A focus on nurses and teachers is key to transforming India’s health and education sectors. Here’s why.

By Minha Khan, Impact Fellow at Noora Health, Mark Butcher, Associate Head of Donor Partnerships & Communications at STiR Education, and Sumbul Siddiqui, Manager of Donor Partnerships and Communications at STiR Education.

The COVID-19 pandemic taught us so much, including by shining a light on how much we rely on those who provide care for our communities. In particular, we came to realize that the nursing and teaching professions are on the frontlines of community care to help us reach our physical, mental, and emotional potential.

To ensure that nurses and teachers can continue to play the vital roles that they do, we explored the similarities and differences between their respective experiences to understand: who takes care of community caregivers?

Together, Noora Health and STiR Education, international NGOs respectively supporting nurses and teachers to equip them to best meet the needs of their communities, gathered four public sector nurses and teachers from across India for a candid discussion about the realities, struggles, and bright spots of two essential professions. Here is what we learned.

Appreciation is a great motivator…

Participating teachers and nurses identified the appreciation that they receive from children and patients respectively as a key motivator. This joy and gratitude encourage them to continue in their roles. As Komal, a Delhi school teacher, says: “Students are very giving. If you make any effort, they appreciate it very much. Through letters and gestures, they let you know how important you are to them.” Arti, a nurse from Madhya Pradesh, adds: “I am inspired when patients leave the hospital happy and satisfied.”

…but society does not value these roles

However, this appreciation does not always follow outside the doors of the hospital and school. Megha, a maternity nurse from Karnataka, says: “Everyone appreciates teachers and nurses when they see us work. When they need us, they realise how important we are. But otherwise, the image is different.” They discussed how their roles are seen as inferior to doctors or engineers. Arti shared the perception that “nurses are skilled but not educated”, while Komal noted that teaching is considered the last resort for individuals who failed to get their first choice of profession. It was interesting to learn that none of our four teachers and nurses had picked their current career as a first choice, but had instead followed family members or been unsuccessful in other careers previously. Today, however, all participants express deep love and respect for their fields.

Expectations are unrealistic

Despite the lack of value often assigned to both roles, our communities simultaneously have high expectations of teachers and nurses. Rohit, who has taught in both Uttar Pradesh and Delhi, says: “Parents expect that in six hours of school, their child will be educated.” As a society, we do not properly acknowledge that these jobs are difficult or our own responsibilities in ensuring the education of our children, and our own personal health. These challenges can also be observed within systems themselves. Arti also talked about negative attitudes from doctors towards the work of nurses, sharing that “all the blame is put on nurses, not on doctors” when things go wrong.

Pay is low and hours are long

We were unsurprised to hear that all respondents felt that their pay was much less than other careers despite the high levels of time and effort that they invest at work. In some cases, salaries are also not paid on time. But with shortages in both careers, our teachers and nurses feel forced to put in extra time. Arti described working six 12-hour night shifts each week, while Rohit talked about classroom overcrowding and the impact this has on the attention they are able to provide to each child.

Based on these findings, Noora Health and STiR Education make the following recommendations:

Consider mechanisms to increase the appreciation of nurses and teachers

While teachers and nurses continue to receive low pay relative to other professions, these roles will continue to be devalued. Governments must find a way to increase salaries, recognising the years of training required to fulfil these roles, and encourage young people to pursue nursing and teaching as first choice careers.

However, we can also encourage greater appreciation in other ways. It is disheartening to hear that doctors can have negative attitudes towards nurses, while education leaders in many systems have long dismissed teachers as part of the problem in improving education outcomes. We must work to improve relationships within our systems, developing trust and understanding of the challenges faced by all roles, and then role-model this appreciation in our interactions with patients, parents and children. Both Noora Health and STiR Education are pleased to be addressing this aspect through our activities.

Invest in the development and wellbeing of nurses and teachers

All of our interviewees also told us that they were motivated by investment in their personal development. For systems, this can be a valuable and relatively low-cost mechanism to encourage retention and improvement of the existing workforce.

For example, STiR Education partners with state governments in India to improve their support for teachers and reignite their passion for teaching. A core focus on intrinsic motivation puts teachers at the heart of education transformation, and encourages systems to ensure that they have the autonomy, mastery and purpose to effect meaningful change.

Make nurses and teachers as co-designers in the health and education systems

Nurses and teachers are best-positioned to understand the ground realities of our health and education systems. They know the community needs, context, and individuals. We must invite them to be co-designers in hospitals and schools.

Noora Health works in collaboration with nurses to develop tools and resources with which to train family caregivers to provide care for their loved ones, thereby reducing readmission rates and frequent trips to the hospital. We are able to turn hospital waiting rooms into classrooms and empower family caregivers because our training materials were co-developed with the very people who care for the community every single day, and best understand the patients, their families, and the illnesses.

In conclusion: empathy to action

For a brief moment, COVID-19 evoked within many of us a sudden and overwhelming sense of appreciation for nurses and teachers. As Megha shares: “What we do is an everyday job but because of COVID it’s been seen”. We must channel the empathy we felt during the COVID-19 pandemic into action: speaking kindly to our teachers and nurses, appreciating their efforts, and recognizing that these individuals put care for the community before they put care of themselves.

Ravi is hopeful that a positive change is coming. Through education, he shares, it is possible to “improve the fabric of society so that kids learn to regard nurses and teachers as valuable.” Change, he explains, comes from the inside. As Megha told us, “teachers and nurses are doing such great jobs. We need to reimagine and redefine our perceptions of what these professions really are.” Let’s reconsider our own preconceptions of nurses and teachers – and encourage our systems to do the same.

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  1. Organisation Behaviour and Health Service Effectiveness: Valuing New Qualification and Competency

    The UNESCO Chair for Global Health and Education, a Collaborating Center with the World Health Organisation has held a workshop in mid June 2023. This was entitled “Practice based Solutions for Community Health”. An Indian study focusing on addiction and mental health was powerful because sustainability was the focus, leading to training lay people to provide some health service. This can be perceived as new competency and qualification because the lay people are trained to the requirements of the patients. This may not necessarily be a full fledged training in the traditional field and occupational classification. Thus, one can argue that the nursing profession may not be devalued as such, but it is changing.

    Needless to say that the pandemic has led to the cost of living crisis. Subsequently, the affordability of health services is challenging, let alone to the poor in the community, to the professional health service workers both in the UK and the US because they have staged “Historical” strikes for pay increase this year. Unequivocally, when we look into community health provision, the aforementioned study in the Indian context is exemplary. Other countries can follow such exemplary work. However, competency and qualification can be held by a handful organisations and these can be the Ivory Tower where heavy handed gatekeeping, fee requirement, neocolonization, lack of adherence to the socioeconomic determinants of health can affect a move in a new direction, which is attaining sustainability by valuing new competency and qualification. Health service effectiveness can be challenging because similar agendas being run by UNESCO-UNEVOC forum on new competency and qualification can be challenged by top down dictums of “National Qualification Framework ” which is often run by state actors. Indeed, the United Nations embraces non-state actors and the aforementioned UNESCO Chair community is also open to individual experts, civil society organisations, community members and other actors. Nonetheless, new competency and qualification can have diverse criteria and the critical internationalisation of higher education is at an interplay. Experts with professorship titles can lead the revolutionization of the health sector field including nursing, nursing philosophy, health promotion and education. Yet, these titles can be challenged by Ivory Towerism who often lead the field. Countries can also run paternalism with high level of state involvement. As we know, the United Nations has declared that the civic space is shrinking. If this is the case for organisations, we can deduce that individual expert roles can become not only devalued, but extinct.

    Going Forward

    When we look into the teaching profession, the lack of willingness to use technology has been transmitted in this blog very recently. This is the digital era and where possible, teaching has to be in the virtual world, so is telemedicine the trend. Accordingly, working hours may decrease and the skill sets that are required to conduct work in such a medium may have to be learned. In other words, Organisation Behaviour has to change and the multistakeholder arena such as knowledge exchange platforms need to be valued.

    Sincerely,

    Lul Admasachew

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