NURS 8100 Nursing and Health Policy in Other Nations

NURS 8100 Nursing and Health Policy in Other Nations

NURS 8100 Nursing and Health Policy in Other Nations

There are numerous health-related policies in the United States and also all over the globe. While some of these policies are similar in different countries there still remain some distinct differences. Immunization remains to be one of those policies that will be addressed in this discussion. In the United States there is an advisory committee on immunization practices that has in the past voted to approve immunization schedules recommended for adults, (Murthy, Wodi, Bernstein & Ault, 2022). The 2022 schedule has also been approved by different medical bodies including the director of the Centers for Disease Control and Prevention, (Centers for Disease Control and Prevention [CDC], 2022).

One specific immunization policy directly affects centers for Medicare and Medicaid services health care facilities like the long-term care facilities, hospitals, surgery centers among others. The vaccination rule or policy requires every staff member working at certified health care facilities to be vaccinated against COVID-19. There are those who are exempted for very specific reasons like being allergic to the vaccine, (complying with the CMS COVID-19 Vaccine Mandate, 2022). The seriousness of this policy made some health care staff members resign from their jobs because they did not want to receive the mandated vaccines.

Country Compared to the U.S.

The country that will be compared to the United States is Kenya. It is located in east Africa below the horn of Africa. Kenya straddles the equator and borders Ethiopia, Eritrea, Uganda, Tanzania and the Indian ocean. Unfortunately, according to the World health organization (WHO) Kenya ranks as one of the worst in health care system, (KENYA,2021). This was even before the COVID epidemic. Over 80% of the population who are also involved in most of the economic activities are concentrated in the southern part of the country which is about 40% of the land.

In Kenya the COVID vaccine is to be received not just by the health care personnel but to all those who qualify. The president of Kenya with the ministry of health department passed a policy that all Kenyans should receive the vaccine and carry proof of vaccination when travelling to and from the country (Kenyan Consulate staff in Washington DC, personal communication, February 28, 2022).

Compare and Contrast the Two Policies

The two policies are very similar but enforcing them is very different. As much as Kenyans would like to receive the vaccine it takes a lot of effort to get it. Different people have shared about vaccine accessibility. One Kenyan, living in America shared how his friend died before getting a vaccine in Kenya yet he has not only received two doses of the vaccine but a booster too in a drug store. The inequality of making the policy practical is evident when the United States is compared to Kenya.

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The policy in United States may not be achieved not because of lack of the vaccine but due to personal choices or other reasons. In Kenya, however the government has the money to purchase the vaccine but as the Kenyan president told reporters, the vaccine is unavailable due to high income countries reserving COVID-19 vaccines that can be produced by manufactures for future need, (Deadly inequity, 2021). 

Role of International Organizations in Developing Policy

The COVID-19 epidemic is a global health concern. There are millions of doses of coronavirus disease 2019 (COVID-19) vaccines, that have been administered all over the world. Unfortunately, the rates of vaccination are different for different countries. The role of international organization would be to make the vaccines available to those with a dire need.

NURS 8100 Nursing and Health Policy in Other Nations
NURS 8100 Nursing and Health Policy in Other Nations

Helping implement a policy would be more effective than making one. When a solution to eradicate or minimize a disease is identified it is important for international organizations to play a role in developing or executing policies that would make it possible for success to be achieved. Contagious diseases are managed well when there is herd immunity. It is therefore important to have equitable access to safe and effective vaccines if the COVID pandemic will be managed. World Health Organization (WHO) continues to encourage different tolerable and effective vaccines to be manufactured by different partners all over the world, (World Health Organization, 2022).


Centers for Disease Control and Prevention. (2022).  Immunization schedules

Deadly inequity. (2021). Christian Century138(17), 7.

KENYA. (2021). In Political Risk Yearbook: Kenya Country Report (pp. 1–18).

Murthy, N., Wodi, A. P., Bernstein, H., & Ault, K. A. (2022). Recommended Adult Immunization Schedule, United States, 2022. Annals of Internal Medicine175(3), 432–443.

World Health Organization (2022). Covid Vaccines.

Complying with the CMS COVID-19 Vaccine Mandate. (2022, April 30). MagMutual.

There is no health care without mental health care and “access to mental health services is one of the most important and most neglected civil rights issues facing the Nation” (Haffajee et al., 2019). There are two policies addressing mental health in the United States (US), the Mental Health Parity Act (MHPA), enacted in 1996, to eliminate discriminatory insurance practices, and establish the no disparity principle, in health insurance between mental health and general medical benefits. The second was the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 to cover preventative services, mental health screenings and, eliminate the annual and lifetime benefit caps (Busch, 2012). The comparison policy is the Mental Health Act (1983) of the United Kingdom (UK), the main legislation that covers the mental health assessments, treatments, and the rights of these patients. This was amended to the Mental Health Act of 2007 mandating the health professionals, to detain, assess and treat these patients as needed, in the interests of their health, safety, or public safety (Keown et al., 2018).

The mental disorder still has associated stigma in both countries but has improved some. There are some notable differences in the policies: In the US a visit to a psychologist is perceived as routine, however, in Britain, the same visit is a major step, and an admission of an illness, which is still considered shameful, so these mental visits are publicized (Mills & Phull, 2017). This is mostly rooted in Britain’s reserved culture that, if a person is depressed, he should not make a fuss, but get on with it, or simply sort it out, so, these mental patients cannot share this information at work, fearing it would hamper their careers, and, if claiming that the job itself was contributing to that state, could be construed, as an admission that one is simply not up to the job (Mills & Phull, 2017). The U.S. has lesser mental health professionals, about 105 professionals per 100,000 people, while the UK has twice that number of mental health workers. In the UK, mental health services are available, and free for everyone through the National Health Service (NHS), with both psychiatrists and psychologists being part of the system, however, the consultant-led medical services have an 18-week maximum wait that is mandated by law. To be able to obtain mental health care under the NHS system, patients must be referred to a psychiatric specialist by their General Practitioner (GP), because mental health care is regarded as part of a patient’s overall health care and is approached in the light of their full medical history, with no reported issues or any care denial (Mulvaney-Day et al., 20 19) This applies to all mental patients, except those experiencing mental issues related to drug and, or alcohol abuse, who do not require a referral from a GP to obtain treatment. There is flexibility in the choice of practitioner, and the patients have the right to choose their first mental health practitioner, and if unsatisfied, can opt for a second opinion. There are still waiting lists for some treatments, like inpatient treatments, but most services are outpatient, similar to the US (Keown et al., 2018). The U.S mental health policies have been described as being in the dark ages because, they were not covered, and it was legal for the insurance companies to completely deny them, just because they could, and. It was only with the passage of the Affordable Care Act (ACA), in 2008, that the U.S system was slightly comparable to the U.K system. The UK system is considered very superior due to easy and free access through primary care, to the US system,  because its care access depends on the sick person’s ability to pay, leaving the patients at the mercy of the expensive inaccessible insurance coverage plans. US citizens in comparison to the UK citizens are among the most willing individuals, to seek mental health treatments, but they are the least likely to report access or affordability issues, which results in high unmet needs. This reflects a limited health system capacity, inability to meet the required needs, with data reporting that the US has some of the worst mental health-related outcomes, the highest suicide rates in the industrialized world, and the second-highest drug-related death rates in the world (Mulvaney-Day et al., 20 19).

Every U K resident has some form of health coverage, even before dissecting mental health services, which is distinctive, and their definition of health coverage includes mental health services. Nothing in the US mental system is free, and the patients solely depend on their insurance, and access to care depends on the affordability of the premiums, hindering much-needed care access. The NHS England expanded access to talk therapies in primary care settings more than a decade ago, through the Increasing Access to Psychological Therapies program. It now has more than 1.4 million patients in the program, served by specialized, nonclinical mental health practitioners, which has been described as the world’s most ambitious effort to treat depression, with reported favorable favorable outcomes (Keown et al., 2018). The US. leaders could learn from the UK, in terms of prioritizing mental health on the policy agenda, initiating interventions to reduce cost, and related access barriers, and overall improving and promoting the availability of community-based needed care. 

The World Health Organization (WHO) is a global, technical, and normative agency that encourages research sets standards, and develops a wide range of advisory for governments and other stakeholders in its active Mental Health Division. The WHO through its division of the Plan of Action on Mental Health (PAHO), engages in the development and implementation of programs for the promotion and prevention of mental health systems and services. It then approves and adopts them through the World Health Assembly, an example is the adoption of the Comprehensive Mental Health Action Plan 2013–2020 by the 66th World Health Assembly, with a goal to promote further development of mental health policies across the world (Jenkins et al., 2011). These were broad strategies for mental health promotion, prevention of mental illness, promotion of rights, early childhood programs, life course skills, healthy working conditions, protection against child abuse, and domestic and community violence among others.  In its 2001 Report, the WHO, functioned as a catalyst, setting out the rationale, with a broad framework for the development of mental health programmers (Jenkins et al., 2011).


Busch S. H. (2012). Implications of the Mental Health Parity and Addiction Equity Act. The American journal of psychiatry169(1), 1–3.

Haffajee, R. L., Mello, M. M., Zhang, F., Busch, A. B., Zaslavsky, A. M., & Wharam, J. F. (2019). Association of Federal Mental Health Parity Legislation with Health Care Use and Spending Among High Utilizers of Services. Medical care, 57(4), 245–255.

Jenkins, R., Baingana, F., Ahmad, R., McDaid, D., & Atun, R. (2011). International and national policy challenges in mental health. Mental health in family medicine, 8(2), 101–114.

Keown, P., Murphy, H., McKenna, D., & McKinnon, I. (2018). Changes in the use of the Mental Health Act 1983 in England 1984/85 to 2015/16. The British Journal of Psychiatry, 213(4), 595-599. doi:10.1192/bjp.2018.123

Mills, J., & Phull, J. (2017). The Mental Health Act 1983. InnovAiT. 2017;10(11):638-643. doi:10.1177/1755738017727021

Mulvaney-Day, N., Gibbons, B. J., Alikhan, S., & Karakus, M. (2019). Mental Health Parity and Addiction Equity Act and the Use of Outpatient Behavioral Health Services in the United States, 2005-2016. American journal of public health, 109(S3), S190–S196.

. Thanks for the insightful discussion. From your analysis, one of the main questions I would ask is: What are the similarities and differences between the Mental Health Parity Act (MHPA) of the United States policy and the Mental Health Act (1983) of the United Kingdom? The Mental Health Parity Act (MHPA) of the United States, enacted in 1996, requires that health insurance plans that offer mental health benefits must provide coverage for those benefits at parity with coverage for medical and surgical benefits. This means that if a plan offers $1,000 in coverage for medical and surgical benefits, it must also offer $1,000 in coverage for mental health benefits (Mulvaney-Day et al., 2019). The Mental Health Act (1983) of the United Kingdom is similar to the MHPA of the United States in that it requires that health insurance plans that offer mental health benefits must provide coverage for those benefits at parity with coverage for medical and surgical benefits (Peterson & Busch, 2018). However, there are some key differences between the two acts. There are several key differences between the Mental Health Parity Act (MHPA) of the United States and the Mental Health Act (1983) of the United Kingdom. For one, the MHPA only applies to group health plans and insurers, while the Mental Health Act (1983) covers all health care providers in the UK. Additionally, the MHPA only requires parity in coverage for mental health benefits, while the Mental Health Act (1983) requires that all health care providers provide equal access to mental health services (Scarbrough, 2018). Finally, the MHPA does not include any provisions for compulsory treatment, while the Mental Health Act (1983) does allow for involuntary treatment in certain cases.


Mulvaney-Day, N., Gibbons, B. J., Alikhan, S., & Karakus, M. (2019). Mental Health Parity and Addiction Equity Act and the Use of Outpatient Behavioral Health Services in the United States, 2005-2016. American journal of public health, 109(S3), S190–S196.

Peterson, E., & Busch, S. (2018). Achieving mental health and substance use disorder treatment parity: a quarter century of policy making and research. Annual Review of Public Health39, 421-435.

Scarbrough, J. A. (2018). The growing importance of mental health parity. American Journal of Law & Medicine44(2-3), 453-474.

In this week’s learning resources we reviewed how healthcare is provided in various countries impacting the international continuum of care.  This international continuum of care has been a topic of interest for centuries, but really pick up momentum as individuals gained access to convenient and fast international travel.  Bodenheimer & Grumback (2020) shared that there is no universal design for healthcare delivery. This discrepancy can be a barrier and opportunity for each country to tailor the delivery system to what their population of citizens.  For example, social determinants of health are addressed differently in each country.  Additionally, various nursing organizations are also focused on the international continuum of care.  The International Council of Nursing (n.d.) is focused on several international nursing policies like socio-economic welfare.  This is a demonstration of the role of an international organization in developing policy. 

I am currently working in collaboration with a university in Rwanda creating curriculum content for a Nursing Leadership and Midwifery graduate level program.  I am also an international nursing mentor and am working with students in Rwanda and Kenya on implementing quality improvement projects.  The country that I am comparing to the U.S. is Rwanda.    

A policy that Rwanda’s Ministry of Health (n.d.) is working on is related to how social determinants of health are addressed.  Rwanda is currently rebounding from civil war in the mid 1990’s.  In the past several decades they have made significant improvements in address it’s citizens social determinants of health.  However, the country has an opportunity to optimize this effort due to persistent extreme poverty, overexploited land, and effects of climate change on housing and healthcare (Government of the Republic of Rwanda Ministry of Health, n.d.).  The country’s nursing population is also largely midwives due to lack of providers in the country.  Bazirete et. al. (2020) shared how social determinants of health impact maternal mortality and morbidity in rural Rwanda.

Social determinants of health is also a policy that is address in the U.S.  The American Academy of Nursing has a policy from 2019 which prioritizes a focus on social determinants of health for nursing (Kuehnertet. al., 2022).  We’ve incorporated social determinants of health into screening tools and electronic health records to provide targeted population health to support our existing healthcare system and reduce the burden on resources.  Bedside nursing is incorporating social determinants of health into clinical practice by allowing the information to impact clinical decision making for improved health outcomes (Phillips et. al., 2020). 

From the comparison between how Rwanda and the U.S. are creating policy around social determinants of health I’ve gained an understanding of how different the social needs of each country can be.  Additionally, I’ve gained an understanding that it’s challenging to compare a third world and first world healthcare system.  Each country is working with vastly different healthcare resources, infrastructure, and population health needs. 


Bazirete, O., Nzayirambaho, M., Umubyeyi, A., Uwimana, M. C., & Evans, M. (2020).    Influencing factors for prevention of postpartum hemorrhage and early detection of      childbearing women at risk in Northern Province of Rwanda: beneficiary and health worker perspectives. BMC Pregnancy and Childbirth, 20(1), 678.

Bodenheimer, T., & Grumbach, K. (2020). Understanding health policy: A clinical approach (8th    ed.). McGraw-Hill. 

Government of the Republic of Rwanda Ministry of Health. (n.d.). Policies.     

International Council of Nurses. (n.d.).

Kuehnert, P., Fawcett, J., DePriest, K. N., Chinn, P., Cousin, L., Ervin, N., Flanagan, J., Fry-        Bowers, E., Killion, C., Maliski, S., Manughan, E., Meade, C., Murray, T., Schenk, B., &        Waite, R. (2022). Defining the social determinants of health for nursing action to achieve         health equity: A consensus paper from the American Academy of Nursing. Nursing       Outlook, 70(1), 10-27.

Phillips, J., Richard, A., Mayer, K. M., Shilkaitis, M., Fogg, L. F., & Vondracek, H. (2020).         Integrating the social determinants of health into nursing practice: Nurses’        perspectives. Journal of Nursing Scholarship, 52(5), 497–505.