01/23/2026
Nursing: The Backbone of the Health Sector
Author: Syed Ahmed Tanshir Uddin
In June 1999, during the centennial session of the International Council of Nurses, Dr. Gro Harlem Brundtland, then Director-General of the World Health Organization (WHO), stated:
“The way nurses work wholeheartedly as the most essential health workers for a healthy world is unmatched. In most countries, nurses and midwives occupy 80% of the positions in healthcare organizations. They are a key force in bringing about the necessary changes to meet 21st-century health needs. In fact, they contribute more than any other group across all branches of healthcare... It is clear that nurses are the backbone of most healthcare teams—silent warriors for a healthy world.”
Current scenario and achievements of bangladesh’s healthcare system in global context:
Although Bangladesh has achieved considerable success in the health sector, it still lags significantly in areas like universal health coverage, the Global Health Security Index, and the Health Inclusivity Index. According to the Service Coverage Index, the country scores 52 out of 100—this must be improved to at least 80 by 2030. Currently, 68.5% of total health expenditure comes from out-of-pocket spending, which needs to be reduced to 30%.
According to 2021 data, Bangladesh scored 35.5 out of 100 in the Global Health Security Index, ranking 95th out of 195 countries. In the Health Inclusivity Index, Bangladesh scored the lowest—only 30.8 out of 40 countries.
Clearly, these figures do not align with our national development goals, dreams, or strategies. Moreover, these indices highlight that healthcare infrastructure, delivery, and access do not depend solely on the health sector itself.
The scenario of health care indicators of various countries: Healthcare indicators vary significantly across countries, reflecting disparities in access and quality of medical services. In the United States, there is one doctor for every 330 people, with 2.8 hospital beds per 1,000 people, and an average life expectancy of 78.54 years. India faces a notable shortage, with one doctor for every 1,600 people, 2.7 hospital beds per 1,000 people, and a lower life expectancy of 69.16 years. Bangladesh is even more constrained, with just one doctor per 1,900 people, fewer than one hospital bed per 1,000 (0.87), and an average life expectancy of 72 years. In contrast, Cuba stands out with one doctor for every 105 people, a high hospital bed availability of 5 per 1,000, and a life expectancy of 78.66 years. These figures highlight the strengths of Cuba’s public healthcare system and the challenges faced by densely populated developing countries like Bangladesh.
This proves that effective healthcare policies depend more on government accountability than on national wealth. Cuba, often overlooked, stands as a model of structured and planned healthcare.
Over the past decade, we have heard stories of development and growth. At this juncture, a quote from Confucius comes to mind: “There is no merit in rising swiftly; merit lies in rising again after falling into a pit.”Without dwelling on the past, we must now focus on building a strong healthcare system to avoid future crises.
Nursing: The Backbone of Healthcare
Nursing is the backbone of the health sector because nurses provide holistic patient care, assist doctors, respond to emergencies, raise public awareness, and ensure continuity of care—making healthcare services functional and effective.
1. Daily Patient Care:Nurses provide round-the-clock physical and mental care for patients, administer medicines and injections, manage physical hygiene, relieve pain, and ensure patient comfort—integral components of treatment.
2. Supporting Doctors and Other Professionals: Nurses follow physicians’ instructions, regularly report patients’ conditions, and actively participate in care planning, ensuring continuity of treatment.
3. Crisis and Emergency Response: During emergencies, nurses act promptly and effectively to save lives—this responsiveness is critical to a functioning health system.
4. Public Health Education: Nurses educate the public on disease prevention and healthy habits—such as hand washing, nutrition, and prevention of infectious diseases.
5. Effective Hospital Management: Nurses handle patient records, manage medical supplies, and coordinate care, contributing to smooth hospital operations.
Global Demand and Market for Nurses and Midwives:
Before assessing Bangladesh’s nursing sector, it is important to understand the global demand. According to a 2024 WHO report, there are currently around 290 million nurses and 22 million midwives worldwide. However, due to rising population, aging, and increased health needs, a shortage of 45 million nurses and 3.1 million midwives is projected by 2030. This shortage will mostly affect low- and lower-middle-income countries.
Nurses Status in Various Countries:
Many countries differ significantly in their nurse-to-population ratios when compared to the World Health Organization’s benchmark of 3 nurses per 1,000 people. The United States, with 11.7 nurses per 1,000 people, is well above the WHO target. Similarly, Cuba performs strongly with 7.6 to 8.2 nurses per 1,000 people, exceeding the benchmark. In contrast, India has only 1.96 nurses per 1,000 people, which falls below the recommended level, while Bangladesh faces a critical shortage with just 0.2 nurses per 1,000 people—far below the global standard. To address nursing shortages, high-income countries have increasingly turned to recruiting foreign nurses. For instance, in 2023, the United States had approximately 3.18 million registered nurses. The United Kingdom had 748,000 nurses as of 2022, Germany had about 1 million, and Japan had 1.73 million. Saudi Arabia, with 235,461 registered nurses, is also part of this trend, often relying on international recruitment to meet its healthcare staffing needs. This global competition for nurses can strain the healthcare systems of countries already facing shortages, such as India and Bangladesh. These figures demonstrate the immense global demand for nurses.
Health Reform Commission Recommendations and Political Perspectives in nursing context:
The Health Sector Reform Commission, formed under a caretaker government, made several recommendations for improving the nursing profession in Bangladesh. Key suggestions include:
1. Integration of Nursing Departments: Nursing, Family Planning, To***co Control, and other technical service organizations should be integrated under the Directorate General of Health Services to build a more efficient system.
2. Establish an Autonomous Cadre: A new “Bangladesh Health Services” cadre, modeled after the judiciary, is proposed. This independent civil service cadre would include nursing officers.
3. Career Growth and Promotion: Clear career pathways and promotion systems should be established across three divisions: healthcare, education, and administration.
4. Training and Skill Development: Regular training and capacity-building workshops are essential so that nurses can keep up with modern healthcare trends.
Hope for the Future:
If these recommendations are implemented, the nursing sector will progress significantly. Notably, 90% of people surveyed in the Commission's report expressed support for free universal healthcare. Achieving this will require improving the conditions and capacity of healthcare workers, especially nurses and midwives.
On February 4, 2025, the National Citizens Committee recommended better working conditions and fair compensation for healthcare workers. The BNP also highlighted nursing as a key health sector in point 26 of their 31-point policy plan. Thus, nursing is now being recognized not only as a healthcare issue but also as a matter of national policymaking.
We emphasis on Nursing in Autonomy: Nursing needs to be autonomous to improve patient outcomes, job satisfaction, and professional growth by allowing nurses to use their critical thinking and clinical judgment to make independent decisions within the scope of their practice. This independence includes advocating for patients, making timely decisions, and contributing to the improvement of healthcare policies and practices. Autonomy in nursing is not about working without guidance but about having the authority to act based on one's knowledge and expertise when established protocols allow.
Benefits of nursing autonomy
• Improved patient care: Autonomous nurses can provide more optimized and patient-centered care by making informed, independent decisions based on their knowledge and the patient's specific needs.
• Enhanced professional growth: The ability to make decisions fosters critical thinking and professional development, leading to a more skilled and confident nursing workforce.
• Increased job satisfaction: When nurses are trusted to use their expertise, it leads to higher job satisfaction and a greater sense of professional value.
• Better patient outcomes: Independent decision-making, especially in time-sensitive situations, can lead to better and faster outcomes for patients.
• Increased efficiency: A system that empowers nurses to act autonomously can be more efficient by reducing the need for constant consultation for every decision.
How nursing autonomy is practiced
• Clinical decision-making: Nurses can make independent judgments on patient care, such as when to administer medication or respond to an emergency.
• Patient advocacy: Autonomous nurses can strongly advocate for their patients' rights and wishes, ensuring they have the information to make their own choices.
• Policy and practice improvement: They can contribute to shaping health care policies and suggesting improvements for the practice environment, such as improving workflows or supply management.
• Full scope of practice: It allows nurses to practice to the full extent of their license, skills, and education.
Conclusion
To achieve the Sustainable Development Goals (SDGs) and ensure universal health coverage, the nursing sector must be made self-reliant and well-structured.
Author: Nurse and Nutritionist, Cox’s Bazar
syedahmedtanshiruddin@gmail.com
