From Policy to Practice: Implementing the WHO Strategic Directions to Strengthen Nursing and Midwifery
Tjukanov, Nina (2025)
2025
Master's Programme in Public and Global Health
Yhteiskuntatieteiden tiedekunta - Faculty of Social Sciences
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Hyväksymispäivämäärä
2025-06-02
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:tuni-202505306399
https://urn.fi/URN:NBN:fi:tuni-202505306399
Tiivistelmä
This study explores the implementation and enforcement of the World Health Organization’s (WHO) Global Strategic Directions for Nursing and Midwifery 2021–2025 (SDNM) across nine middle- and high-income countries. The aim was to assess how the SDNM has been adopted and integrated into national health policies and programmes, and carried out in everyday health care practices, and to identify key factors influencing the implementation and enforcement of the SDNM. The SDNM is a significant policy for strengthening nursing and midwifery globally. This study has the potential to support the implementation and enforcement of the SDNM in diverse contexts and to inform the development of a more feasible SDNM policy.
A qualitative, cross-country research design was employed, utilising semi-structured inter- views (n=9) with government chief nursing and midwifery officers (GCNMOs) and senior nursing and midwifery leaders (SNMLs). The data was analysed using reflexive thematic analysis (RTA), which aims to illustrate themes constructed from shared meanings in the data.
Findings indicate that the SDNM has been at least partially implemented in eight out of the nine countries, meaning that these countries have adopted, and to some extent integrated the SDNM into their national health strategies and health care programmes for execution. However, the extent to which these programmes were enforced in everyday health care practices varied. The analysis identified three themes that capture the key factors influencing policy implementation and enforcement: 1. Interplay between global policy and national context, 2. Sufficiency of imple- mentation capacity, and 3. The role of political and institutional engagement and commitment. The first theme addresses how the perceived relevance of the SDNM depended on its alignment with national priorities; in some cases, SDNM was pushed aside by domestic agendas or seen as less relevant in already well-developed systems. The second theme relates to the capacity of the country to operationalise the policy; limitations in resources, leadership, and communication capacity often slowed or blocked progress. The third theme emphasises that effective implemen- tation and enforcement depend on political will, institutional support, and the ability of nursing and midwifery leaders to influence decision-making processes at high levels. Key factors that influ- enced implementation and enforcement included policy alignment with national and health care contexts, funding, leadership, and active political and stakeholder engagement, and sustained commitment.
To support implementation and enforcement of the SDNM, this study highlights three key strat- egies: adapting global policies to national and health care contexts through building inclusive and flexible mechanisms; ensuring stable, long-term funding; and strengthening leadership capacity and formal representation of nursing and midwifery within national governance structures. These strategies deepen the understanding of how global policies are implemented at the national level and offer practical guidance for the effective and sustained implementation and enforcement of the SDNM to advance nursing and midwifery globally.
A qualitative, cross-country research design was employed, utilising semi-structured inter- views (n=9) with government chief nursing and midwifery officers (GCNMOs) and senior nursing and midwifery leaders (SNMLs). The data was analysed using reflexive thematic analysis (RTA), which aims to illustrate themes constructed from shared meanings in the data.
Findings indicate that the SDNM has been at least partially implemented in eight out of the nine countries, meaning that these countries have adopted, and to some extent integrated the SDNM into their national health strategies and health care programmes for execution. However, the extent to which these programmes were enforced in everyday health care practices varied. The analysis identified three themes that capture the key factors influencing policy implementation and enforcement: 1. Interplay between global policy and national context, 2. Sufficiency of imple- mentation capacity, and 3. The role of political and institutional engagement and commitment. The first theme addresses how the perceived relevance of the SDNM depended on its alignment with national priorities; in some cases, SDNM was pushed aside by domestic agendas or seen as less relevant in already well-developed systems. The second theme relates to the capacity of the country to operationalise the policy; limitations in resources, leadership, and communication capacity often slowed or blocked progress. The third theme emphasises that effective implemen- tation and enforcement depend on political will, institutional support, and the ability of nursing and midwifery leaders to influence decision-making processes at high levels. Key factors that influ- enced implementation and enforcement included policy alignment with national and health care contexts, funding, leadership, and active political and stakeholder engagement, and sustained commitment.
To support implementation and enforcement of the SDNM, this study highlights three key strat- egies: adapting global policies to national and health care contexts through building inclusive and flexible mechanisms; ensuring stable, long-term funding; and strengthening leadership capacity and formal representation of nursing and midwifery within national governance structures. These strategies deepen the understanding of how global policies are implemented at the national level and offer practical guidance for the effective and sustained implementation and enforcement of the SDNM to advance nursing and midwifery globally.