Nurses and midwives are the steady hands in emergencies, the calm voices in crisis, and the constant presence at life’s most vulnerable moments.
Yet beyond the applause lies a harder truth: too few professionals are carrying too much of the burden.
Beneath the surface, many nurses are at breaking point; working under intense pressure in underfunded systems, navigating rising patient expectations, frequent litigation threats, public scrutiny on social media, inadequate staffing, limited supplies, delayed salaries, and at times even workplace violence. These realities rarely make it into the celebratory speeches.
Nurses and midwives form the backbone of healthcare delivery. According to WHO, they make up nearly half of the global health workforce. Yet demand for care continues to outpace supply. Population growth, the increasing burden of chronic diseases, and the lessons of the Covid-19 pandemic have exposed just how thinly stretched this workforce has become.
The numbers are sobering. Globally, there is an estimated shortage of about five million nurses, with sub-Saharan Africa accounting for about 89 per cent of this gap, despite having only about 3.0 percent of the world’s 27.9 million nurses.
In Africa, the density stood at about 17.78 nurses per 10,000 people (2020). In Kenya, the situation is even more constrained. The country has about 12 nurses and midwives per a population of 10,000, far below the WHO’s recommended ratio of 30.5 per 10,000.
These shortages translate directly into unsafe nurse-to-patient ratios on the ground. In Kenya, a single nurse may attend to 30-60 patients per shift in outpatient or general wards.
In maternity units, one midwife may simultaneously manage three to five labouring mothers, far above safe standards of one-to-one care during active labour. These are not exceptional cases; they are daily realities, particularly in rural and under-resourced settings.
The causes are well known yet insufficiently addressed. First is the allure of opportunities abroad. Better pay, safer working conditions, and clearer career pathways continue to attract Kenyan nurses and midwives to high-income countries. While migration is a personal right, its cumulative impact leaves local systems depleted. Referral hospitals have lately experienced waves of resignations as staff leave for overseas employment.
Secondly, burnout is taking a heavy toll. Long working hours, emotional strain, and understaffing are pushing many out of the profession.
Applause cannot compensate for exhaustion. Those who remain feel demotivated, forced to work in survival mode rather than delivering optimal care.
Third, training capacity has not kept pace with demand. Limited faculty, infrastructure, and clinical placement opportunities constrain how many professionals can be trained each year.
Even with the growth in training institutions, output still falls short of national and global needs. Finally, recruitment into the public sector often lags behind reality.