Community and Public Health Nurses as Drivers of Universal Health Coverage: Roles, Contributions, Challenges and Strategies for Strengthening Primary Care

Abstract

Background: Universal Health Coverage (UHC) requires that everyone can obtain quality essential services without financial hardship. Nurses form the largest share of the health workforce, yet the specific contribution of community and public health nurses (CHNs/PHNs) to UHC is rarely synthesised.

Aim: To review the concept of UHC and the roles, contributions, challenges, and enabling strategies of CHNs/PHNs in advancing it.

Methods: Narrative review of peer-reviewed literature and WHO documents (2021–2026) from Africa, Asia, the Pacific, Europe, and Australia.

Findings: CHNs/PHNs deliver health promotion, prevention, primary care, surveillance, advocacy, and care coordination, extending coverage to underserved groups. Their impact is limited by underfunding, workforce shortages, weak infrastructure, sociocultural barriers, and limited professional development. Promising responses include workforce investment, continuous training, sustainable financing, supportive policy, digital health, community partnerships, and multisectoral collaboration.

Conclusion: UHC cannot be achieved without a well-supported community nursing workforce. Quantitative evidence on nurse-led impact and standardised competency frameworks is a priority research need.