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The Pacific Islands countries consist of thousands of isolated islands with a combined population of over 10 million people. It is a heterogeneous and diverse region culturally, linguistically economically and politically. Health challenges are considerable and healthcare systems are often overstretched. Framed in the context of the World Health Organisation's strategic directions and policy priorities, this paper describes an account of collaboration across these countries to develop leadership skills in the nursing and midwifery professions. It outlines lessons for nursing leadership, healthcare policy development and the valuable role of Government Chief Nursing and Midwifery Officers. The South Pacific Chief Nursing and Midwifery Officers Alliance (SPCNMOA) is a cooperative partnership, which was formed to improve the quality of healthcare in the region. It acts as an enabler to promote leadership skills and provide a safe space for learning, developing policy and the sharing of good practice. Through mentorship programs, international meetings and strong relationship-building, the SPCNMOA has strengthened partnerships within the region and improved community health services in even the most remote areas. By strengthening leadership and collaboration, these health professionals are now recognised by key policy makers as knowledgeable experts who have a legitimate role in guiding policy development, changing practice and delivering health policy improvements at local, country and international levels.

The quality of healthcare services and outcomes in the Pacific vary widely, with some countries enjoying some of the world's longest life expectancies, others have high rates of maternal and child mortality and relatively low life expectancy. Nurses and midwives make up more than two thirds of the regional regulated healthcare workforce. This paper argues that if countries are to meet Universal Health Coverage  nursing and midwifery leaders need to be explicitly involved in shaping policy  at the highest levels of government to optimise individual and community health both now and in the future. Using United Nations 2019  declaration towards building a healthier world, this paper provides a rationale for inclusion of these leaders  into national and regional decisionmaking forums related to health policy to provide an informed voice in ministerial deliberations on health policy. We suggest that following several comprehensive regional and global studies, South Pacific Chief Nursing and Midwifery Officer Alliance  and the newly developed Pacific Heads of Nurses and Midwifery provide a vehicle for this to occur. As outlined in the WHO Strategic Directions, it is now time to embed Chief Nurses in national and regional health policy development., Competing Interests: None, (© 2021 The Author(s).)