On March 10, 2015, the Institute of Medicine (IOM) of the US National Academy of Science will host a global webinar open to all called “A Discussion on Empowering Women and Strengthening Health Systems through Nursing and Midwifery Investment and Enterprise.” This followed the publication of an IOM report on a workshop of the same title. The report and the discussion are both led by Marla Salmon, ScD, RN, FAAN, at the University of Washington. She was stimulated by interest in “the feasibility and desirability of innovative investment in nursing and midwifery education and practice enterprise as avenues of opportunity for women’s empowerment.” One conclusion for those in more industrial countries: “Investment in innovative nursing and midwifery enterprise that is taking place has value to informing developments globally and in the United States.”
The workshop, report, and discussion are joint projects of the IOM Global Forum on Innovation in Health Professional Education and the IOM Forum on Public-Private Partnerships for Global Health and Safety. A key focus was on entrepreneurial models for advancing businesses such as the Well Family Midwife Franchise Clinics, begun in 1997 in the Philippines. It is owned and managed by licensed midwives and backed by a consortia of non-governmental organizations (NGOs). Much dialogue focused on empowerment, business education, “social enterprises,” scaling, and sustainability of models.
Comment: Great topic, for many reasons. One is simply that, as the New York Times recently began to admit, midwifery needs to be elevated in a reformed delivery system focused on bettering health outcomes and lowering cost. In addition, the intersection of public and private drivers, such as “social enterprise” models, so critical here, are also underexplored in the entire integrative health and medicine enterprise. Back in 2001, an interprofessional stakeholder identified this need in a set of Design Principles for Healthcare Renewal as “a partnership between an expanded commitment to the public health and a thriving industry of health creation.”
One unfortunate note: the organizers missed a beat in not including in their meeting at least one representative of an excellent go-between profession between nursing and the world’s traditional midwives: the homebirth-oriented, non-nurse midwives. In truth, the attendee list did not readily reveal any inclusion of direct-entry midwives. In the United States, these are organized as Certified Professional Midwives and have the entire apparatus of accredited education, national certification, and licensing. Most midwives globally are not nurses. Ironically, the leading academic center in the United States for such education is in Salman’s backyard, at the Bastyr University Midwifery Department. An innovation for nurses is to give non-nurse midwives as much respect as they, nurses, would like from medical doctors and that we’d all like to see for the mainly female-run enterprises that are the subject of Salman’s work.