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Qualifications

1.    Purpose of the Consultancy

The main purpose of this consultancy is to support the development of Syria’s national nursing strategy (NNS). The consultant will provide expert guidance, evidence-based recommendations, and technical assistance in strengthening the nursing workforce to meet the country’s evolving health needs. The consultancy will work closely with national health authorities, nursing associations, academic institutions, users or health services and international partners to assess current challenges, identify priority areas, and design a comprehensive framework that addresses workforce planning, education, regulation, management, service delivery, and professional development. By aligning with global standards and local contexts, the consultancy aims to ensure that nursing in Syria is empowered, adequately resourced, and strategically positioned to play a central role in rebuilding and advancing the national health system.

2.    Background

The protracted crisis in Syria has placed immense pressure on the health system, resulting in significant damage to health infrastructure, disruption of services, and depletion of the health workforce. Many health professionals have migrated or been displaced, leading to shortages and imbalances in workforce availability and distribution across the country. Nurses, who constitute the largest segment of the health workforce and serve as the first point of contact for patients in many settings, are particularly affected. Despite their critical role in service delivery—including primary healthcare, maternal and child health, chronic disease management, emergency care, and mental health support—nurses in Syria often work in under-resourced environments with limited recognition, career pathways, and opportunities for professional development.

The nursing profession in Syria also faces systemic challenges related to suboptimal education and training programs, outdated curricula, insufficient regulation and licensing frameworks, and weak governance structures. There is currently no comprehensive national policy framework to guide workforce planning, deployment, retention, and capacity-building for nurses. At the same time, the demand for nursing services is increasing, given the ongoing expansion of the health service network, the country’s growing burden non-communicable diseases, the long-term health consequences of conflict such as disabilities and mental health ailments, and the need to expand access to quality primary and secondary healthcare services.

Information about HRH in Syria is insufficient, severely fragment and often out of date. Figures differ depending on the source of choice. The WHO-based National Health Workforce Accounts database in 2025 reports a total number of nurses and midwives of 34,073 with a density of 15.4 per 10,000 population. There is unsubstantiated evidence of this density having been decreasing in the last years, while the needs are increasing as the system starts to recover. The production capacity of the existing nursing education system is around 1,400 N/MWs per year which represents a 4% of the total active nursing workforce suggesting a very low workforce replenishment capacity. Apparently, the education capacities for nurses have not increased at the same pace than other health professions. Nursing is not very attractive among university applicants due to an undefined scope of practice and the existing recruitment policy. In addition, nursing workforce is aging with 70-80 % of nurses expected to retire in the next decade according to unsubstantiated evidence. In summary, nursing workforce is quantitatively insufficient which represents a major barrier for health system recovery.

Nurses are educated at different levels in Syria including certificate (2 years after secondary education), diploma (3 years after secondary school) and bachelor levels (4 years after secondary school). Master and doctorate level nurses also exist. There are currently two public nursing faculties in Hama and Latakia and several private faculties in Aleppo, Tartous and Homs, all under the Ministry of Higher Education. In addition, there are 11 diploma level nursing schools active under the Ministry of Health. Specialist training is provided in some of the faculties mainly in Lattakia university. There are reports of shorter programmes, but this needs to be corroborated.   However, all information about education institutions needs to be updated. Many concerns have been raised about the quality of education, with reports of outdated curricula and faculty shortages. There is certainly the need to restructure the nursing education and enhance the institutional and faculty capacities. In the absence of a well-defined scope of practice for nurses, education is not based on competencies.

There is a gender stereotype that nurses are mainly female in Syria. However, recent studies in NWS showed that around 50% of the nursing workforce there are men . However, other sources of information about the situation suggest nursing professionals being mostly women. Gender distribution seems to be influenced by socio-cultural gender norms, educational pipeline and access to training, conflict-related workforce displacement, and other factors. However, this needs to be confirmed by current data.

In Syria, the social perception of nurses is generally poor, shaped by cultural norms, gender roles, and entrenched medical hierarchies. Nursing is seen as subordinate to medicine, with doctors regarded as authority figures and nurses perceived as assistants. As a female-dominated profession, nursing is often stigmatized due to night shifts, contact with male patients, and concerns about social respectability. Low pay, heavy workloads, and limited opportunities for advancement reinforce the view of nursing as a low-status career. However, the war has shifted perceptions in some regions: in rural or conflict-affected areas where doctors are scarce, nurses have taken on expanded responsibilities and gained community respect as primary healthcare providers. This needs now to be generalised to the entire nation.

Working conditions of nurses are challenging with often precarious working environment with severe lack of resources, poor management, insecurity and very low salary levels. As the scope of practice and job descriptions are not well defined, they may be assigned to irrelevant tasks or just being underutilized and even underemployed in some cases.

In summary, the overall nursing situation in the country is in crisis and requires special and urgent attention. Developing a National Nursing Strategy (NNS) is therefore a crucial step toward strengthening the Syrian health system. It will provide a roadmap for building a resilient, well-trained, and equitably distributed nursing workforce that can meet both current and future health needs. The strategy will also ensure alignment with the broader national health strategy, the Sustainable Development Goals (SDGs), and the WHO Global Strategic Directions for Nursing and Midwifery (2021–2025). By investing in nursing, Syria can advance universal health coverage, improve health outcomes, and contribute to rebuilding trust in the health system.

3.    Planned timelines
Three months  
 

4.    Work to be performed

4.0 Preliminary work (month 1)

4.0.1 Inception report
4.0.2 Establish a steering committee

4.1 Situation analysis (see Annex 1) (month 1)
4.1.1 Literature/document review
4.1.2 Stakeholder mapping and analysis
4.1.3 Assess nursing workforce (e.g. numbers, distribution, gender, regulation, education, professional development, attrition, etc.).

4.2 Stakeholder engagement (month 2)
4.2.1 Consultation with MoH, syndicates, academic institutions, NGOs, patients, donors/international partners, etc.)
4.2.2 Ensure inclusive participation of nurses at various levels of practice

4.3 Draft National Nursing Strategy (NNS) (e.g. stakeholders’ workshop) (months 2)
4.3.1 Vision, mission and core values development 
4.3.2 Identify key challenges, gaps and opportunities (e.g. SWOT)
4.3.3 Identification and development of strategic objectives and interventions (see Annex 2 for suggested areas/pillars)

4.4 Develop a M&E framework (e.g. KPIs) (month 3)                                                                                                                

4.5 Validation and finalization (month 3)
4.5.1 Present draft strategy in workshop for feedback
4.5.2 Finalize NNS
4.5.3 Costing of the NNS
4.5.4 Develop action plan for year 1

5.    Deliverables: 
•     Inception report with detailed methodology and work plan (end of first two weeks).
•     Situational analysis report (including stakeholder mapping) (end of assignment)
•     Draft National Nursing Strategy with vision, mission, strategic priorities, objectives, and implementation plan (end of assignment)
•     Final National Nursing Strategy, incorporating stakeholder inputs (end of assignment)
•     PowerPoint presentation summarizing key findings and recommendations (end of assignment)

6.    Technical Supervision
The selected Consultant will work under the supervision of:
Responsible Officer:     Dr Wail Ismail       
Manager:    Dr Alvaro Alonso-Garbayo    

7.    Specific requirements

Educational Qualifications:
•     Essential: A university degree in nursing, medicine, public health, management or a relevant field.
•     Desirable: Advanced university degree in one of the above fields.

Experience required:
•     Essential:  previous minimum experience of 5 years in nursing management at senior level (MoH) including undertaking situation analyses, and development of strategic plans
•     Desirable: experience with UN organisations

Skills / Technical skills and knowledge:
-Good knowledge of the setup in Syria’s health system with particular attention to nursing workforce
-Good communication, research, analytical and writing skills

Language requirements:
English & Arabic proficiency required

8.    Payment instalments:
        -First instalment – upon receipt of inception report (20%)
        -Final instalment – upon submission of final product (80%)

9.    Place of assignment
Damascus, Syria

10.    Medical clearance 
The selected Consultant will be expected to provide a medical certificate of fitness for work.

11.    Travel
Not Applicable