Empowering Women and Strengthening Health Systems and Services Through Investing in Nursing and Midwifery Enterprise: Lessons from Lower-Income Countries: Workshop Summary (2015)

Empowering Women and Strengthening
Health Systems and Services
Through Investing in
Nursing and Midwifery Enterprise

Lessons from Lower-Income Countries

WORKSHOP SUMMARY

Patricia A. Cuff, Deepali M. Patel, and Megan M. Perez, Rapporteurs

Global Forum on Innovation in Health Professional Education

Forum on Public–Private Partnerships for Global Health and Safety

Board on Global Health

INSTITUTE OF MEDICINE
      OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.

www.nap.edu

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NOTICE: The workshop that is the subject of this workshop summary was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

This activity was supported by a contract between the National Academy of Sciences and the University of Washington/Robert Wood Johnson Foundation (Prime Award No: 71456, Sub Award No: 758912). The views presented in this publication do not necessarily reflect the views of the organizations or agencies that provided support for the activity.

International Standard Book Number-13: 978-0-309-31672-9
International Standard Book Number-10: 0-309-31672-3

Additional copies of this workshop summary are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

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The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

Cover photo © Chad Bartlett, courtesy of LifeNet International. L.N. Nurse Trainer Dorine Gahimbare is pictured on the left walking with Seraphine, a nurse at Gakwende Health Center, a LifeNet International partner health center in Southern Burundia. For more information about LifeNet International, visit http://www.lninternational.org.

Suggested citation: IOM (Institute of Medicine). 2015. Empowering women and strengthening health systems and services through investing in nursing and midwifery enterprise: Lessons from lower-income countries: Workshop summary. Washington, DC: The National Academies Press.

“Knowing is not enough; we must apply.
Willing is not enough; we must do.”      

                                                —Goethe

INSTITUTE OF MEDICINE
              OF THE NATIONAL ACADEMIES

Advising the Nation. Improving Health.

THE NATIONAL ACADEMIES

Advisers to the Nation on Science, Engineering, and Medicine

The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.

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The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Victor J. Dzau is president of the Institute of Medicine.

The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.

www.national-academies.org

PLANNING COMMITTEE FOR EMPOWERING WOMEN
AND STRENGTHENING HEALTH SYSTEMS AND SERVICES
THROUGH INVESTING IN NURSING AND MIDWIFERY
ENTERPRISE: LESSONS FROM LOWER-INCOME COUNTRIES¹

MARLA SALMON (Chair), University of Washington

MARY BARGER, American College of Nurse-Midwives

LAKSHMI KARAN, Genentech

GINA LAGOMARSINO, Results for Development Institute

ADDRESS MALATA, University of Malawi

LIESBET D. PEETERS, D. Capital Partners

KRISHNA UDAYAKUMAR, International Partnership for Innovative Healthcare Delivery

DIỆP N. VƯƠNG, Pacific Links Foundation

________________

¹ Institute of Medicine planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

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GLOBAL FORUM ON INNOVATION IN HEALTH
PROFESSIONAL EDUCATION^1,2

JORDAN COHEN (Co-Chair), George Washington University

AFAF MELEIS (Co-Chair), University of Pennsylvania

KENN APEL, Council of Academic Programs in Communication Sciences and Disorders

CAROL ASCHENBRENER, Association of American Medical Colleges

GILLIAN BARCLAY, Aetna Foundation

MARY BARGER, American College of Nurse-Midwives

TIMI AGAR BARWICK, Physician Assistant Education Association

JOANNA CAIN, American Board of Obstetrics and Gynecology/American College of Obstetricians and Gynecologists

LINDA CASSER, Association of Schools and Colleges of Optometry

LINCOLN CHEN, China Medical Board

MARILYN CHOW, Kaiser Permanente

ELIZABETH CLARK, National Association of Social Workers

THOMAS CLAWSON, National Board for Certified Counselors, Inc. and Affiliates

DARLA SPENCE COFFEY, Council on Social Work Education

JAN DE MAESENEER, Ghent University

MARIETJIE DE VILLIERS, Stellenbosch University

JAMES G. FOX, Association of American Veterinary Medical Colleges

ROGER GLASS, John E. Fogarty International Center

ELIZABETH (LIZA) GOLDBLATT, Academic Consortium for Complementary and Alternative Health Care

CATHERINE GRUS, American Psychological Association

YUANZHI GUAN, Peking Union Medical College

NEIL HARVISON, American Occupational Therapy Association, Inc.

DOUGLAS HEIMBURGER, American Society for Nutrition

JOHN HERBOLD, National Academies of Practice

ERIC HOLMBOE, Accreditation Council for Graduate Medical Education

PAMELA JEFFRIES, Johns Hopkins University School of Nursing

RICK KELLERMAN, American Academy of Family Physicians

KATHRYN KOLASA, Academy of Nutrition and Dietetics

JOHN (JACK) KUES, Alliance for Continuing Education in the Health Professions

MARYJOAN LADDEN, Robert Wood Johnson Foundation

LUCINDA MAINE, American Association of Colleges of Pharmacy

BEVERLY MALONE, National League for Nursing

________________

¹ Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

² This is the list of Forum members as of September 11, 2014.

MARY E. (BETH) MANCINI, Society for Simulation in Healthcare

FURMAN MCDONALD, American Board of Internal Medicine

LEMMIETTA G. MCNEILLY, American Speech-Language-Hearing Association

DONNA MEYER, National Organization of Associate Degree Nursing

FITZHUGH MULLAN, George Washington University

WARREN NEWTON, American Board of Family Medicine

LIANA ORSOLINI, Bon Secours Health System, Inc.

BJORG PALSDOTTIR, Training for Health Equity Network (THEnet)

RAJATA RAJATANAVIN, Mahidol University

SCOTT REEVES, University of California, San Francisco

ELENA RIOS, National Hispanic Medical Association

KAREN SANDERS, Veterans Health Administration

MADELINE SCHMITT, American Academy of Nursing

NELSON SEWANKAMBO, Makerere University College of Health Sciences

STEPHEN SHANNON, American Association of Colleges of Osteopathic Medicine

SUSAN SKOCHELAK, American Medical Association

HARRISON SPENCER, Association of Schools and Programs of Public Health

RICHARD (RICK) TALBOTT, Association of Schools of the Allied Health Professions

GEORGE THIBAULT, Josiah Macy Jr. Foundation

JAN TOWERS, American Academy of Nurse Practitioners

DEBORAH TRAUTMAN, American Association of Colleges of Nursing

RICHARD (RICK) W. VALACHOVIC, American Dental Education Association

SARITA VERMA, University of Toronto

PATRICIA HINTON WALKER, Uniformed Services University of the Health Sciences

SHANITA WILLIAMS, Health Resources and Services Administration, U.S. Department of Health and Human Services

KELLY WILTSE NICELY, American Association of Nurse Anesthetists

HOLLY WISE, American Council of Academic Physical Therapy

XUEJUN ZENG, Peking Union Medical College

BRENDA ZIERLER, University of Washington

SANJAY ZODPEY, Public Health Foundation of India

IOM Staff

PATRICIA A. CUFF, Senior Program Officer

MEGAN M. PEREZ, Research Associate

BRIDGET CALLAGHAN, Senior Program Assistant (from January 2015)

CHRISTIE BELL, Financial Officer (from January 2015)

ROSALIND GOMES, Financial Associate (until December 2014)

PATRICK W. KELLEY, Senior Board Director, Board on Global Health

FORUM ON PUBLIC–PRIVATE PARTNERSHIPS FOR
GLOBAL HEALTH AND SAFETY^1,2

JO IVEY BOUFFORD (Co-Chair), New York Academy of Medicine

CLARION JOHNSON (Co-Chair), ExxonMobil

TARA ACHARYA, PepsiCo

RAJESH ANANDAN, U.S. Fund for UNICEF

MARLEECE BARBER, Lockheed Martin Corporation

SIMON BLAND, UNAIDS

ROBERT BOLLINGER, Johns Hopkins University School of Medicine

KIM C. BUSH, The Bill & Melinda Gates Foundation

GARY M. COHEN, Becton, Dickinson & Co.

BRENDA D. COLATRELLA, Merck

BRUCE COMPTON, Catholic Health Association of the United States

PATRICIA DALY, Save the Children

PATRICIA J. GARCIA, Cayetano Heredia University

HELENE D. GAYLE, CARE USA

ELAINE GIBBONS, PATH

ROGER GLASS, Fogarty International Center

LOUISE GRESHAM, Fondation Mèrieux USA

RICHARD GUERRANT, University of Virginia

TREVOR GUNN, Medtronic

JESSICA HERZSTEIN, U.S. Preventive Services Task Force

BEN HOFFMAN, GE Energy

JAMES JONES, ExxonMobil

ALLISON TUMMON KAMPHUIS, The Procter & Gamble Company

ROSE STUCKEY KIRK, Verizon Foundation

SEEMA KUMAR, Johnson & Johnson

JOHN E. LANGE, The United Nations Foundation

NANCY MAHON, Estee Lauder Companies

LAUREN MARKS, Office of the Global AIDS Coordinator

EDUARDO MARTINEZ, UPS Foundation

MICHAEL MYERS, Rockefeller Foundation

REGINA RABINOVICH, Harvard School of Public Health

SCOTT C. RATZAN, Anheuser-Busch InBev

B.T. SLINGSBY, Global Health Innovative Technology Fund

KATHERINE TAYLOR, University of Notre Dame

WENDY TAYLOR, USAID

________________

¹ Institute of Medicine forums and roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteurs and the institution.

² This is the list of Forum members as of September 11, 2014.

JACK WATTERS, Pfizer

HOLLY WONG, U.S. Department of Health and Human Services

DEREK YACH, Vitality Group

TADATAKA “TACHI” YAMADA, Takeda Pharmaceuticals

IOM Staff

KIMBERLY A. SCOTT, Senior Program Officer

RACHEL M. TAYLOR, Program Officer

PRIYANKA NALAMADA, Senior Program Assistant (from March 2015)

ANGELA CHRISTIAN, Program Associate (until December 2014)

FAYE HILLMAN, Financial Associate (from January 2015)

ROSALIND GOMES, Financial Associate (until December 2014)

PATRICK W. KELLEY, Senior Board Director, Board on Global Health

Reviewers

This workshop summary has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published workshop summary as sound as possible and to ensure that the summary meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this workshop summary:

JULIE A. FAIRMAN, University of Pennsylvania School of Nursing

ALLISON TUMMON KAMPHUIS, The Procter & Gamble Company

PETRA TEN HOOPE-BENDER, ICS Integrare

Although the reviewers listed above have provided many constructive comments and suggestions, they did not see the final draft of the workshop summary before its release. The review of this workshop summary was overseen by Colleen Conway-Welch, School of Nursing Vanderbilt University. Appointed by the Institute of Medicine, she was responsible for making certain that an independent examination of this summary was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this workshop summary rests entirely with the rapporteurs and the institution.

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Acknowledgments

The Institute of Medicine (IOM) Global Forum on Innovation in Health Professional Education and Forum on Public–Private Partnerships for Global Health and Safety would like to thank the workshop planning committee chair, Marla Salmon, for her leadership and her vision for this workshop topic. We also thank the planning committee members, Mary Barger, Lakshmi Karan, Gina Lagomarsino, Address Malata, Liesbet Peeters, Krishna Udayakumar, and Diệp Vương, for their hours of service in developing and superbly executing the final workshop agenda. The event would not have been possible without the participation of the workshop attendees who we thank for taking the time to attend this meeting and for contributing to the fruitful discussions captured in this summary report.

A number of individuals contributed to the development of this workshop and report. This event could not have happened without the keen dedication of the IOM staff of the Global Forum on Innovation in Health Professional Education, including Patricia Cuff, forum director, Megan Perez, research associate, and Bridget Callaghan, senior program assistant, as well as the IOM staff of the Forum on Public–Private Partnerships for Global Health and Safety, including Kimberly Scott, forum director, and Rachel Taylor, program officer. In addition, we thank the University of Washington staff, especially John Compton, as well as workshop rapporteur Deepali Patel. We also thank The Rockefeller Foundation Bellagio Center, Pilar Palacia, and Laura Podio for their generous support of this event. And most important, we acknowledge with deep appreciation the Robert Wood Johnson Foundation and in particular Deborah Bae, whose support of this topic made the workshop possible.

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Preface

Investment in women’s enterprise as a means for their empowerment is a longstanding international development practice. These investments have most often focused on engagement in commercial and agriculture ventures. However, reports of the emergence of investment in innovative forms of nursing and midwifery practice enterprise in lower-income countries hold promise for even greater opportunity for women. Understanding these opportunities and their value to the well-being of women, their communities, and health systems and services globally and in the United States has become a central focus for my work over the past decade.

The prospectus for this workshop grew out of initial exploration of the topic during a Fall 2012 Rockefeller Foundation Bellagio Center Residency, and matured while working at the Institute of Medicine as the 2012-2013 Distinguished Nurse Scholar in Residence.¹ During that time, I explored the feasibility and desirability of innovative investment in nursing and midwifery education and practice enterprise as avenues of opportunity for women’s empowerment, and strengthening health systems and services in lower-income countries. This work benefitted greatly from the expertise, ideas, and support of colleagues and organizations in and outside the

________________

¹ The Institute of Medicine/American Academy of Nursing/American Nurses Foundation/ American Nurses Association Distinguished Nurse Scholar in Residence.

Institute of Medicine (IOM),² and the inspiration and experiences of the nurses and midwives I have been privileged to know over the many years of my work in global health. The culmination of these efforts led to two major personal conclusions: (1) investment in nursing and midwifery enterprise can improve the lives of women associated with these innovations, those they serve, and strengthen health services/systems; and (2) the experiences of lower-income countries where rapid growth of investment in innovative nursing and midwifery enterprise is taking place have value to informing developments globally and in the United States.

This global workshop provided a unique opportunity to bring these conclusions into sharp and critical focus through the engagement of international thought leaders from multiple sectors. Their perspectives and insights bring much greater clarity to this important topic, and set the stage for the way forward that moves well beyond my initial explorations. Their contributions and the potential downstream benefit are significant and go well beyond my greatest hopes for this work.

The workshop and this report also reflect the important and unique capacity of the IOM to encourage and support critical exploration, deliberation, and exchange, and to share what is learned in ways that inform and advance the health of people worldwide. I deeply appreciate the remarkable opportunity of their engagement in this project—and the great privilege of collaborating with the staff who helped to make this work possible.

Marla Salmon, Chair
Workshop Planning Committee

________________

² My deep appreciation to the individuals and organizations in the Acknowledgments, and for the University of Washington, Evans School of Public Affairs and the School of Nursing; the Center for Health Market Innovation; the American Association of Colleges of Nursing; the American Nurses Foundation; the American Nurses Association; and the Center for Health Market Innovation.

Contents

Acronyms and Abbreviations

1 Introduction

PART I

2 Women’s Empowerment

3 Strengthening Health Systems

PART II

4 Nursing and Midwifery Education and Enterprise

5 Country Perspectives

6 Innovations and Organizational Strategies to Strengthen Health Systems

7 Social Enterprise and Investment in Health

PART III

8 Transferability of Models and Lessons Learned

9 Models for the United States and the Larger Global Context

APPENDIXES

A Workshop Agenda

B Speaker Biographical Sketches

C List of Participants

D Innovations in the Provision of Health Services Using Empowered Nurses and Midwives in the Philippines

Oscar F. Picazo, Valerie Gilbert T. Ulep, Ida Pantig, Danica Ortiz, Melanie Aldeon, and Nina Ashley de la Cruz

Acronyms and Abbreviations