The meaning of "capacity building" for the nurse workforce in sub-Saharan Africa: An integrative review

How capacity building of district health managers has been designed, delivered and evaluated in sub-Saharan Africa: a scoping review and best fit framework analysis

OBJECTIVES

We aimed to understand how capacity building programmes (CBPs) of district health managers (DHMs) have been designed, delivered and evaluated in sub-Saharan Africa. We focused on identifying the underlying assumptions behind leadership and management CBPs at the district level.

DESIGN

Scoping review.

DATA SOURCES

We searched five electronic databases (MEDLINE, Health Systems Evidence, Wiley Online Library, Cochrane Library and Google Scholar) on 6 April 2021 and 13 October 2022. We also searched for grey literature and used citation tracking.

ELIGIBILITY CRITERIA

We included all primary studies (1) reporting leadership or management capacity building of DHMs, (2) in sub-Saharan Africa, (3) written in English or French and (4) published between 1 January 1987 and 13 October 2022.

DATA EXTRACTION AND SYNTHESIS

Three independent reviewers extracted data from included articles. We used the best fit framework synthesis approach to identify an a priori framework that guided data coding, analysis and synthesis. We also conducted an inductive analysis of data that could not be coded against the a priori framework.

RESULTS

We identified 2523 papers and ultimately included 44 papers after screening and assessment for eligibility. Key findings included (1) a scarcity of explicit theories underlying CBPs, (2) a diversity of learning approaches with increasing use of the action learning approach, (3) a diversity of content with a focus on management rather than leadership functions and (4) a diversity of evaluation methods with limited use of theory-driven designs to evaluate leadership and management capacity building interventions.

CONCLUSION

This review highlights the need for explicit and well-articulated programme theories for leadership and management development interventions and the need for strengthening their evaluation using theory-driven designs that fit the complexity of health systems.

Capacity building of district health management teams in the era of provincial health administration reform in the Democratic Republic of Congo: a realist evaluation protocol

INTRODUCTION

In 2006, the Congolese Ministry of Health developed a health system strengthening strategy focusing on health district development. This strategy called for reforming the provincial health administration in order to better support the health district development through leadership and management capacity building of district health management teams. The implementation is currently underway, yet, more evidence on how, for whom and under what conditions this capacity building works is needed. The proposed research aims to address this gap using a realist evaluation approach.

METHODS AND ANALYSIS

We will follow the cycle of the realist evaluation. First, we will elicit the initial programme theory through a scoping review (completed in December 2022, using MEDLINE, Health Systems Evidence, Wiley Online Library, Cochrane Library, Google Scholar and grey literature), a review of health policy documents (completed in March 2023), and interviews with key stakeholders (by June 2023). Second, we will empirically test the initial programme theory using a multiple-embedded case study design in two provincial health administrations and four health districts (by March 2024). Data will be collected through document reviews, in-depth interviews, non-participant observations, a questionnaire, routine data from the health information management system and a context mapping tool. We will analyse data using the Intervention-Context-Actor-Mechanism-Outcome configuration heuristic. Last, we will refine the initial programme theory based on the results of the empirical studies and develop recommendations for policymakers (by June 2024).

ETHICS AND DISSEMINATION

The Institutional Review Board of the Institute of Tropical Medicine and the Medical Ethics Committee of the University of Lubumbashi approved this study. We will also seek approvals from provincial-level and district-level health authorities before data collection in their jurisdictions. We will disseminate the study findings through the publication of articles in peer-reviewed academic journals, policy briefs for national policymakers and presentations at national and international conferences.

"Caring for Breast Cancer Patients Is a Work That Brings Sorrow": A Qualitative Interview Study with Nurses in Tanzania

Introduction

Breast cancer is increasing in sub-Saharan Africa (SSA), and most women are diagnosed at a late stage. This leads to increased suffering for the patients and challenging care situations for nurses. Limited resources in healthcare, lack of oncology training, and low health literacy in society result in even more demanding situations for nurses.

Objective

The objective was to explore nurses' experiences of caring women for with breast cancer in Tanzania.

Methods

The study employed a descriptive qualitative design. Fifteen nurses, working in oncology units in three major hospitals in Tanzania were interviewed using a semistructured interview guide. The participants had a minimum of 6 months experience of caring for breast cancer patients. Purposive sampling was used. Data were analyzed by qualitative content analysis.

Results

Two main themes emerged: Challenges in caring for breast cancer patients and Nurses' psychological distress. The late diagnosis was very challenging for the nurses. Low health literacy regarding breast cancer disease and treatment, patients' financial difficulties, minimal oncology nursing education, and technology in healthcare systems were also major challenges. The nurses experienced psychological distress, lost hope, and faced ethical dilemmas while providing cancer care.

Conclusion

The findings of this study conclude that nurses face emotional distress and ethical dilemmas while caring for patients with breast cancer. Late diagnosis, lack of infrastructure and resources, and low health literacy among patients, family, and healthcare providers have a great impact on the stress that the nurses experience.

Intention to Leave Nursing Profession and Its Associated Factors Among Nurses: A Facility Based Cross-Sectional Study

Nurses' intention of leaving their profession is the main challenge for healthcare and hospital administrators in many countries. It has significant impact on the performance, stability and productivity of health facilities. However, there is limited evidence on the nurses' intention to leave their profession and associated factors among nurses in developing countries including Ethiopia. This study was aimed to assess intention to leave nursing profession and its associated factors among nurses working in West Shoa Zone public Hospitals, Oromia region, Central Ethiopia, 2020. Institution based cross-sectional study was conducted among 393 nurses working in West Shoa zone public hospitals, Ethiopia from May 1 to 30, 2020. Simple random sampling technique was used to select the study participants. Structured self- administered questionnaire was used to collect data. Data were cleaned and entered into Epi-data version 3.1 then exported to SPSS version 25 for analysis. Descriptive statistics such as frequency mean and standard deviation was computed to describe variables of the study. All covariates that were significant at P value <0.25 in bivariate logistic regression analysis were considered for further multivariable logistic regression analysis. Backward stepwise logistic regression model was fitted, crude ratio and odds ratio were calculated for factors at 95% confidence interval (CI). Level of statistical significance was declared at P value <0.05. In this study, the overall nurses' intention to leave nursing profession was 61.3% [95% CI (56.5%, 66.2%)]. Nurses' educational status, age, working experience, working position, professional commitment, job stress, job satisfaction and organizational factor were significantly associated with nurses' intention to leave their profession. The overall nurses' intention to leave their profession was high. Reducing this level of leaving intention needs collaborative intervention related to factors like safety of working environment, job related stress, job satisfaction, professional commitment and education opportunities which are a big homework for managers on health sectors of West Shoa zone public Hospitals and higher level health sector managers.

Gender equality policies, nursing professionalization, and the nursing workforce: A cross-sectional, time-series analysis of 22 countries, 2000-2015

BACKGROUND

Nursing professionalization has substantial benefits for patients, health care systems, and the nursing workforce. Currently, however, there is limited understanding of the macro-level factors, such as policies and other country-level determinants, influencing both the professionalization process and the supply of nursing human resources.

OBJECTIVES

Given the significance of gender to the development of nursing, a majority-female occupation, the purpose of this analysis was to investigate the relationship between gender regimes and gender equality policies, as macro-level determinants, and nursing professionalization indicators, in this case the regulated nurse and nurse graduate ratios.

DESIGN

This cross-sectional, time-series analysis covered 16 years, from 2000 to 2015, and included 22 high-income countries, members of the Organisation for Economic Co-operation and Development. We divided countries into three clusters, using the gender policy model developed by Korpi, as proxy for gender regimes. The countries were grouped as follows: (a) Traditional family - Austria, Belgium, France, Germany, Greece, Italy, Netherlands, Portugal, and Spain; (b) Market-oriented - Australia, Canada, Ireland, Japan, New Zealand, South Korea, Switzerland, United Kingdom, and the United States; and (c) Earner-carer - Denmark, Finland, Norway, and Sweden.

METHODS

We used fixed-effects linear regression models and ran Prais-Winsten regressions with panel-corrected standard errors, including a first-order autocorrelation correction to examine the effect of gender equality policies on nursing professionalization indicators. Given the existence of missing observations, we devised and implemented a multiple imputation strategy, with the help of the Amelia II program. We gathered our data from open access secondary sources.

RESULTS

Both the regulated nurse and nurse graduate ratios had averages that differed across gender regimes, being the highest in Earner-carer regimes and the lowest in Traditional family ones. In addition, we identified a number of indicators of gender equality policy in education, the labour market, and politics that are predictive of the regulated nurse and nurse graduate ratios.

CONCLUSION

This study's findings could add to existing upstream advocacy efforts to strengthen nursing and the nursing workforce through healthy public policy. Given that the study consists of an international comparative analysis of nursing, it should be relevant to both national and global nursing communities.

Looking toward 2030: Strengthening midwifery education through regional partnerships

AIMS

The purpose of this paper is to describe the impact of a regional capacity-building project between Thailand and Laos that supports the United Nation's sustainable development goal 3 through midwifery education.

DESIGN

Discussion paper based on an exemplar.

DATA SOURCES

The International Confederation of Midwifery's standards of midwifery education and World Health Organization midwifery educator core competencies provided the framework for capacity-building of Lao midwifery educators.

IMPLICATIONS FOR NURSING

Knowledge gained from this 2-year project (October 2015-November 2017) increased the teaching confidence of midwifery educators while linking international standards and competencies to curriculum revision. In addition, capacity-building projects based on a needs assessment and implementation from regional partners may result in policy changes at the local and national level.

CONCLUSION

Partnerships are essential to meeting the sustainable development goals. These regional partnerships may be highly effective in creating sustainable capacity-building projects.

IMPACT

Maternal mortality and preventing deaths of children under 5 years old continues to be a challenge across the globe despite progress made in recent years. Progress toward sustainable development goal 3, requires efforts addressed in sustainable development goal17, partnership. Laos has one of the highest maternal mortality rates in Southeast Asia. A project to increase capacity of midwifery educators demonstrated the benefit of regional partnerships in Laos to have an impact on sustainable development goal 3 ultimately improving maternal outcomes throughout the country. Partnerships especially those between countries in the same region, are crucial to the success of meeting the sustainable development goals.