Care for the carers

In the bustling corridors of Pakistan’s hospitals, where the cries of newborns mingle with the quiet urgency of critical care units, nurses and midwives serve as the often-unseen backbone of our healthcare system. Behind their calm, capable demeanours lie stories of exhaustion, emotional strain and neglect.

According to the Ministry of National Health Services, Regulations, and Coordination, there were 127,050 registered nursing professionals in Pakistan as of 2022, including nurses, midwives, lady health visitors, community midwives and certified nursing assistants. These individuals are often the first and sometimes only point of contact for patients, yet they endure long hours, understaffing and minimal support. The toll this takes on their physical and mental health is immense yet consistently overlooked.

The World Health Organization (WHO) has long emphasised that investing in the health and safety of healthcare workers is fundamental to building resilient, high-performing health systems. Pakistan's nursing and midwifery personnel ratio is just 5.2 per 10,000 people, significantly lower than regional and global benchmarks – India stands at 17.2 and the US at 133.76. This stark disparity places an enormous burden on our existing workforce and underlines the urgency for reform.

Improving the health and well-being of nurses and midwives must begin with protecting their basic rights. This includes enforcing safe staffing (adequate nurse-patient ratios), a healthy work environment, ensuring access to protective equipment, regulating working hours, and providing holistic (physical, emotional, mental) health support and work-life balance. Respecting their dignity, safety and well-being is not optional but critical to positive patient outcomes.

Equally important is investment in high-quality, accredited nursing education programmes. Although Pakistan produces thousands of nurses each year, a clear gap remains between education and practical readiness. Many institutions lack academia and service partnership, preceptor and mentorship programmes, trained clinical nurse instructors and specialist and modern clinical training facilities. To address this gap, educational institutions and hospitals must partner to equip and prepare nurses and midwives for today’s complex healthcare environment.

Low-and middle-income countries (LMICs) are undergoing a transformation amid resource constraints, rising patient demand, nurse turnover, and the need for cost-effective care solutions. Nurses continue to be at the forefront of these changes, adapting to new practices, improving patient outcomes, integrating technology, and playing an essential role in advancing quality and patient safety.

Institutions like the Aga Khan University School of Nursing and Midwifery and Aga Khan Hospitals, Nursing Services have set a strong example by offering high-quality degree programmes and sub-speciality nursing certifications; however, isolated efforts are not enough, and such initiatives must be scaled nationwide. Universities with nursing schools and colleges must collaborate to improve education, clinical practice, infrastructure and access to clinical placements. Special attention should also be given to expanding these opportunities in underserved and rural areas, where the need is often greatest.

Improving the health and well-being of nurses and midwives is not just a matter of fairness, but a public health imperative. Health systems are only as strong as the people who sustain them. Pakistan must act decisively to support and strengthen this vital segment of its workforce. The future of healthcare in Pakistan depends on how we care for those who care for us. A little effort will go a long way.

The writer is the chief nursing officer at the Aga Khan University Hospital Karachi.