A strong nursing workforce key in universal health

By Eunice Pallangyo

Universal Health Coverage (UHC) is a global health priority, aiming to ensure that all individuals and communities receive the health services they need. As the world advances toward Universal Health Coverage, persistent challenges are a stark reminder that progress has stalled, with 4.5 billion people still lacking adequate health coverage.

In Tanzania, significant milestones and initiatives have been put in place to enhance the implementation of UHC as we enter phase 2 in the push for health equity.

The introduction and role of the Universal Health Insurance Act (UHI) by the government, requiring health insurance coverage for all residents to close the coverage gap, is one such initiative in this new phase.

One key initiative in this new phase is the introduction and implementation of the Universal Health Insurance (UHI) Act by the government, which mandates health insurance coverage for all residents in an effort to close the coverage gap.

Lessons from phase one have taught us that achieving UHC 2.0 will require a robust, equitable, and accessible health system with Primary Health Care (PHC) as a reliable foundation to leverage. Nurses, as the largest component of the health workforce, are crucial to delivering effective PHC.

However, in many settings, nurses remain underutilised, undertrained for expanded roles, or unsupported by regulatory frameworks. According to the World Health Organization (WHO)in Tanzania has a nurse-to-population ratio of 1:1,982, far below the recommended standard of 1 nurse per 500 people.

 Investing in nursing capacity, including the development and deployment of Advanced Practice Nurses (APNs), is therefore a critical strategy to strengthen PHC and accelerate progress toward UHC.

According to the World Health Organisation’s (WHO) State of the World’s Nursing Report 2020, Advanced Practice Nurses, such as nurse practitioners, play a pivotal role in primary health care delivery in many countries and should be developed as part of efforts to achieve UHC.

This investment represents a high-impact, cost-effective investment in health systems, aligning nursing education, policy, and practice with UHC goals, not only addressing workforce gaps but also ensuring equitable, quality, and sustainable health care for all.

The pressing question, then, is how do we get there?

Building capacity in nursing education and practice aligned with primary healthcare priorities

We must begin by building capacity in nursing education and practice that is aligned with primary healthcare priorities. This includes curriculum reforms, clinical training opportunities, and policy support to define and expand the scope of advanced practice nursing in Tanzania’s health system.

In many remote communities, where access to hospitals or physicians is limited, nurses often serve as the first and sometimes only point of care. They do more than diagnose and treat illness; they provide comfort, educate families, and guide communities through crises.

This is why, as we chart a course toward UHC 2.0, elevating the nursing profession is not just necessary, it is urgent. At the Aga Khan University, we launched the country’s first Master’s programme for advanced nursing and established the Centre for Innovation in Medical Education as a significant step in strengthening the health system through the training of skilled, compassionate, and community-centred professionals.

Promote and institutionalise Advanced Practice Nursing roles in health systems

As we build capacity in nursing education and practice, the institutionalisation of Advanced Practice Nursing roles offers a suitable solution to persistent workforce gaps in Tanzania’s health system.

Formalising the curriculum to guide the development of successful Advanced Practice Nursing programmes will pave the way for nurses with advanced clinical education and those interested in the training to provide high-quality, cost-effective care, particularly in underserved areas where access to physicians is limited.

Pivotal to its success will be engaging and supporting nursing councils and professional bodies to lead the advocacy on Universal Health Care 2.0 and primary healthcare at the community level.

Establish clear policy and regulatory frameworks

To make this vision a reality, strong policy and regulatory foundations must also be put in place. The creation and implementation of a national Advanced Practice Nursing policy will be essential to complement the capacity building efforts mentioned above.

This policy should support the existing National Nursing and Midwifery Policy (2022–2032) and help to clearly define the scope of practice for Advanced Practice Nurses. Doing so will enable Primary Health Care providers to deliver more comprehensive and efficient services, especially in underserved areas.

Investing in nurses for the success of Universal Health Care is not optional, it is urgent. If Tanzania is to achieve UHC 2.0 and deliver on the promise of equitable, people-centred care, we must continue to take bold, deliberate steps to strengthen and elevate the nursing profession.

Dr Eunice Siaity Pallangyo serves as the Associate Dean of the School of Nursing and Midwifery, Tanzania, and the Associate Vice-Provost of Aga Khan University, Tanzania