Nursing Leadership in Global Health

1. Nursing Leadership in Global Health The art & science of articulating the change David C. Benton RN, PhD, FRCN ChiefExecutiveOfficer International Council of Nurses 26th February 2014

2. Archimedes - 220 BC Mechanics Magazine published in in 1824

3. Areas to be addressed • Changes to enable • Nursing’s voice to be more integrated into shaping health policy • Nursing to have greater involvement in decision making, programme planning and strategy implementation • Nurses to become more responsive and effective as advocates for patient populations • .

4. Nursing’s Voice • What do we know ? • Few countries have nursing and midwifery personnel providing professional and policy level services in WHO country offices. • Data from the WHO human resources annual report of January 2013 reveals nursing specialists represent 0.6% of staff in professional and higher categories. Medical specialists represent 90.7% and dieticians and nutritionists (at 2.6 %) and pharmacists (at 2.0%) have greater representation than nurses. • The situation has deteriorated over the past 40 years. In 1968 there were more than 200 nurses working for the World Health Organization and the representation of nursing specialists was 2.9% in 2001.Since May 2010, the position of Chief Scientist, Nursing and Midwifery has been vacant.

5. Nursing’s Voice • What do we know ? • More diverse than ever before. • Level of preparation. • Certificate to Masters • Nurses or Nursing • Variation in scope.

6. Nursing’s Voice • What do we know ? • Not all bad news. • Nurses in wider government and intergovernmental position • More Nurses as part of WHA delegations • Increasing availability of BSN, MSN and Doctoral provision • Diversitycanprovidestrength.

7. An experiment in perceptions

8. What Did You See? ?

9. An experiment in perceptions

10. The Nursing Context • Clinical Practice • Professional Associations • Regulators • Academia • Trade Unions • Public and Private • Governmental and Non-governmentalagencies • Other Disciplines • Patients, families, communities and Populations

11. The First Three Messages • Have the facts but don’t stick to a single solution • Agreeing the key message also provides the potential for synergistic leverage • See diversity and differing perspectives as multiple opportunities.

12. How is Policy Made? • In a galaxy far far away? • In a Government near you? The Iron Triangle Model

13. How is Policy Made? • In the Eighties, Ninety's and alive & kicking! Kingdom’s Agenda Setting Process

14. The Game Changer? • Brutal criticism Systematic reviews and concise summaries of findings are rarely used for developing recommendations. Instead, processes usually rely heavily on experts in a particular specialty, rather than representatives of those who will have to live with the recommendations or on experts in particular methodological areas. Oxman, Lavis and Fretheim (2007) Lancet 2007; 369: 1883–89 DOI:10.1016/S0140-6736(07)60675-8

15. The Game Changer? • Brutal criticism "This is a pretty seismic event," Lancet editor Dr. Richard Horton, who was not involved in the research for the article. "It undermines the very purpose of WHO.” "If countries do not have confidence in the technical competence of WHO, then its very existence is called into question," said Horton. "This study shows that there is a systemic problem within the organization, that it refuses to put science first."

16. Some WHO Resources

17. How is Policy Made? • The complexities of today’s reality Policy Networks

18. A focus on health - missed opportunities?

19. SocialNetworks – Existing Structures

20. SocialNetworks

21. SocialNetworks

22. SocialNetworks –Impact of LFC (Before)

23. SocialNetworks – Impact of LFC (After)

24. SocialNetworks – GNLI

25. SocialNetworks – GNLI

26. The Next Three Messages • Know how policy is made • Who decides, when is it decided, does it get implemented • Understand the starting landscape • Knowing where you are helps in setting challenging but achievable targets • Remember topography can change • It is sometimes easier and more effective to get others to carry your message

27. Nurses as Advocates • Power • Principles of Influence • Competencies • Opportunities

28. SourcesofPower • Resource Power • Information • Expertise • Connections • Coercion • Position • Personal Power

29. TheSixPrinciplesofInfluence • Contrast • Commitment & Consistency • Scarcity Value • Social Proof • Linking & Integrating • Emotion

30. Nurses as Advocates • Competencies • Leadership – Vision, passion, commitment • Media skills – right story for the right audience • Economics – makes the world go round • Evidence – in god we trust everyone else brings data • Alliances – achieve more

31. Who should we influence? • Governments • Intergovernmental structures • WHO, UNFPA, UNHCR, etc • WTO, UNESCO • World Bank • Regional entities (The EU but the rest?) • Employers • GAVI, Global Fund, Gates • National and Transnational Corporations

32. Transnational Corporations - Opportunities? • Funding – many have foundations • Population for health improvement • Target for carrying your policy message (they often spend a lot on lobbying) • Raise our profile and our image

33. Final Four Messages • Map where the power lies in your universe • You don’t need to be the head of the organisation to hold power • Use different strategies to influence and remember that you can use more than one at a time • Using a hammer to cut a plank is not a good choice • Integrate policy competencies into pre-registration and build upon them in post registration • Policy is set and implemented at various levels • Understand the new policy landscape and who has control of resources • Talk is cheap – implementation is a further opportunity but requires funding

34. Just in Case You Want to Move the World http://www.starstryder.com/2008/02/18/with-a-lever-i-move-the-earth/

35. Bibliography Part 1 • Benton D.C. (1999) Seize the moment: opportunities for parliamentary lobbying in Scotland. Nursing Standard 14:5,16-17 • Benton DC. (1999) Assertiveness, Power and Influence Nursing Standard 13:52, 48-52 • Benton, D.C. Fernandez-Fernandez, M.P. (2014) Social network analysis: A tool for the identification of next generation trainers. Collegian: The Australian Journal of Nursing Practice, Scholarship and Research.http://dx.doi.org/10.1016/j.colegn.2013.08.001 • Borgatti,, S. P., Everett, M.G., and Johnson, J.C. (2013) Analyzing social networks. London, Sage Publications Ltd. • Lavis, J.N., Oxman, A.D., Souza, N.M., Lewin, S., Gruen, R.L., Fretheim (209) Health Research Policy and Systems 7(Suppl 1):S9 http://www.health-policy-systems.com/content/7/S1/S9 • National Collaborating Centre for healthy public policy (2012) A Framework for Analyzing Public Policies: Practical Guide. Québec, Institut national de santé publique. http://www.ncchpp.ca/docs/Guide_framework_analyzing_policies_En.pdf • Oxman, Lavis and Fretheim (2007) Lancet 369: 1883–89 DOI:10.1016/S0140-6736(07)60675-8

36. Bibliography (Part 2) • UNCTAD (2007) The universe of the largest transnational corporations: UNCTAD current studies on FDI and development No 3. New York, United Nations. http://unctad.org/en/docs/iteiia20072_en.pdf • Walt, G., Shiffman, J., Schneider, H., Murray, S.F., Brugha, R. Gilson, L (2008) Health Policy and Planning, 23:5, 308-317.http://heapol.oxfordjournals.org/content/23/5/308.full.pdf • WHO (2009) Systems thinking for healthsystemsstrengthening. Geneva, WHO. http://whqlibdoc.who.int/publications/2009/9789241563895_eng.pdf • WHO (2010) WHO Country Cooperation Strategies: Guide 2010. Geneva, WHO. http://www.who.int/countryfocus/cooperation_strategy/WHO-CSS_Guide2010_Eng_intranet_24sep10.pdf • WHO (2012) Changing Mindsets: Strategies on health policy and systems research. Geneva, WHO. http://apps.who.int/iris/bitstream/10665/77942/1/9789241504409_eng.pdf