QUESTION: Can you briefly share about your partnership with the other unions you work with. What motivated this partnership and what similarities have you found in your shared struggle on behalf of your members.

ANSWER: In a world where democracy and human rights face increasing challenges, strong trade unions and vocal civil societies are fundamental. By promoting social dialogue and workers’ rights, trade unions strive to reduce inequality and promote human rights at national and global levels. A sustainable healthcare system relies on empowering healthcare workers to address challenges effectively.

In our experience, organisations (professional organisations and unions) with a large membership base have a better chance of being heard and achieving their goals. Strong negotiation and advocacy skills are also crucial for success and can enable these organisations to, for example, influence national authorities, support educational institutions, and bargain with employers. Internal and external evaluations have documented that Norsk Sykepleierforbund | Norwegian Nurses Organisation (NNO)’s partner organisations have contributed to, among other things, the recruitment of more nurses/midwives; more nurses/midwives having better and/or higher levels of education; and more young female nurses aspiring for and taking on leadership positions. 

While the causal relationship between labour unions (nurses’ organisations) and stronger health systems can be difficult to verify, the International Labour Organization (ILO) points out that “improving working conditions among key health workers requires investments in healthcare systems that allow for adequate staffing in order to guarantee quality services and social health protection for all, in line with ILO standards, in addition to funding physical infrastructure. These necessary investments are an enabling condition for improving job quality among key health workers, which, together with strengthening labour institutions, can deliver decent work”.

This is why NNO contributes to the development of strong nurses’ organisations that are enabled to work for good working conditions, fair wages, job satisfaction, adequate staffing and fulfilment of international labour standards. According to testimonies from NNO partners, NNO’s approach is unique in its personalised follow-up and the exchange of like-minded experiences and knowledge. 

 International development work and solidarity are an integral part of NNO’s identity. For over 40 years, NNO has worked to strengthen nurses’ organisations by sharing knowledge, expertise and experiences. Competence, systems, and routines must be in place for nurses’ organisations to become strong and sustainable advocates for their members. As a trade union and professional organisation, NNO has competence and experience that no other Norwegian civil society actor possesses. With decades of experience with international development work, NNO has unique insights into the various stages of the development process of a dual-mandate nurses’ organisation and possesses broad expertise in the many fields that these organisations work with. Our vision is to contribute to making our sister organisations attractive membership organisations.

Even though the contexts the partner organisations operate in are quite different, the organisations share many of the same challenges through being professional organisations and unions working for the welfare of nurses and midwives. For instance, for all five organisations, education and continued professional development are important focus areas. Our partners aim to increase the number of competent nurses since a significant share of the nurse workforce often has an education that is shorter than a bachelor’s degree. Then there is the issue of fair compensation – that nurses and midwives are being compensated for the education that they have – again something that is relevant for all organisations. Working conditions — such as wages, working hours and locum arrangements — are also a cross-cutting issue, together with workplace safety. 

In addition to similarities that are linked to the nursing profession, there are also challenges or similarities that relate to being a union or professional organisation – representing members, nurses and midwives, the majority of the health workforce. As well as the importance of positioning the organisation to be heard, to speak with one voice to reach the policymakers and the public. 

QUESTION: What strategies have been most effective in growing and sustaining your union and the unions you work with.

ANSWER: According to NNO’s partners, the partnership model, the approach, is unique in its personalised follow-up and the exchange of like-minded experiences and knowledge. While motivating application of different approaches to advocacy and lobbying has been important, the organisational development has been just as important. A professional organisation and union is nothing without its trusted brand and loyal membership, hence the efforts – and positive developments – in the areas of financial management, good governance and strategic membership work /member administration have been significant.

What we do falls under the umbrella of capacity building and organisational development. We focus on strengthening internal structures as well as advocacy and lobbying skills.

By strengthening the organisations to be democratic, accountable, inclusive and sustainable organisations, the partnership also contributes to the organisations becoming effective watchdogs and advocates for nurses and midwives, and for stronger and more resilient health systems. 

As mentioned above, organisations with a large membership base have a better chance of being heard and achieving their goals. There is strength in numbers. 

To achieve this, NNO has worked strategically with placing the member at the centre of what we do. Both in NNO and within the partnership with other National Nurses Associations (NNAs). 

 As several of the partner organisations highlight, they have strengthened workplace structures through the training of shop stewards and provincial leadership teams, ensuring effective representation at all levels. Continuous leadership development, mentorship programmes, and organising training have enhanced the capacity of union leaders to recruit, mobilise, and retain members. They have also leveraged digital communication platforms to improve engagement and responsiveness. These strategies, supported by strong partnerships and knowledge exchange, have enhanced the union’s visibility, credibility, and long-term sustainability.

QUESTION: How has your partnership supported industrial work such as collective bargaining and negotiations?  

ANSWER: NNO has collaborated with some of the organisations in the partnership for 15–20 years. The Zimbabwe Nurses Association (ZINA) and the Tanzania National Nurses Association (TANNA) are quite new to the partnership; they joined in March 2024. Hence, how the partnership has supported industrial work varies from organisation to organisation.

Throughout the partnership period, there has been a shift in how some of the organisations are being perceived by stakeholders and by the public. This is a result of exchange in advocacy, lobbying, negotiation and strategic communication. 

We see that some organisations, like the National Organisation of Nurses and Midwives of Malawi (NONM), have strengthened their position both in terms of visibility and recognition. The organisation has become a trusted partner and solution provider, not only to the government but also to the regulatory body and academia. This is evident in the way the organisation is invited to participate in key processes related to human resources for health, processes related to the nursing profession both in terms of education and regulation/regulatory issues. 

Moreover, the organisation signed a conciliatory agreement with the Malawi Government through the Ministry of Health and Sanitation. The agreement addresses some of the issues affecting nurses and midwives in Malawi, namely recruitment, promotion and review of locum (overtime) rates. 

In Zimbabwe, we see that ZINA has been elected as the leader of the Health Apex, representing all health workers in the country. 

In Rwanda, we see that the Rwanda Nurses and Midwives Union (RNMU) has been instrumental in negotiating for the safety and working conditions of nurses and health workers during the recent Marburg outbreak. The organisation was also an important actor when nurses and midwives in Rwanda were recognised as a priority group, which resulted in an increase in pension contributions. 

It is also worth mentioning that when NNO and RNMU first began collaborating, RNMU was a professional organisation without union status. Achieving a dual mandate was identified early on as a strategic goal for the partnership, and after some years, RNMU became an organisation with a dual mandate.

While NONM and RNMU have been part of the partnership for a long time, ZINA and TANNA are new to it. Strengthening the partner organisations’ ability to advocate for their members’ needs and strengthening decentralised structures is also integrated into NNO’s work with their partner organisations. Through technical support and training, union leaders and local representatives gain essential skills in labour law, negotiation and evidence-based advocacy. According to ZINA, the partnership has significantly strengthened their capacity to engage in industrial relations. Through technical support, training, and mentorship, union leaders have gained essential skills in labour law, collective bargaining, negotiation, and evidence-based advocacy. This has enabled ZINA to effectively participate in engagements with the government and other stakeholders on matters relating to salaries, allowances, and working conditions. The collaboration has enhanced ZINA’s strategic approach to negotiations, ensuring that the organisation represents the interests of nurses with confidence, professionalism, and credibility.

NONM stakeholders' consultation meeting in Lilongwe, Malawi ahead of collective bargaining (Photo: NONM)

QUESTION: Can you highlight any wins on working conditions which your programme has supported?

ANSWER: As an advocate and lobbyist, NONM has been a key driver behind the increase in nursing positions being staffed across the Malawian health system. By persistently pushing for functional reviews, NONM has successfully lobbied for an increase in the numbers of nurses in the establishment as well as the level of competence. In 2024, their advocacy had yielded over 6,000 new health worker recruits. Moreover, they have also succeeded in increasing locum rates as well as health specific allowances. 

RNMU, on the other hand, highlights their ability to advocate and negotiate for nurses and midwives to be included in horizontal promotion. Horizontal promotion is an appraisal of public servants conducted every three years, through which public sector employees may receive a salary increment. By ensuring that nurses and midwives, as public servants, are included in this scheme, RNMU has contributed to increased income for nurses and midwives in Rwanda. 

During COVID-19, both NONM and RNMU also advocated for the provision of sufficient personal protective equipment (PPE) for health workers. 

Ahead of an industrial sit-in over unimplemented commitments by the employer on recruitment, promotions and overtime rates: Peter Mvuma, NONM Executive Director (L) and NONM President Shouts Simeza (R)
(Photo: Maren Olene Kloster / Norwegian Nurses Organisation (NNO))

QUESTION: Can you walk us through a specific joint training or strategy-sharing session you have run that’s supported unions to grow their membership?

ANSWER: Thematic focus areas are jointly identified in dialogue with partner organisations, after which NNO draws on relevant internal expertise to support the work.

 In 2025, the partnership placed a specific focus on strategic membership work – how to recruit, activate and retain members. NNO’s advisers on strategic membership work organised several tailor-made sessions on the topic, covering areas such as strategic communication and recruitment, the link between membership engagement and influence, dialogue training, and practical counter-argument exercises. These sessions were delivered either as joint workshops bringing together all partner organisations, or through one-to-one follow-up meetings addressing challenges specific to each organisation.  

As one of the partner organisations writes: This hands-on exercise provided participants with an opportunity to apply recruitment and organising strategies in real workplace scenarios. Elected representatives, including shop stewards, engaged in role-playing, peer learning, and problem-solving activities that enhanced their confidence and effectiveness in member recruitment.

The session demonstrated the tangible impact of the training, as participants developed actionable plans tailored to their respective institutions. It was particularly inspiring to witness the enthusiasm, collaboration, and commitment of union representatives as they translated theory into practice. This experience reinforced the importance of empowering grassroots leaders as drivers of sustainable union growth.   

NONM's 2025 capacity-building workshop ahead of the union's internal elections being held this year.
(Photo: NONM.)

QUESTION: Are there any special moments which stood out for you through these trainings and strategy sharing sessions?

ANSWER: One of the things that has stood out is how learning goes both ways within the partneraship. Even though the contexts in which we operate are quite different, we repeatedly experience that nurses and midwives—our members—face similar challenges. 

For instance, a model that helped NNO develop a highly effective approach to strategic recruitment, member engagement and retention also works across the partner countries. Conversely, the student organisation in Norway gained new perspectives on how to address an issue they had been working on for a long time—after discussions with the student union in Rwanda.

By meeting, discussing professional issues, and sharing experiences and knowledge, all organisations gain new perspectives. The key takeaways are not always the same, but the learning goes both ways.

QUESTION: Discuss the importance of cross-border solidarity initiatives like your programme to grow nurse union power around the world?

ANSWER: This partnership consists of five organisations. Not all are unions, but all are professional organisations, nurses’ organisations that work for the betterment of nurses and midwives. We believe that this way of working – nurses’ organisation to nurses’ organisation – has some added value to it. It strengthens the sense of partnership – that despite the differences we face in day-to-day experiences, cultural and socio-economic backgrounds, and the contexts of practice, we share the same profession. This also fosters mutual learning. 

Cross-border solidarity initiatives, like this partnership between NONM, TANNA, ZINA, RNMU and NNO, are essential for, and hold the potential to strengthen, nurse organisations and unions globally. They provide a platform for sharing knowledge, skills, and innovative strategies, enabling unions to address common challenges more effectively. Such collaborations promote collective advocacy for decent work, fair remuneration, and safe working conditions. They also build resilient and sustainable organisations capable of influencing health policy and labour standards.

The partnership reminds us why strong unions and organisations that aim to strengthen health systems are important. Building strong organisations also has a community-building dimension to it. You do not only strengthen organisations, but the health system as a whole. Health underpins people’s ability to participate fully in society.  In this way, by aiming to improve people’s access to quality health services, you also help contribute to broader societal development.  

At the same time, strengthening nurses’ organisations and health systems comes with a clear preparedness dimension. Strong, more resilient health systems are better equipped to respond to crises such as pandemics or epidemics, and the increasing health impact of climate change. Organisational capacity building, like this partnership, therefore contributes not only to stronger organisations and day-to-day service delivery, but also to resilience and preparedness in the face of current and future challenges.     

By fostering unity and mutual support, these initiatives amplify the global voice of nurses and midwives. They reaffirm that international solidarity is a powerful tool in advancing professional interests, improving healthcare systems and preparedness, and promoting social justice worldwide.