JNA's challenge
to strengthen UHC in Japan andenhance nursing capacity in community:from the perspective of public health nurses, midwives, and nurses

Nursing Innovation toward 2040
Miho HASHIMOTO
Director, Professional Services Bureau,
Japanese Nursing Association

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To realize a “mutually-supportive community" for all generations
TowardPromotion of the Community-based Integrated Care System2025
A comprehensive support/service provision system should be established for each area of daily living, in order toprovide long term care, medical care, prevention of the need for long term care, livelihood support, and housing
in an integrated manner. The goal of this system is for the elderly to be able to continue to live as they like until theend of their lives, as much as possible, in their familiar areas.
Toward2040
Issue 1:
Diversification and increased complexity of "carerecipients"

Issue 2:
Decrease/regional differences in "care providers"A "mutually-supportive community" for all generations should be realized using the ideas andsystems of community-based integrated care established though geriatric care.
What is a “mutually-supportive community”?
✓ A society where local residents and diverse organizations participate beyond a "vertical division" of each system/field anda relationship between "care providers" and "care recipients,“✓ and have relationships that connect across generations and fields,✓ so that all persons can create livelihoods, meaningful lives, and communities together.
© 2023 Japanese Nursing Association

3

Enhancement of outpatient nursing functions to achieve UHC➢ Nursing professionals are required to "comprehensively" support the health of all generations, throughcross-sectional collaboration and cooperation.
➢ Nursing professionals, who have the viewpoints of both "medical care" and "livelihood support
provision," and who can provide support while looking at the whole picture are expected to play roles to"connect" multiple professions, including inpatient care, outpatient care, and home-based care.
➢ Enhancing outpatient nursing functions will lead to achieving a “mutually-supportive community" and"UHC."

Efforts required for enhancing outpatient nursing functions
Sharing and fulfilling roles according to patient profile and medical functions
Use of highly specialized nurses
Clarification of the value of outpatient nursing© 2023 Japanese Nursing Association4

Contribution to the sustainability and effectiveness of UHC

Maintaining and promoting health of all people in the community
Prevention of aggravation ofchronic diseases at outpatient
clinics, etc.

Nursing approach
Disease management that does not rely on drugs, such as improving self-care skills
and lifestyle✓ A certain level of results has been confirmed, but it does not spread due to insufficient evaluation of the system✓ Limitations because it is practiced in a medical institution (the target is people who are already in the treatment phase)

It is necessary to establish a system to maintain and promote the health of all people in the communityand promote the creation of a healthy community

Establishment of nursing hubs that serve "primary care functions" in the community
Medicalinstitutions(Outpatients, etc.)

Expand the field

Expand the target

From passive approach toactive delivery

Approach to all
generations

Expand the scope
Improvement of the health literacy
Maintenance and promotion of health
Disease prevention/prevention of
disease aggravation

Comprehensive support for all generations from primary to tertiary prevention
Promoting a change in people's awareness of health
Fostering a healthy town and culture
Support for patients receiving treatment/careand their families

Support for all people living in thecommunity© 2023 Japanese Nursing Association5

Number of employed nursing professionals◼ The total number of nursing professionals in employment has increased over the years. By
occupation, the increase is particularly large for nurses.
(People)1,800,000■Public Health Nurse

1,700,000

public healthnurse■ Midwife■ Nurse■ midwife
Assistant Nurse

1,600,000
1,500,000
1,400,000
1,300,000

Enactment of the Act of
1,100,000 Work Forces of Nurses andOther Medical Experts
1,200,000

1,000,000
900,000
800,000
700,000
600,000
500,000
400,000
300,000
200,000
100,000
01990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 2020

Prepared based on “Report on Public Health Administration and Services (Employed Medical Personnel) in 2020,” Ministry of Health, Labour and Welfare (MHLW).

© 2023 Japanese Nursing Association6

Number of nursing professionals working in medical facilities and communities◼ The proportion of employed nursing professionals working in the community has increased over the years.
organisations
Nursing professionals working in the community
Nursing professionals working in healthcare facilities
nurses working
in theworking
community.
Percentage of nursing
professionals
in the community(People)

1,400,000

1,200,000

25%・Medical facilities: Hospitals, clinics
・Community: Health centres and municipalities, maternity homes,health/welfare facilities, visiting nursing station in-home services, plants
and industries20%
1,000,000
15%

800,000

600,000

Statistical categories
have changed.

10%400,000

200,000

152,053

69,92533,392075,72589,89896,889165,135 173,449

184,628 188,834

211,881
199,508 203,803

223,837 231,230

243,120 253,308

262,223 272,046

283,320 293,236

310,466 317,108

5%

114,504 123,385

37,736 38,419

0%1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Source: Masahiro Ishida Policy Research Group https://www.masahiro-ishida.com/category/ppt/ DATA: From the Statistical Data on Nursing Service in Japan, last updated on June 26, 2021
© 2023 Japanese Nursing Association

Contribution to the sustainability and effectiveness of UHC

Direction of measures to secure the nursing workforce
Three pillars of the existing efforts
Increasing the number ofnursing professionals

Support for returning to work

Promoting retention⚫ Providing information on attractivenessof nursing for young people⚫ Support for acquiring nursing-related
licenses for those who have workingexperience⚫ Support for latent nurses*1 to return towork through free employment
services, information provision andconsultation by the nurse centers set
up in each prefecture.

⚫ Improving the working environment(development and operation of inhouse childcare facilities, andexpansion of rest areas)⚫ Creating a workplace where people cancontinue to work

Additional pillar to existing efforts
Workforce migration⚫ Changes in the place of work between
regions/areas⚫ Expansion of work to other facilities*2
besides medical institutions*1: Latent nurses are those who are not currently working as a nursing professionals*2: Home nursing stations, long-term care insurance and welfare facilities© 2023 Japanese Nursing Association8