A commentary on the Pan American Network of Nursing and Midwifery Collaborating Centres

ABSTRACT

This article provides a commentary on the Pan American Network of Nursing and Midwifery Collaborating Centres (PANMCC). The objectives are to present an overview of the formation and evolution of the network, its impact on education, research, policy and communication and the benefits of membership. The advantages of international networks as a mechanism to strengthen nursing and midwifery workforces and improve health systems are also highlighted. The Pan American Health Organization (PAHO), the World Health Organization (WHO) Office in the Americas, oversees collaborating centres in the Region. Established in 1999, PANMCC consists of 17 centres situated in universities and schools of nursing. These centres provide crucial nursing and midwifery input to PAHO/WHO. The network supports global engagement and capacity building via collaboration, resource sharing and research colloquia. The linkages within the network enhance professional development, increase capacity building and heighten visibility of PANMCC and the work of its members.

There are more than 800 World Health Organization (WHO) Collaborating Centres (CCs) in 80 Member States around the globe. As defined by WHO, a "Collaborating Centre is an institution designated by the Director-General of WHO to form part of an international collaborative network set up by WHO in support of its programme at the country, intercountry, regional, interregional and global levels" (1). The Centres were launched in 1947 to advance world health, promote research and strengthen country resources (1). Eligibility is open to healthcare facilities, agencies and higher education institutions, which are designated by WHO as CCs based on their excellence and technical expertise in research and education that aligns with WHO goals. The Centres are organized by fields, including occupational health, primary care, advanced practice nursing and midwifery development (2).

The WHO first established CCs in schools of nursing in the 1970s, and there are currently 47 Centres engaged in funded projects, educational partnerships and research focusing on building expertise in nursing and midwifery (3). Specific activities include supporting baccalaureate and doctoral study in nursing and midwifery and consensus building regarding standards of practice. There is an understanding within WHO and across the CCs that education, professional development and collaboration in nursing and midwifery can save resources, reduce unnecessary interventions and improve the quality of care (4).

The Pan American Health Organization (PAHO), the WHO Regional Office for the Americas (AMRO), receives applications for CCs and oversees designees. This article provides a commentary on the Pan American Network of Nursing and Midwifery Collaborating Centres (PANMCC). The objectives are to present an overview of the formation and evolution of the network, its impact on education, research, policy and communication and the benefits of membership. The advantages of international networks as a mechanism to strengthen nursing and midwifery workforces and improve health systems are also highlighted.

PAN AMERICAN NETWORK OF NURSING AND MIDWIFERY COLLABORATING CENTRES

Formation and evolution

Created in 1999, PANMCC has 17 member CCs and provides information on workforce trends, education and health issues to PAHO/WHO. It also champions "the role of nurses and midwives in the advancement of 'Universal Health Coverage' by addressing current health priorities and promoting regional and global cooperation" (2). PAHO advisors work with each Centre to establish terms of reference in line with PAHO/WHO priorities and these shape the nature and goals of projects undertaken by the Centres.

PANMCC was established by representatives of CCs in the AMRO Region as an informal, voluntary group. In an effort to increase collaboration and sustainability, a more formal structure was later established. The original broad goals included nursing and midwifery input to PAHO/WHO and advancing the work and visibility of these professions. Outcomes of the work and projects undertaken by each CC are documented in annual reports to PAHO/WHO, papers published by the Centres and policy documents produced by PAHO/WHO and nursing and midwifery organizations. There is also an annual meeting of all the Centres, followed by a research colloquium. The latter includes presentations, poster sessions and workshops in English, Spanish and Portuguese. The colloquium provides a forum for participants to discuss issues and trends in nursing and midwifery, create professional and academic connections through networking and identify opportunities for joint research.

The mission and objectives of PANMCC include identifying and maximizing the strengths of each Centre and fostering collaboration among them. Dr. Rita Carty, the first Director of the network, emphasized the potential power of bringing people together. The projected outcomes of collaboration include honing the skills of nursing and midwifery faculty and encouraging interest in evidence-based nursing and midwifery practice and research, student exchanges among CCs and schools of nursing and support for baccalaureate and graduate programs in countries where tertiary education (i.e., at the college or university level) was absent or limited.

To ensure recognition of and respect for the diversity of nurses and midwives in the Americas, it was mandated that the Executive Committee include officers from North and South America and that membership dues are scaled to country economies. Each CC in the network has a distinct specialty focus (Table 1).

TABLE 1. Pan American Network of Nursing & Midwifery Collaborating Centres.

Country	Host institution	Specialty focus areas
Brazil	University of São Paulo at Ribeirão Preto College of Nursing	Nursing Research Development
Canada	McMaster University School of Nursing	Primary Care Nursing and Health Human Resources
Chile	Pontificia Universidad Católica de Chile Escuela de Enfermería	Health Services and Nursing Development for Non-communicable Disease Care
Chile	University of Chile Departamento de Enfermería	Development of Midwifery
Jamaica	University of the West Indies School of Nursing	Nursing and Midwifery Development in the Caribbean
Mexico	Universidad Nacional Autónoma de México Escuela Nacional de
Enfermería y Obstetricia	Development of Professional Nursing
Trinidad and Tobago	University of the West Indies School of Nursing, St. Augustine Campus	Leadership and Health Policy
USA: Alabama	University of Alabama at Birmingham (UAB) School of Nursing	International Nursing
USA: Florida	University of Miami School of Nursing and Health Studies	Nursing Human Resources Development and Patient Safety
USA: Illinois	University of Illinois at Chicago College of Nursing	International Nursing Development in Primary Health Care
USA: Maryland	Johns Hopkins University School of Nursing	Nursing Knowledge, Information Management & Sharing (KIMS)
USA: Maryland	University of Maryland Division of Occupational and Environmental Medicine	Occupational Health
USA: Michigan	University of Michigan School of Nursing	Research and Clinical Training in Health Promotion Nursing
USA: New York	Columbia University School of Nursing	Advanced Practice Nursing
USA: New York	New York University Rory Meyers College of Nursing	Gerontological Nursing Education
USA: North Carolina	University of North Carolina at Chapel Hill School of Nursing	Quality and Safety Education in Nursing and Midwifery
USA: Pennsylvania	University of Pennsylvania School of Nursing	Nursing and Midwifery Leadership

Source: Prepared by the authors using information from PANMCC (2).

PANMCC is a member of the WHO Global Network of Collaborating Centres for Nursing and Midwifery, which spans six regions: Africa, Americas, Eastern Mediterranean, Europe, South-East Asia and Western Pacific. It maintains relationships with key nursing and midwifery associations such as the International Council of Nurses and the International Confederation of Midwives, which liaise with non-governmental organizations and agencies, healthcare organizations and community groups worldwide.

Influence of the network

Collaborating Centres are vital given that nurses and midwives are underrepresented in regional and national dialogues related to key issues such as universal healthcare, health workforce planning and policy (5, 6). The linkages within the network enhance professional development, increase capacity building and heighten visibility of PANMCC and the work of its members. For example, PANMCC researchers published a number of jointly written articles in various high-ranking journals in 2021, including Lancet Global Health, Revista Latino-Americana de Enfermagem, International Journal of Mental Health Nursing and BMC Nursing. The articles focused on studies related to nurse staffing and patient outcomes in Chile (7), an online community of practice for nurses and midwives (8), nursing students' attitudes regarding alcohol use in four countries (9) and academic service-learning nursing partnerships (10).

Innovative activities and successful outcomes in education, research, policy and communication have emerged from the relationships established within PANMCC and the collective nursing and midwifery expertise of its members (11). Highlights include the following:

• Supporting the Safe Motherhood Initiative - Several organizations, including PAHO, the United Nations and Ministries of Health, have worked together to reduce maternal mortality and achieve universal access to reproductive healthcare (12).

• Contributing to the HIV Network - Through ongoing dialogue between Johns Hopkins University School of Nursing and the Global Alliance of Nursing and Midwifery (GANM).

• Conducting nursing mental health projects - The University of Alberta in Canada and the University of Maryland in the United States collaborated in research focusing on nurses in Central and South America.

• Participating in the GANM - This network, of which PANMCC is a member, provides nurses and midwives with "equitable access to knowledge and discussions regardless of internet bandwidth … [and provides] a global voice" (13).

• Promoting the advanced practice nursing (APN) strategy - Intended to "guide and support the introduction of primary health care APN roles in Latin America and the Caribbean" (14).

• Collaborating to strengthen a midwifery program at the University of West Indies and doctoral study at Pontificia Universidad Católica de Chile Escuela de Enfermería.

• Providing country-specific nursing and midwifery human resource data for a variety of PAHO/WHO publications.

• Creating a compendium of best practices in nursing in Brazil to facilitate universal access to health.

• Developing a health human resource plan for Barbados.

• Producing and implementing a campaign to improve the image and visibility of nursing in Mexico.

• Advancing health equity through interprofessional projects, collaborations and a learning network that focuses on global innovations in health.

• Translating three WHO books on core competencies for midwifery: Midwifery educator core competencies; Midwifery educator core competencies: Building capacities of midwifery educators; and Midwifery educator core competencies: Adaptation tool (15-17).

BENEFITS OF MEMBERSHIP

Collaborating Centres "are an essential and cost-effective cooperation mechanism … [via which] WHO gains access to top centres worldwide and the institutional capacity to ensure the scientific validity of global health work" (1, p10, p11). Membership in PANMCC is beneficial for increasing the visibility and recognition of nursing and midwifery as critical professions and increasing opportunities for knowledge exchange.

Mentorship has remained a central tenet of PANMCC from its inception. Senior level personnel share their leadership experience with other members. Collaborating Centres with grant writing expertise strengthen capacity by sharing their expertise with other institutions that lack human resources and funding infrastructures. Nursing and midwifery education are supported by faculty development and research is promoted in biennial colloquia and conferences in the United States, the Caribbean and Latin America where Centres exchange data, recruit new researchers, mentor students and create teams for future grant submissions.

A convergence of evidence demonstrates that international collaboration has a significant impact on scholarly and scientific progress (18-20). PANMCC developed an online repository of PAHO and member resources that highlight each Centre's specialty areas. This is accessible on a shared website linked to an archive of information. Every four years a CC is nominated to host the website and be the locus of communication among members, PAHO, WHO and the Nursing and Midwifery Global Communities of Practice.

Collaborating Centre designation provides opportunities for host institutions to highlight nursing and midwifery and raises the profiles of these professions within the institutions. Nursing and midwifery faculty use the CC to sponsor important events and showcase international research and education projects. The Centres serve as training hubs for students and maintain connections to PAHO, a rich resource of educational materials in three languages (English, Portuguese and Spanish). The Centres enable affiliated personnel and faculty to participate in international collaborations and consultations, which provide local and national input on healthcare policy, practice and research.

CONCLUSION

The purpose of this commentary is to provide an overview of PANMCC, its impact and the benefits of membership for CCs within the AMRO Region. More than 20 years following its establishment, PANMCC has grown in size and scope with the addition of new members and establishment of CCs in Latin America. Yet its mission and objectives have remained relevant and its goals and projects support PAHO/WHO priorities.

The WHO has identified the importance of maximizing the capacities and potential of nurses and midwives in intraprofessional and interprofessional partnerships, education and continuing professional development. PANMCC recognizes and endorses baccalaureate and graduate programs in nursing and midwifery as critical to global health systems and healthcare outcomes. Network members are contributing to nursing and midwifery curricula and research and promoting the need for higher education and excellence in educational standards. The activities, collaborations and work of the CCs help strengthen in-country health human resources and contribute to national health development.

Disclaimer.

Authors hold sole responsibility for the views expressed in the manuscript, which may not necessarily reflect the opinion or policy of the Revista Panamericana de Salud Pública / Pan American Journal of Public Health and/or those of the Pan American Health Organization.