Nurses and midwives are a vital input to upstream and downstream public health services

The contributions of nurses and midwives to improving health and preventing disease range from health promotion throughout the life-course to empowering individuals and communities. They often do so in a capacity that links health systems to other sectors.

Hungary (case study 13)

Overview: A public health programme for cervical screening has been in operation in Hungary since 2004. Uptake of the programme has, however, been very low (30% of the target population), and approximately 400 deaths due to cervical cancer occur in in the country each year. A new cervical screening programme was pilot-tested in 2009 in order to increase participation rates. This programme involved "health visitor nurses", who undertook not only activities such as taking cytological smears and sending samples to a laboratory but also health promotion, including providing guidance, counselling and motivation, visiting the local population and communicating information on laboratory results. The health visitor nurses received additional accredited training in cervical screening to extend their role and scope of practice.

Outcomes: By the end of 2012, 285 health visitor nurses had voluntarily attended training. The programme showed good results: a number of women who had not visited a gynaecologist in 10 or more years were convinced to participate in the programme. The involvement of the nurses in screening also personally connected health professionals with local populations. Access to cervical screening was improved by making it available to women living in small settlements and disadvantaged areas, who are least likely to travel to distant gynaecologists or specialist health centres because of lack of time, money and transport.

Health 2020 goal: Strengthening people-centred health systems

Scotland, United Kingdom (case study 51)

Overview: In Tayside in 2009, one third of pregnant women were found to be obese at their antenatal appointment. Scottish Government funding to improve maternal and infant nutrition provided an opportunity to target obese pregnant women and offer a tailored, supportive, evidence-based package of care called optiMum. In this intervention, conducted primarily by midwives, appropriate weight management is promoted by counselling on following a healthy lifestyle during pregnancy and weight loss postpartum..

Outcomes: The number of women seen at optiMum clinics increased from 85 in 2010–2011 to almost 200 in 2012–2013, and the intervention is now offered at two sites. In the first year, the average weight gain of the women who participated in optiMum was 7.1 kg, while that of pregnant women in Scotland  was approximately 12 kg. Feedback from women who attended optiMum programmes has been positive.

Health 2020 goal: Investing in health through a life-course approach and empowering people