Africa cannot build strong health systems without investing in nurses, midwives

ZANZIBAR: WHEN a woman arrives at a health facility in labour, anxious about what lies ahead, one of the first professionals she is likely to encounter is a nurse or midwife. When a newborn needs immediate attention, a patient with a chronic illness requires continuing care, or an emergency suddenly occurs, nurses and midwives are often among those standing closest to the patient.

Their presence extends far beyond hospital wards. They work in health centres, communities, schools, workplaces and homes, providing care, education, monitoring and support. Yet despite this central role, their contribution can sometimes remain less visible than the challenges confronting health systems.

That reality is driving a growing regional call for greater investment in nursing and midwifery as African health systems confront increasingly complex demands. In Zanzibar, the message was strongly delivered at the opening of the 17th Biennial Scientific Conference and 8th Quadrennial General Assembly of the East, Central and Southern Africa College of Nursing and Midwifery (ECSACONM), held from September 14 to 18, 2026.

Representing Zanzibar President Dr Hussein Ali Mwinyi, Minister for Education and Vocational Training Lela Mohammed Mussa told delegates that nurses and midwives are not simply another category of health workers.

They are, as stated in the President’s speech, “the backbone of our health systems.” Behind statistics showing shortages of health workers are real people waiting for care. Every gap in the nursing workforce can mean a mother waiting too long for skilled assistance, a newborn missing timely care, a patient requiring urgent treatment or an entire community remaining underserved.

For patients and families, therefore, the important question is not simply how many nurses a country has. It is whether a competent professional will be available when care is needed most. Africa’s health systems are changing rapidly.

Populations are growing and ageing, while non-communicable diseases are increasing. Infectious disease outbreaks continue to threaten communities, mental health needs are expanding and climate change is placing additional pressure on health services and the people who provide them.

At the same time, digital technologies and artificial intelligence are transforming how healthcare is delivered. These developments create new opportunities, but they also require health professionals to acquire new knowledge and skills.

In this changing environment, increasing the number of health workers alone will not be enough. Countries must ensure that nurses and midwives receive quality education, continuous professional development, appropriate working conditions and opportunities to advance professionally.

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President Mwinyi called for a fundamental change in how nursing and midwifery are regarded from expenditure to investment in health, human capital and economic development. He urged countries to improve education and training, expand postgraduate and specialist programmes, create decent employment, strengthen recruitment and retention, ensure equitable deployment, provide safe working environments and support leadership and research.

His argument carries an important warning: “We cannot simply produce more nurses without creating jobs for them.” Equally, countries cannot create jobs without ensuring that professionals are properly trained, nor can they strengthen nursing education without investing in educators and clinical learning environments. For nurses and midwives, investment in education is not an abstract policy matter. It determines whether the professional standing beside a patient is adequately prepared to deal with the complexity of modern healthcare.

President Mwinyi placed particular emphasis on advanced and specialist training in critical care, neonatal care, perioperative care, chronic disease management, mental health and nursing leadership. Advanced practice, however, should not be understood as an attempt to replace other health professionals. Rather, it should strengthen multidisciplinary teams and allow health systems to make better use of the expertise already available within them.

This regional perspective was echoed by ECSACONM President Dr Glory Msibi, who described the gathering as a platform for sharing research, experiences and best practices while strengthening professional networks and cooperation. The conference brings together nurses, midwives, researchers, educators, policymakers, health managers and development partners.

About 600 participants from 25 African countries are attending the four-day gathering, creating an important opportunity for professionals from different health systems to exchange ideas and consider solutions to shared challenges. For Zanzibar, the conference also provides an opportunity to turn regional knowledge into practical improvements within its health sector.

Zanzibar Ministry of Health Principal Secretary Dr Mngereza Mzee Miraji said the international gathering provides participants with an opportunity to exchange knowledge and experience. He noted that the health sector could draw on ECSACONM graduates to strengthen professional capacity and help address workforce shortages.

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That opportunity is particularly important because health workforce development is not achieved simply by producing graduates. Professionals must be appropriately deployed, supported and given opportunities to continue learning throughout their careers. WHO Zanzibar representative Dr Ndoungou Salla Ba similarly urged countries across East, Central and Southern Africa to increase investment in nurses and midwives, including competency-based education and continuous professional development.

He also identified employment, appropriate deployment, leadership, professional regulation, mentorship and evidence-based healthcare as important priorities. These priorities point to a wider understanding of what it means to build a strong health workforce. A competent nurse needs more than a qualification.

Professional confidence depends on supportive leadership, adequate equipment, safe workplaces, opportunities for advancement and a system that values ethical and evidence-based practice. ECSACONM has consequently been urged to remain a centre of excellence for specialist education, professional development, research, leadership and innovation. It must also embrace simulation, digital learning and other modern technologies suited to African realities.

Such investments can help prepare professionals for situations they will increasingly encounter, from complex emergencies and chronic disease management to technological changes in healthcare delivery. The broader objective is to build a workforce that is competent, ethical, confident and well led. This requires governments, training institutions, professional organisations, health managers and development partners to work together rather than treating nursing and midwifery as the responsibility of one institution alone.

Investment should also extend to clinical learning environments. Students need opportunities to apply classroom knowledge under proper supervision, while practising professionals need access to continuous training that keeps their skills relevant.

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Ultimately, however, healthcare is experienced by people, not institutions or statistics. For the patient entering a hospital ward, all these policies, strategies and investments eventually come down to one human encounter: a nurse who listens, a midwife who guides a mother, a professional who responds when an emergency occurs, or a caregiver who helps a family through a difficult moment.

That is where investment in nursing and midwifery becomes visible. The message from Zanzibar is therefore larger than a professional conference. It is a reminder that Africa’s health ambitions depend heavily on the people who deliver care every day. If countries want stronger health systems, better outcomes and more resilient communities, investing in nurses and midwives cannot remain an afterthought. It must become a deliberate investment in people, health and Africa’s future.