expanded to seven other sites around the country.