The Public Health Nursing Series is a 20-blog collection, written by William (Billy) Rosa, author of the recently released title, Nurses as Leaders: Evolutionary Visions of Leadership (June 2016), that sparks a dialogue about each and every nurse's role in advancing and creating the future of global health. With a focus on cultural considerations and the current status of healthcare in nations worldwide, nurses will learn how they are called to contribute to each of the United Nations' 17 Sustainable Development Goals, an international initiative that seeks to end poverty, protect the planet, and ensure prosperity for all over the next 15 years.This series makes the case that every nurse, regardless of title, position, or credential, is a public health leader.

Sustainable Development Goal #9 – Industry, Innovation, Infrastructure (Part 12)

 How does nursing relate to industry, innovation, and infrastructure? Poor infrastructure may restrict access to health care. It may limit those nurses in low-income countries willing or able to educate communities and provide in-person support when needed (Manjrekar, 2016). If there is a nurse available, they may be the only primary care provider for miles, and the determining factor of a client’s survival (Jones, 2010). Where infrastructure is insufficient, industry is lacking and innovation is not encouraged. This leaves impoverished residents in those areas without opportunities for social and economic development, absent the resources needed to become an empowered and healthy population, and omits them from the development of their nation that occurs in urban and more centralized locations. Public health nurses carry the solution for inclusive healthcare delivery to even the most remote areas through partnership and innovation.

Sustainable Development Goal (SDG) #9 seeks to “build resilient infrastructure, promote sustainable industry, and foster innovation” for all peoples by 2030 (United Nations Sustainable Development [UNSD], 2016). According to UNSD (2016):

  • Basic infrastructure remains scarce in many developing countries
  • 2.6 billion people in the developing world lack adequate electricity
  • 2.5 billion people worldwide lack basic sanitation
  • Quality infrastructure is positively correlated with social, economic, and political goals achievement
  • Up to 40% of business productivity in Africa is hindered by infrastructure restrictions
  • Least developed nations have incredible potential industrialization, leading to sustained employment potential and higher productivity

Some of the SDG #9 targets include efforts to develop dependable and sustainable infrastructure that supports economic growth and well-being for all, introduce developing countries to increased access of small-scale industrial enterprises, and to raise industry’s share of employment and gross domestic product in line with national goals (UNSD, 2016). All of these initiatives improve the quality of communication between and within nations and foster a sense of unity throughout provinces and rural areas that might otherwise be excluded.

There are many companies applying innovative strategies worldwide to overcome the barriers to healthcare delivery posed by poor infrastructure. One such company is Zipline (n.d.), an organization seeking to improve medication, vaccine, and blood access through drone delivery. Zipline is surpassing the obstacles of long travel times, substandard roads, hazardous weather, and challenging topography altogether. This year they begin an exciting collaboration with the government of Rwanda, beginning drone blood delivery to transfusion centers throughout the country. Zipline’s initiative significantly decreases the time of blood product delivery from up to 4 hours by car to somewhere between 15-35 minutes anywhere in Rwanda. The company is currently working on several ventures in other countries, looking to transform the way healthcare is practiced and decrease the mortality rates associated with delayed wait times for blood and other emergent medications.

Public health nurses must invite partnership with these organizations to assess how healthcare systems will need to adapt in order to accommodate these innovations. For example, in Rwanda, as blood delivery wait time is substantially decreased, public health nurses can work with companies such as Zipline to develop and employ the quality improvement protocols required to ensure responsible handling and transfer of blood, ethical and transparent practices in the ordering and distribution of blood products, and safe patient monitoring pre-, intra-, and post-transfusion. Through such a partnership, public health nurses can help steer businesses to understand the role of nursing worldwide, create new approaches to quality healthcare innovations, promote systems thinking, and identify barriers and solutions to real-time implementation. In turn, businesses like Zipline have the opportunity to tap into the knowledge and wealth of clinical understanding that nurses possess to advance sustainability and continued success with collaborating transfusion centers and hospitals throughout Rwanda and beyond.

Nursing can become the translational determinant between businesses like Zipline and the unfolding healthcare scenario in developing nations. They are the link between the theory of improved delivery that innovators strive for and the creation of measurable and positive outcomes in practice. Nurses are the leaders that take a singular idea and integrate it system-wide in a way that creates meaningful and lasting change for all involved.

Bleich (2016) shares his vision for the future of nursing and healthcare that is particularly relevant in this context:

…health systems will be designed to be seamless and continuous rather than needlessly complex and disjointed.  Nurses will play a strong role in the design of these systems through education, training, and presence in the settings where care is needed... Our role in care design at the institutional level will not be trumped at the policy level, as we bridge institutional policies and practices with state and national policies and practices.  Our contribution will be to bring coalitions together to afford needed change in the health system.

It is the unique contribution of nursing in these interdisciplinary collaborations that makes the realization of SDG #9 possible. It is the public health nurse as partner, leader, and advocate that imbeds innovation in infrastructure and industry systems in order to improve health and well-being for individuals, populations, and nations worldwide.


Bleich, M. (2016). Translational and indispensible: Using the gift of foresight to re-envision nursing. In W. Rosa (Ed.), Nurses as leaders: Evolutionary visions of leadership. New York, NY: Springer, in press.

Jones, P. (2010). Health workers on the frontline. British Journal of Healthcare Assistants, 4(9), 460.

Manjrekar, P. (2016). Resourceful and unified: Partnering across cultures and worldviews. In W.   Rosa (Ed.), Nurses as leaders: Evolutionary visions of leadership. New York, NY: Springer, in press.

United Nations Sustainable Development (UNSD). (2016). Goal 9: Build resilient infrastructure, promote sustainable industry, and foster innovation. Retrieved from   

Zipline. (n.d.). The future of healthcare is out for delivery. Retrieved from   

More About the Author

William (Billy) Rosa, MS, RN, LMT, AHN-BC, AGPCNP-BC, CCRN-CMC, is currently Visiting Faculty, University of Rwanda and ICU Clinical Educator, Rwanda Military Hospital, Human Resources for Health Program in partnership with the New York University Rory Meyers College of Nursing. He currently has over 65 publications for refereed and non-refereed journals, newspapers, magazines, and national platform blogs and his book, Nurses as Leaders: Evolutionary Visions of Leadership, was recently published by Springer Publishing in June 2016. Billy currently sits on the US Advisory Board for the Nightingale Initiative for Global Health, and most recently received the American Association of Critical-Care Nurses' 2015 National Circle of Excellence Award and the Association for Nursing Professional Development's 2015 National Change Agent/Team Member Award.

 Quick Links

Part 1 -  Understanding the Nurse as a Public Health Leader

Part 13 - Sustainable Development Goal #10 - Reduced Inequalities