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Bangladesh has one of the lowest rates of nurses and midwives in the world. According to the World Bank, in 2019, there were only 0.4 nurses per 1000 people, a figure which is five times lower than the average for South Asia and ten times lower than the global average. Although the number of nurses has increased over the past decade, they continue to face the challenges of poor career paths and limited voices in affecting healthcare policy design and implementation.

As we celebrate International Development Week 2023 and Canada’s contribution to the achievement of the Sustainable Development Goals, we are reminded of the critical role that nurses play in addressing the underlying causes of poor health, understanding and recognizing the wide range of factors that influence how well and long people live and working across multiple institutions and stakeholders to improve population health outcomes.

Cowater International-led ProNurse Project (Empowering Women through the Professionalization of the Nursing Sector in Bangladesh), funded by Global Affairs Canada, is a 5-year intervention that aims to enhance the voice, influence and empowerment of nurses in Bangladesh. It does so by providing technical assistance to support public and private nursing sector stakeholders; capacity building to strengthen the clinical, managerial and teaching capacity of nurses; as well as infrastructure improvements of nursing education facilities, for example, through the expansion and renovation of the Mohakhali College of Nursing in Dhaka.

Effective leadership in nursing has been linked to lower patient mortality, higher quality of patient care and patient satisfaction, and better staff wellbeing and morale. The International Council of Nurses (ICN) has long understood the critical importance of nursing leadership to improved patient care and nurse performance. In 1996, ICN established its flagship leadership program, Leadership for Change (LFC). ProNurse has partnered with ICN’s LFC program to train new nurse leaders in Bangladesh in a wide range of areas, including quality of health services, patient safety and satisfaction, improved access to care, healthcare workers’ safety and working conditions. The program is also elevating the role of nurses and midwives in health policy formulation.

A key aspect of the LFC training is that it is tailored to respond to the specific needs of Bangladesh. It encompasses both the basic LFC training for selected nurses and also a training-of-trainers approach to build national ownership and ensure the sustainability of capacity building activities.

Leadership for Change training targets improvements in global public health policies by aligning to the Sustainable Development Goals (SDGs). It covers critical issues such as gender equity and equality, dealing with workplace sexual harassment, improving organizational culture, dealing with conflict, working as a team and a wide range of other topics that are critical to improving the performance of the nursing sector in Bangladesh. 50 nurses are currently enrolled in the program, with ProNurse aiming to train over 200 nurse leaders.

According to the ICN, LFC trainings have contributed to reducing the likelihood of nurses emigrating in search for better opportunities in other countries. This suggests that the program is an effective strategy to encourage nurses to stay in Bangladesh and contribute to the improvement of the country’s healthcare system. In addition, ProNurse and ICN are ensuring the sustainability of capacity building interventions by providing ongoing mentoring and the establishment of an LFC Community of Practice (COP) that will be supported by social media platforms like WeChat, Facebook and WhatsApp. The skills and learning shared through the LFC program highlight the importance of a comprehensive, multi-stakeholder approach to building the next generation of nurse leaders and equipping them with the tools and attributes to raise their voices in building a healthier and more prosperous Bangladesh.

ProNurse is implemented in association with the University of Montreal (International Health Unit) and the Canadian Association of Schools of Nursing, and collaborates closely with the Directorate General of Nursing and Midwifery (DGNM), the Bangladesh Nursing and Midwifery Council (BNMC) and the Ministry of Health and Family Welfare (MoHFW).