Investment in the health system and its workforce substantially contributes to inclusive economic growth (SDG 8), particularly through the employment and empowerment of women (SDG 5) and young people. Women account for 70% of the social and health care workforce globally, and nearly 90% of the nursing and midwifery workforce.

The Commission provided a rationale for investment in health and social sectors, and a framework on how that investment can expand education capacity to ensure a sustainable supply of health workers and transform their competencies to meet needs, producing a health workforce with the right skills to fill decent jobs in the right places for better health service delivery, and in sufficient numbers to avert the projected 18 million shortfall.

The nursing workforce, comprising nursing professionals and nursing associates, is the world’s largest single occupation in the health sector and is a foundation of the interprofessional health teams that deliver on the promise of health for all. Improvements in population health and well-being have been, and will continue to be, ably realized through the industry, innovation and inspiration of the nursing profession.

Nursing has existed for centuries and has evolved considerably since the birth 200 years ago of Florence Nightingale, considered the founder of modern nursing. Structured education, clinical standards and nurse professional associations emerged in the 1800s, progressively raising the quality, competencies and working conditions of the nursing profession.

The 1900s saw the growth of specializations and autonomy, along with stronger professional regulation to ensure public accountability and safety. The first international organization for health care professionals, founded in 1899 in America, was the International Council of Nurses.

Accelerating progress towards universal health coverage and achieving SDG 3 is possible by refocusing attention on the investment needs for the health workforce.

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India has far to go in its journey towards achieving these goals on universal health coverage. Despite a rapidly growing economy that provides increasing fiscal flexibility, public expenditure on health has seen no significant increase for a decade (2005-2014), ranging from 1.1% – 1.4% of GDP. These figures compare poorly with India’s neighbours and fellow developing nations, many of which spend more on health care, including Nepal (2.3%), Bhutan (2.6%) and Sri Lanka (2%). The global average is also significantly higher at 6% of GDP.

Such low levels of public expenditure shift the burden of financing health care through out-of-pocket payments for services at the point of care. These services vary widely in quality and price. Out-of-pocket expenditures at the point of care account for 62.4% of total health spending, and are made in the absence of any widespread financial protection scheme. As a result, private spending on health care upsets the financial stability of an estimated 63 million Indians every year, driving them into poverty.

This problem demands urgent attention. India must spend more and spend better on the health of its people in order to alleviate the financial hardship faced by millions of families seeking basic health services. The SDGs recognize that it is only through universal coverage that the right to health for all can be realized, while ensuring that nobody “goes bankrupt when they get sick.”

Global Health Strategies, in partnership with the International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, and the IKP Trust undertook a study to evaluate and recommend public financing mechanisms capable of sustainably delivering universal health coverage in India. The report was shared with Members of Parliament at a roundtable event, on ‘Health Care for All’, organized by GHS.

It recommends that in addition to earmarking a higher percentage of GDP incremental increases for health care, supplementary financing mechanisms and a national SHI scheme must be developed to provide financial protection to diverse populations. Finally, high impact system design changes and interventions must be prioritized, with a focus on improving primary care and programs like immunization that positively impact the productivity and prosperity of the whole country.

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