GAPFON Report: Addressing Professional and Global Health Priorities for the Future


Strong leadership was identified as the core priority for positioning nursing and midwifery for the future in the recently published report by the Global Advisory Panel on Nursing (GAPFON). The report was compiled after broad consultation with nursing and health care leaders in every continent. Other priorities for nursing and midwifery, as well as global health priorities, were also identified.

The GAPFON report was the result of four years of work by the panel which was established in 2013 by the nursing honor society, Sigma Theta Tau International – now newly branded as Sigma. The purpose of the board was “to establish a voice and vision for the future of nursing and midwifery that will advance global health while simultaneously strengthening professional roles.” While nurses and midwives represent over 50% of the health workforce, their voice is often not heard or sought in relation to both healthcare challenges and the profession’s contribution towards achieving global health and universal access to health care. Sigma believed that there should be a unified message to advance nursing and midwifery across the world.


Initially, a core panel of experts from each continent was selected which, through a survey and consensus building meetings, identified four priority professional issues and strategies to address each of these priorities. Health issues where nurses could take the lead in achieving global health were also identified. The panel then recommended that similar meetings should be held with key healthcare stakeholders in regions across the world to determine priority professional and health issues, as well as strategies, relevant to each particular region.

From mid-2015 to mid-2016, meetings were held in seven regions: South East Asia/Pacific Rim, Caribbean, Latin/Central America, North America, Middle East, Europe, and Africa. In each region, leaders from different sectors were identified and invited to the meeting which was led by members of the core GAPFON panel.  Examples of sectors which were represented included ministries of health, regional offices of the World Health Organization, national nursing organizations, practice settings and schools of nursing.


Local context and culture led to differences between each meeting as well as differences in prioritizing both professional and health issues. In some areas, representatives also preferred to develop models to illustrate how the issues were interrelated, rather than listing them in order of priority.


Following the seven regional meetings, the core GAPFON panel analyzed, weighted and synthesized the data from all the meetings to arrive at the GAPFON model.


Despite other differences, strong leadership was identified in every region and as the core issue underlying advancement of and excellence in all the other professional priorities. In the GAPFON model leadership takes a place central to all the other, interconnected and equally important, priorities – policy (including professional regulation), workforce, practice, education, and research. The model further emphasizes the importance of collaboration between nurses and all other healthcare stakeholders in order to achieve the goal of global health.


GAPFON Model. Image via:

Each region also differed with regard to the ranking of priority health issues, but cumulative rankings from all the regions identified the top five global health priorities as follows:

  1. Non-communicable diseases, including chronic diseases
  2. Mental health in general, as well as secondary to substance abuse and violence
  3. Communicable diseases
  4. Disaster preparedness and response
  5. Maternal-Child Health


Numerous strategies for advancing nursing and midwifery as well as global health were identified for each of the priority areas in the GAPFON model.

As can be expected leadership featured prominently in relation to each of the areas. From local to global levels, nurses should be critical partners in discussions relating to nursing as well as health care. For this purpose, nurses’ leadership skills must be developed, starting in basic nursing education. Furthermore, nurse leaders need to be positioned in policy-making bodies at all levels nationally, regionally and internationally. The leadership role of nurses in evidence-based healthcare innovations and in educating the community about health issues and solutions was also emphasized.

Also featuring prominently in the strategies was the promotion of specialization and advanced nursing practice to maximize nurses’ scope of practice in the interest of meeting priority health challenges and universal access to health care. Nurses should also focus on distributing evidence of positive outcomes and cost benefits of nursing and midwifery interventions, position themselves as the first point of contact with media and identify themselves as nurses when appearing on public platforms in relation to health matters.


GAPFON has identified the next step as establishing partnerships with organizations that have a specific interest in developing action plans for achieving the strategies in one or the other of the priority areas. In this way, different approaches can be addressed at the same time to accomplish more rapid progress. Organizations will be encouraged to include other health disciplines as well as partners from other sectors in developing the implementation plans which should include recommendations, action steps as well as outcome targets. These plans can then be shared with and used by regions according to their specific priorities and needs. 

To take nursing and midwifery forward professionally, as well as towards meeting the healthcare challenges of the future the Gapfon research, report and implementation plans provide “a platform for nursing and midwifery to have an inclusive voice worldwide, to be a catalyst for global health partnerships and collaborations, and to help develop and influence policy and practice.” 

Frieda Paton is a registered nurse with a Master’s degree in nursing education. Her passion for nursing education, nursing issues and advocacy for the profession were ignited while she worked as an education officer, and later editor, at a national nurses’ association. This passion, together with interest in health and wellness education since her student days, stayed with her throughout her further career as a nurse educator and occupational health nurse. Having reached retirement age, she continues to contribute to the profession as a full-time freelance writer. In the news and feature articles she writes for Nurseslabs, she hopes to inspire nursing students and nurses on the job to reflect on the trends and issues that affect their profession and communities - and play their part in advocacy wherever they find themselves.