Nurses and midwives form the linchpin of health care delivery across the world. The Covid-19 pandemic highlighted how the absence of an optimal number of nurses and midwives can debilitate the health care sector.


  • India has 1.7 nurses per 1,000 people, less than the World Health Organization’s norm of three per 1,000.
  • According to the State of World's Nursing 2020 report by the World Health Organisation (WHO), India was among countries with the largest shortages of nurses (in numerical terms) in 2018.
  • In India, nurses, midwives and other nursing professionals make up 47% of the health workforce and carry out 80% of patient care responsibilities.
  • Nurses and midwives account for nearly 50% of the global health workforce.
  • For all countries to reach Sustainable Development Goal 3 on health and well-being, WHO estimates that the world will need an additional 9 million nurses and midwives by the year 2030.
    • The World Health Assembly has designated 2020 the International Year of the Nurse and the Midwife.


  • Pandemic times: During the pandemic, nurses, alongside doctors, helped thousands to recover from the deadly virus. With a fresh surge in cases, nurses are at the centre of managing the health crisis.
    • Nurses have been continuously providing service to the patients, being the backbone of the healthcare system in hospitals.
  • Patient centred care close to community: As part of strong multidisciplinary healthcare teams, nurses and midwives make a significant contribution to delivering on the commitments made in the 2018 Astana Declaration on Primary Health Care, ensuring patient-centred care close to the community.
  • Frontline of patient care: Nurses and midwives are often the first and sometimes the only health professional that people see and the quality of their initial assessment, care and treatment is vital.
    • They are also part of their local community sharing its culture, strengths and vulnerabilities, hence they can shape and deliver effective interventions to meet the needs of patients, families and communities.
  • Role in primary health centres: According to reports, about  27% of approved positions of doctors in Primary Health Centres and more than half of the sanctioned posts of specialists in Community Health Centres remain vacant.
    • It has been suggested that nurses can play an instrumental role by actings as essential healthcare providers in terms of counseling and educating patients and families, conducting physical examinations etc


  • Revision of Indian Nursing Council Act,1947: recognition of qualification, code of ethics, professional conduct (and misconduct) continues under the Indian Nursing Council Act, 1947, but this law, limited in power, has not seen significant revisions for 69 years.
  • Nursing education: Nursing education is also being impacted by increasing privatisation, with the private health sector providing almost 88% of this education. Along with soft skills development, these institutions need to improve the quality of education.
  • Brain drain: Nursing and midwifery are witnessing a brain drain due to poor salaries and working conditions in the private sector, and the absence of proper careers in the government sector.
    • This migration is also encouraged by the lack of infrastructure.
  • Structural challenges: the issues like long working hours, short-staffing, workplace violence, and pay disparity also plague the field.
  • Absence in leadership roles and policy making:While nurses enjoy a majority in the health workforce, they remain starkly absent from leadership roles.
    • Also, the limited involvement of nurses and midwives in policymaking and decision-making has deterred equitable and fair policies to reduce policy-practice gaps.


  • Improving nursing education:There has been progress in improving nursing education by the Government of India and the Indian Nursing Council (INC) through initiatives such as a nurse practitioners programme and a national nursing & midwifery commission bill (NMMC) draft.
    • Residency programmes have also been added to allow nurses to start specialising beyond general nursing skill set
    • As per the National Health Policy, 2017, phasing out the General Nursing and Midwifery (GNM) programmes into a Bachelor of Science (Nursing) programme would ensure the quality of nursing education.
  • Midwifery initiative: Under initiative in the guidelines on midwifery services, 2018, the government aims to create a cohort of nurse practitioners in midwifery, capable of providing positive birth experiences to women by promoting physiologic birth, respectful maternity care, and decongesting higher-level health facilities
  • Providing benefits to nurses:The nursing registration and tracking system, developed by INC, is one approach to maintaining records and providing benefits to nurses across the country.
    • A live register of this kind can be integrated into central and state-level planning.
  • Making them partners in decision making: filling the nursing and midwifery leadership positions that are lying vacant can give them a well-deserved seat at the table of policy making and decision-making at the national level.
    • Similarly, nursing directorates at the state level would also be essential in promoting nursing and midwifery across various states.


India has developed its health services and workforce planning, yet there remains room for improvement. Setting up a systemic basis for monitoring and evaluation to enable periodic reviewing and upgradation of systems can be a cohesive way ahead. This step can effectively set the country on the right path to realising its universal health care coverage goals, with nurses and midwives becoming the foot soldiers of a healthier India.

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