Triad Communiqué 17 May 2014

Government chief nursing and midwifery officers, leaders of national nursing and midwifery associations and regulatory bodies from 83 countries met in Geneva on 16-17 May 2014, together with the International Confederation of Midwives, the International Council of Nurses and the World Health Organization, to address issues critical to the provision of safe, quality nursing and midwifery care, the development of the nursing and midwifery professions and the effective regulation of these professions.

The focus of the fifth Triad meeting was strengthening the nursing and midwifery workforce to support universal health coverage (UHC) as a means to achieve health goals. UHC has gained significant support within the post-2015 development agenda and is the focus of United Nations and World Health Assembly Resolutions, the Recife Political Declaration on Human Resources for Health and the WHO/Global Health Workforce Alliance report, “A universal truth: no health without a workforce”. Its underpinning principle, which is rooted in theories of social justice, equity (including gender equity) and international covenants on the right to health, is to ensure that all people have access to quality health services. However, the goal of UHC cannot be achieved without a strong focus on human resources for health, including the education and training,  regulation,  management,  remuneration  and  continuing  development  of  a  quality nursing and midwifery workforce equitably deployed to meet population needs.

Leadership and Policy Direction for UHC

Nurses and midwives, who are the closest and often the only available professional health workers for many, have a great responsibility to improve the health of the population as well as contribute toward the achievement of global development goals. Nurses and midwives, as professionals and in collaboration with interprofessional teams, have expertise in building on the strength  of  individuals, families  and  communities  to  achieve  better  health  outcomes.  This expertise will be pivotal in addressing the complexity of factors related to providing access to quality health care and health coverage for all. In order to maximise the contribution of nurses and midwives to UHC, it is essential that they are involved in policy dialogue and decision- making regarding the planning, development and evaluation of services and policies. In a time of global economic uncertainty, nurses and midwives are key contributors to cost-effective care planning and delivery of quality assured services in all settings. Having a Chief Government Nursing and Midwifery Officer can provide an effective vehicle to engage nursing and midwifery in these matters.

Quantity, quality and relevance of the nursing and midwifery workforce

Careful and effective health workforce planning is needed to  meet the  goal of  scaling  up sufficient numbers of a competent and diverse nursing  and  midwifery workforce . Ensuring nurses and midwives have the necessary competencies and scope of practice that allows them to effectively promote health and provide care is critical if we are to ensure equitable access to quality health services. Furthermore, to assure achievement and sustainment of UHC, a supportive and enabling environment focused on quality of care is needed to maximise the highest return on investment made in training, recruitment and retention of nurses and midwives in the health care workforce.  Participants at this Triad meeting commit to working with others to transform nursing and midwifery education so that the next generation of nurses and midwives is prepared in sufficient quantity, quality and relevance so as to contribute to meeting the current and future health needs of the populations they serve and throughout the world. It is crucial that there be systems and processes in place to ensure the quality and capacity of pre- service and continuing education and that education oversight/accreditation mechanisms are achievable, acceptable, credible, feasible and supported by legislation. Instead of just quick fix solutions, a thorough and thoughtful review of education systems and programmes is needed so as to ensure true transformation of nursing and midwifery education. Programmes need to have appropriate educational standards in place, the right curricular content, access to sufficient and appropriate clinical placements, an adequate quantity of well-prepared faculty and sufficient capacity, resources and technology.

It is critical that effective regulatory frameworks are in place to ensure the entry and ongoing competency of nurses and midwives. Addressing health promotion and supporting self-care, key factors in addressing health coverage, lie within nurses’ and midwives’ scopes of practice. Nursing and midwifery leaders call on governments, educators and employers to collaborate with us to establish and support effective regulatory frameworks and  remove barriers (e.g. legislative, educational and employment-based) that prevent nurses and midwives from working to their full scope of practice. The work environment is also a key aspect of improving patient safety and  the quality of  health  care.  An educated  and  competent nursing  and  midwifery workforce and a good work environment result in high quality care. This simple, evidence-based equation whether applied at a local or global level in the health system is fundamental to making the best use of the vital resource that is nursing and midwifery services.

Collaborative partnerships in the current social and economic realities and beyond

With the complexity of the health context and the current social and economic realities, the advantages  of  partnerships  in  health  for  mutual  collaboration  and  resource  sharing,  both financial and human, are clear. The evidence shows that investing in nursing and midwifery makes a difference. Collaborations and coordinated action among the nursing and midwifery communities, other health professionals, policy makers, labour organisationsnon-governmental organisations, donor agencies and other stakeholders are critical to achieve equitable and quality care and access to health services. We are committed to working with others to develop innovative approaches to workforce challenges, to take transformative action on human resources for health and to identify and implement measures to improve safety, quality and productivity. We commit to a collective response using evidence-based pathways to address access to quality and affordable care and to achieve UHC.

ThInternational Confederation of Midwives (ICM) represents more than 110  associations of midwives throughout the world.  ICM is the global voice of midwives, supporting and strengthening the midwifery profession as a means of improving global maternal and newborn health.

Laan van Meerdervoort 70

2517 AN – The Hague – The Netherlands

Tel: +31 70 30 60 520 – Fax: + 31 70 35 55 651

The International Council of Nurses (ICN) is a federation of more than130 national nurses associations representing the millions of nurses worldwide.  ICN is the international voice of nursing and works to ensure quality care for all and sound health policies globally

3, Place Jean Marteau – 1201 – Geneva – Switzerland

Tel: +41 22 908 01 00 – Fax: + 41 22 908 01 01

E–mail: Web:

ThWorld Health Organization is the United Nations specialized agency for health. It was established on 7 April 1948. WHO’s objective, as set out in its Constitution, is the attainment by all peoples of the highest possible level of health.

Health Workforce Department (Nursing and Midwifery), 20, Avenue Appia, 1211 – Geneva –


Tel: +41 (22) 791 21 11 – Fax: +41 (22) 791 4153

Web: www.who.int