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McGivern G, Wafula F, Seruwagi G, Kiefer T, Musiega A, Nakidde C, Ogira D, Gill M, English M. Deconcentrating regulation in low- and middle-income country health systems: a proposed ambidextrous solution to problems with professional regulation for doctors and nurses in Kenya and Uganda. HUMAN RESOURCES FOR HEALTH 2024; 22:13. [PMID: 38308369 PMCID: PMC10835984 DOI: 10.1186/s12960-024-00891-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 01/08/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Regulation can improve professional practice and patient care, but is often weakly implemented and enforced in health systems in low- and middle-income countries (LMICs). Taking a de-centred and frontline perspective, we examine national regulatory actors' and health professionals' views and experiences of health professional regulation in Kenya and Uganda and discuss how it might be improved in LMICs more generally. METHODS We conducted large-scale research on professional regulation for doctors and nurses (including midwives) in Uganda and Kenya during 2019-2021. We interviewed 29 national regulatory stakeholders and 47 subnational regulatory actors, doctors, and nurses. We then ran a national survey of Kenyan and Ugandan doctors and nurses, which received 3466 responses. We thematically analysed qualitative data, conducted an exploratory factor analysis of survey data, and validated findings in four focus group discussions. RESULTS Kenyan and Ugandan regulators were generally perceived as resource-constrained, remote, and out of touch with health professionals. This resulted in weak regulation that did little to prevent malpractice and inadequate professional education and training. However, interviewees were positive about online licencing and regulation where they had relationships with accessible regulators. Building on these positive findings, we propose an ambidextrous approach to improving regulation in LMIC health systems, which we term deconcentrating regulation. This involves developing online licencing and streamlining regulatory administration to make efficiency savings, freeing regulatory resources. These resources should then be used to develop connected subnational regulatory offices, enhance relations between regulators and health professionals, and address problems at local level. CONCLUSION Professional regulation for doctors and nurses in Kenya and Uganda is generally perceived as weak. Yet these professionals are more positive about online licencing and regulation where they have relationships with regulators. Building on these positive findings, we propose deconcentrating regulation as a solution to regulatory problems in LMICs. However, we note resource, cultural and political barriers to its effective implementation.
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Affiliation(s)
| | | | | | - Tina Kiefer
- University of Warwick, Coventry, United Kingdom
| | | | | | | | - Mike Gill
- University of Oxford, Oxford, United Kingdom
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MacKay RE, Gross JM, Hepburn KW, Spangler SA. Nurse- and Midwife-Led HIV Services in Eastern and Southern Africa: Challenges and Opportunities for Health Facilities. J Assoc Nurses AIDS Care 2020; 31:392-404. [PMID: 32604219 PMCID: PMC8477788 DOI: 10.1097/jnc.0000000000000176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In eastern and southern Africa, much is unknown about implementation of nurse-initiated and managed antiretroviral therapy (NIMART). The purpose of this study was to identify perceived barriers and facilitators of NIMART for the prevention of mother-to-child transmission and pediatric HIV services in high-volume, high HIV-burden health facilities across this region. A total of 211 nurses, midwives, and nurse midwives and 62 supervisors from 30 health facilities in 11 countries participated in this mixed-methods evaluation. The findings show that although nurses, midwives, and nurse midwives clearly had the authority to provide NIMART services, they did not necessarily feel that they were well prepared and supported to do so. Deficits in supportive supervision and clinical mentorship were viewed as substantial challenges to effective provision of NIMART for the prevention of mother-to-child transmission and pediatric HIV services-particularly with respect to pediatric HIV services. Health facilities have important opportunities to advance NIMART practice through strengthening these aspects of in-service support.
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Affiliation(s)
- Rebecca E. MacKay
- Emory University, Rollins School of Public Health, Atlanta, Georgia, USA
| | | | - Jessica M. Gross
- Division of Global HIV and TB, the U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kenneth W. Hepburn
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, USA
| | - Sydney A. Spangler
- Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, Georgia, USA
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Ajuebor O, McCarthy C, Li Y, Al-Blooshi SM, Makhanya N, Cometto G. Are the Global Strategic Directions for Strengthening Nursing and Midwifery 2016-2020 being implemented in countries? Findings from a cross-sectional analysis. HUMAN RESOURCES FOR HEALTH 2019; 17:54. [PMID: 31300058 PMCID: PMC6626395 DOI: 10.1186/s12960-019-0392-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/04/2019] [Indexed: 05/29/2023]
Abstract
BACKGROUND Nurses and midwives are the largest component of the health workforce in many countries. The World Health Organization (WHO) together with its partners facilitates the joint development of strategic policy guidance for countries to support the optimization of their nursing and midwifery workforce. The Global Strategic Directions for Strengthening Nursing and Midwifery 2016-2020 (SDNM) is a global policy guidance tool that provides a framework for Member States, the WHO and its partners to adapt, develop, implement and evaluate nursing and midwifery policy interventions in Member States. As part of the broader monitoring and accountability functions of the WHO, assessing the progress of the SDNM implementation at a country level is key to ensuring that countries stay on track towards achieving universal health coverage (UHC) and the sustainable development goals (SDGs). METHODS This is a cross-sectional mixed methods study involving the analysis of quantitative and qualitative data on the implementation of country-level interventions in the SDNM. Data was provided by government chief nursing and midwifery officers or their representatives using an online self-reported questionnaire. The quantitative data was assessed using a three-level scale and descriptive statistics while qualitative comments were analysed and presented narratively. RESULTS Thirty-five countries completed the survey. Summing up the implementation frequency of interventions across all thematic areas, 19% of responses were in the category of "completed"; 55% were reportedly "in progress" and 26% indicated a status of "not started". Findings reveal a stronger level of implementation for areas of nursing and midwifery development related to enhancing regulation and education, creating stronger roles for professional associations and policy strengthening. Leadership and interprofessional collaboration are intervention areas that were less implemented. CONCLUSION Monitoring and accountability of countries' commitments towards implementing nursing and midwifery interventions, as outlined in the SDNM, contributes to strengthening the evidence base for policy reforms in countries. This stock-taking can inform policy- and decision-makers' deliberations on strengthening the contributions of nurses and midwives to achieving UHC and the SDGs.
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Affiliation(s)
- Onyema Ajuebor
- Health Workforce Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
| | - Carey McCarthy
- Health Workforce Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
| | - Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, USA
| | | | | | - Giorgio Cometto
- Health Workforce Department, World Health Organization, 20 Avenue Appia, CH-1211 Geneva 27, Switzerland
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Gross JM, McCarthy CF, Verani AR, Iliffe J, Kelley MA, Hepburn KW, Higgins MK, Kalula AT, Waudo AN, Riley PL. Evaluation of the impact of the ARC program on national nursing and midwifery regulations, leadership, and organizational capacity in East, Central, and Southern Africa. BMC Health Serv Res 2018; 18:406. [PMID: 29866081 PMCID: PMC5987602 DOI: 10.1186/s12913-018-3233-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/24/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The African Health Professions Regulatory Collaborative (ARC) was launched in 2011 to support countries in East, Central, and Southern Africa to safely and sustainably expand HIV service delivery by nurses and midwives. While the World Health Organization recommended nurse initiated and managed antiretroviral therapy, many countries in this region had not updated their national regulations to ensure nurses and midwives were authorized and trained to provide essential HIV services. For four years, ARC awarded annual grants, convened regional meetings, and provided technical assistance to country teams of nursing and midwifery leaders to improve national regulations related to safe HIV service delivery. We examined the impact of the program on national regulations and the leadership and organizational capacity of country teams. METHODS Data was collected to quantify the level of participation in ARC by each country (number of grants received, number of regional meetings attended, and amount of technical assistance received). The level of participation was analyzed according to two primary outcome measures: 1) changes in national regulations and 2) improvements in leadership and organizational capacity of country teams. Changes in national regulations were defined as advancement of one "stage" on a capability maturity model; nursing and midwifery leadership and organizational capacity was measured by a group survey at the end of the program. RESULTS Seventeen countries participated in ARC between 2012 and 2016. Thirty-three grants were awarded; the majority addressed continuing professional development (20; 61%) and scopes of practice (6; 18%). Fourteen countries (representing approximately two-thirds of grants) progressed at least one stage on the capability maturity model. There were significant increases in all five domains of leadership and organizational capacity (p < 0.01). The number of grants (Kendall's tau = 0.56, p = 0.02), duration of technical assistance (Kendall's tau = 0.50, p = 0.03), and number of learning sessions attended (Kendall's tau = 0.46, p = 0.04) were significantly associated with improvements in in-country collaboration between nursing and midwifery organizations. CONCLUSIONS The ARC program improved national nursing regulations in participating countries and increased reported leadership, organizational capacity, and collaboration among national nursing and midwifery organizations. These changes help ensure national policies and professional regulations underpin nurse initiated and managed treatment for people living with HIV.
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Affiliation(s)
- Jessica M. Gross
- Division of Global HIV and TB at the U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Carey F. McCarthy
- Independent Health Systems and Nursing Workforce Consultant, Geneva, Switzerland
| | - Andre R. Verani
- Division of Global HIV and TB of the U.S. Centers for Disease Control and Prevention, Atlanta, USA
| | - Jill Iliffe
- Commonwealth Nurses and Midwives Federation, London, UK
| | - Maureen A. Kelley
- ARC and Professor Emeritus at Emory University’s Nell Hodgson Woodruff School of Nursing, Atlanta, USA
| | - Kenneth W. Hepburn
- ARC and a Professor at Emory University’s Nell Hodgson Woodruff School of Nursing, Atlanta, USA
| | - Melinda K. Higgins
- Emory University’s Nell Hodgson Woodruff School of Nursing, Atlanta, USA
| | - Alphonce T. Kalula
- East Central and Southern Africa Health Community (ECSA-HC), Arusha, Tanzania
| | - Agnes N. Waudo
- Africa Health Workforce Project and ARC Secretariat, Nairobi, Kenya
| | - Patricia L. Riley
- Health Systems Program Integration Team in the International Lab Branch at the U.S. Centers for Disease Control and Prevention, Atlanta, USA
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Kelley MA, Spangler SA, Tison LI, Johnson CM, Callahan TL, Iliffe J, Hepburn KW, Gross JM. Promoting Regulatory Reform: The African Health Profession Regulatory Collaborative (ARC) for Nursing and Midwifery Year 4 Evaluation. JOURNAL OF NURSING REGULATION 2017. [DOI: 10.1016/s2155-8256(17)30159-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kurth AE, Jacob S, Squires AP, Sliney A, Davis S, Stalls S, Portillo CJ. Investing in Nurses is a Prerequisite for Ensuring Universal Health Coverage. J Assoc Nurses AIDS Care 2016; 27:344-54. [DOI: 10.1016/j.jana.2016.02.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 02/23/2016] [Indexed: 10/22/2022]
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Establishing an Online Continuing and Professional Development Library for Nurses and Midwives in East, Central, and Southern Africa. J Assoc Nurses AIDS Care 2016; 27:297-311. [PMID: 27086190 DOI: 10.1016/j.jana.2016.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 01/25/2016] [Indexed: 11/23/2022]
Abstract
Over the past 4 years, the African Health Profession Regulatory Collaborative for nurses and midwives has supported 12 countries establish national continuing and professional development frameworks and programs, linking continuing education to nursing and midwifery re-licensure through technical assistance and improvement grants. However, lack of electronic media and rural practice sites, differences in priority content, and varying legal frameworks make providing accessible, certifiable, and up-to-date online continuing education content for the more than 300,000 nurses and midwives in the 17 member countries of the East, Central, and Southern Africa College of Nursing a major challenge. We report here on how the East, Central, and Southern Africa College of Nursing, with technical assistance from an Afya Bora Fellow, developed an online continuing professional development library hosted on their Web site using data collected in a survey of nursing and midwifery leaders in the region.
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Dawson A, Kililo M, Geita L, Mola G, Brodie PM, Rumsey M, Copeland F, Neill A, Homer CSE. Midwifery capacity building in Papua New Guinea: Key achievements and ways forward. Women Birth 2015; 29:180-8. [PMID: 26563637 DOI: 10.1016/j.wombi.2015.10.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 10/13/2015] [Accepted: 10/14/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND Papua New Guinea has some of the poorest health outcomes in the Asia-Pacific region. Maternal mortality is unacceptably high and there is a severe midwifery shortage requiring a quadrupling of the workforce. AIM This paper outlines the findings of an evaluation of the Maternal Child Health Initiative (MCHI) (2012-2013) to determine key factors contributing to maternal health workforce strengthening. METHOD A descriptive mixed methods study was undertaken. Data were gathered through interviews, focus group discussions and surveys with clinicians, midwifery students and staff from nursing and midwifery schools and National Department of Health staff. Documentation from stakeholder meetings and regular site reports were reviewed. Each data set was analysed separately and meta-inferences were drawn across all data. FINDINGS Learning opportunities were found to have increased for midwifery educators and improvements were described in midwifery educators teaching capacity and student clinical education experience. There was an increase in the number of midwifery graduates and improvements were noted in the working environment and skills of clinical staff. Education challenges were described including the lack of clinical preceptoring and limited continuing education for clinical educators. Participants recommended increasing clinical education hours and extending the length of the midwifery program. Ongoing efforts to accredit the midwifery curricula and regulate midwifery graduates were noted. CONCLUSION The MCHI has contributed to strengthening the midwifery workforce nationally. However, scaling-up and sustaining these achievements requires leadership and funding commitments from the midwifery schools and government alongside the accreditation of midwifery curricula and regulation of new graduates.
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Affiliation(s)
- Angela Dawson
- Centre for Midwifery Child and Family Health, Faculty of Health, University of Technology, Sydney, PO Box 123, Ultimo, NSW 2007, Australia.
| | - Mary Kililo
- Papua New Guinea National Department of Health, AOPI Centre, Waigani Drive, PO Box 807, Waigani 131, Port Moresby, National Capital District, Papua New Guinea
| | - Lahui Geita
- Papua New Guinea National Department of Health, AOPI Centre, Waigani Drive, PO Box 807, Waigani 131, Port Moresby, National Capital District, Papua New Guinea
| | - Glen Mola
- Department of Obstetrics and Gynaecology, School of Medicine and Health Sciences, University of Papua New Guinea, PO Box 320, University 134, Port Moresby, National Capital District, Papua New Guinea
| | - Pat M Brodie
- Centre for Midwifery Child and Family Health, Faculty of Health, University of Technology, Sydney, PO Box 123, Ultimo, NSW 2007, Australia
| | - Michele Rumsey
- World Health Organization Collaborating Centre for Nursing, Midwifery and Health Development, Faculty of Health, University of Technology, Sydney, PO Box 123, Ultimo, NSW 2007, Australia
| | - Felicity Copeland
- Centre for Midwifery Child and Family Health, Faculty of Health, University of Technology, Sydney, PO Box 123, Ultimo, NSW 2007, Australia
| | - Amanda Neill
- World Health Organization Collaborating Centre for Nursing, Midwifery and Health Development, Faculty of Health, University of Technology, Sydney, PO Box 123, Ultimo, NSW 2007, Australia
| | - Caroline S E Homer
- Centre for Midwifery Child and Family Health, Faculty of Health, University of Technology, Sydney, PO Box 123, Ultimo, NSW 2007, Australia
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Gross JM, Maureen K, Carey M. A Model for Advancing Professional Nursing Regulation: The African Health Profession Regulatory Collaborative. JOURNAL OF NURSING REGULATION 2015. [DOI: 10.1016/s2155-8256(15)30790-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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McCarthy CF, Kelley MA, Verani AR, St. Louis ME, Riley PL. Development of a framework to measure health profession regulation strengthening. EVALUATION AND PROGRAM PLANNING 2014; 46:17-24. [PMID: 24863957 PMCID: PMC4822514 DOI: 10.1016/j.evalprogplan.2014.04.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 04/22/2014] [Accepted: 04/22/2014] [Indexed: 05/08/2023]
Abstract
This paper describes the development of a framework to evaluate the progress and impact of a multi-year US government initiative to strengthen nursing and midwifery professional regulation in sub-Saharan Africa. The framework was designed as a capability maturity model, which is a stepwise series of performance levels that describe the sophistication of processes necessary to achieve an organization's objectives. A model from the field of software design was adapted to comprise the key functions of a nursing and midwifery regulatory body and describe five stages of advancing each function. The framework was used to measure the progress of five countries that received direct assistance to strengthen regulations and to benchmark the status of regulations in the 17 countries participating in the initiative. The framework captured meaningful advancements in regulatory strengthening in the five supported countries and the level of regulatory capacity in participating countries. The project uses the framework to assess yearly progress of supported countries, track the overall impact of the project on national and regional nursing regulation, and to identify national and regional priorities for regulatory strengthening. It is the first of its kind to document and measure progress toward sustainably strengthening nursing and midwifery regulation in Africa.
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Affiliation(s)
- Carey F. McCarthy
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30333, USA
- Corresponding author at: Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road MS E-30, Atlanta, GA 30333, USA. Tel.: +1 404 639 1597; fax: +1 404 639 4268; mobile: +1 404 825 2384
| | - Maureen A. Kelley
- Nell Hodgson Woodruff School of Nursing, Lillian Carter Center for Global Health and Social Responsibility, Emory University, Atlanta, GA 303XX, USA
| | - Andre R. Verani
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30333, USA
| | - Michael E. St. Louis
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30333, USA
| | - Patricia L. Riley
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30333, USA
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Moetsana-Poka F, Lebaka M, McCarthy CF. Developing a Continuing Professional Development Program to Improve Nursing Practice in Lesotho. ACTA ACUST UNITED AC 2014; 8:10-13. [PMID: 27053950 DOI: 10.12968/ajmw.2014.8.sup2.10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
INTRODUCTION In 2010, the Lesotho Ministry of Health and Social Welfare (MOHSW) issued the Continuing Education Strategy for all Health Care Workers in Lesotho, requiring professional regulatory bodies to enforce continuing education requirements amongst their members. In order to comply with this strategy, the Lesotho Nursing Council worked to develop a national comprehensive program for continuing professional development (CPD). METHODS Through a seed grant and technical assistance from the African Health Professions Regulatory Collaborative (ARC), national nursing and midwifery leadership collaboratively developed a national CPD framework. The draft CPD framework and logbook were formally vetted with stakeholders during consultative meetings held around the country. ACHIEVEMENTS The CPD framework was successfully piloted prior to being launched nationally in October 2012. This is the first health professional CPD program in Lesotho. Development of a CPD program in Lesotho has created a platform to reconcile nursing practice with the legislative standards governing the workforce. CHALLENGES The one-year grant timeframe, along with limited financial and staff resources limited presented implementation challenges. CONCLUSION In establishing a comprehensive national CPD program, it is critical for countries to engage in a staged planning process that includes monitoring and evaluation.
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Affiliation(s)
- Flavia Moetsana-Poka
- Bachelor of Nursing Education and Administration; Registrar at Lesotho Nursing Council
| | - Makholu Lebaka
- Bachelor of Nursing Education and Administration, Master of Nursing Science in Child and Adolescent Mental Health; Director of Nursing Services, Lesotho Ministry of Health
| | - Carey F McCarthy
- Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention
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Zuber A, McCarthy CF, Verani AR, Msidi E, Johnson C. A survey of nurse-initiated and -managed antiretroviral therapy (NIMART) in practice, education, policy, and regulation in east, central, and southern Africa. J Assoc Nurses AIDS Care 2014; 25:520-31. [PMID: 24739661 DOI: 10.1016/j.jana.2014.02.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 02/05/2014] [Indexed: 11/18/2022]
Abstract
In sub-Saharan Africa, nurses and midwives perform many HIV service delivery tasks, such as diagnosis of HIV and prescription of antiretroviral therapy (ART), which used to be the responsibility of physicians. While this task shifting is critical to scaling-up HIV services in Africa, the extent of HIV task shifting is not well understood. A survey of senior nursing leadership teams from 15 African countries was carried out to describe the extent of nurse-initiated and -managed antiretroviral therapy (NIMART) in practice, education, policy, and regulation. The survey took place at the African Health Professions Regulatory Collaborative meeting in Pretoria, South Africa, in June 2012. The findings indicated that NIMART is widely practiced and authorized in policy, but is not reinforced by regulation nor incorporated into preservice education. Further investment in policy, regulation, and pre-service education is needed to ensure sustainable, high quality ART service expansion through the region.
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McCarthy CF, Voss J, Salmon ME, Gross JM, Kelley MA, Riley PL. Nursing and midwifery regulatory reform in east, central, and southern Africa: a survey of key stakeholders. HUMAN RESOURCES FOR HEALTH 2013; 11:29. [PMID: 23800079 PMCID: PMC3706367 DOI: 10.1186/1478-4491-11-29] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 06/13/2013] [Indexed: 05/12/2023]
Abstract
BACKGROUND In sub-Saharan Africa, nurses and midwives provide expanded HIV services previously seen as the sole purview of physicians. Delegation of these functions often occurs informally by shifting or sharing of tasks and responsibilities. Normalizing these arrangements through regulatory and educational reform is crucial for the attainment of global health goals and the protection of practitioners and those whom they serve. Enacting appropriate changes in both regulation and education requires engagement of national regulatory bodies, but also key stakeholders such as government chief nursing officers (CNO), professional associations, and educators. The purpose of this research is to describe the perspectives and engagement of these stakeholders in advancing critical regulatory and educational reform in east, central, and southern Africa (ECSA). METHODS We surveyed individuals from these three stakeholder groups with regard to task shifting and the challenges related to practice and education regulation reform. The survey used a convenience sample of nursing and midwifery leaders from countries in ECSA who convened on 28 February 2011, for a meeting of the African Health Profession Regulatory Collaborative. RESULTS A total of 32 stakeholders from 13 ECSA countries participated in the survey. The majority (72%) reported task shifting is practiced in their countries; however only 57% reported their national regulations had been revised to incorporate additional professional roles and responsibilities. Stakeholders also reported different roles and levels of involvement with regard to nursing and midwifery regulation. The most frequently cited challenge impacting nursing and midwifery regulatory reform was the absence of capacity and resources needed to implement change. DISCUSSION While guidelines on task shifting and recommendations on transforming health professional education exist, this study provides new evidence that countries in the ECSA region face obstacles to adapting their practice and education regulations accordingly. Stakeholders such as CNOs, nursing associations, and academicians have varied and complementary roles with regard to reforming professional practice and education regulation. CONCLUSION This study provides information for effectively engaging leaders in regulatory reform by clarifying their roles, responsibilities, and activities regarding regulation overall as well as their specific perspectives on task shifting and pre-service reform.
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Affiliation(s)
- Carey F McCarthy
- Center for Global Health, Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, MS-E30, Atlanta, GA, 30333, USA
| | - Joachim Voss
- Department of Global Health, University of Washington School of Nursing, 1959 NE Pacific Avenue, Seattle, WA, 98195, USA
| | - Marla E Salmon
- University of Washington Evans School of Public Affairs, 4100 15th Ave NE, Seattle, WA, 98195, USA
| | | | - Maureen A Kelley
- Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA, 30322, USA
| | - Patricia L Riley
- Center for Global Health, Division of Global HIV/AIDS, U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, MS-E30, Atlanta, GA, 30333, USA
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Nursing and midwifery regulation and HIV scale-up: establishing a baseline in East, Central and Southern Africa. J Int AIDS Soc 2013; 16:18051. [PMID: 23531276 PMCID: PMC3608854 DOI: 10.7448/ias.16.1.18051] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 01/30/2013] [Accepted: 02/13/2013] [Indexed: 11/24/2022] Open
Abstract
Introduction Shifting HIV treatment tasks from physicians to nurses and midwives is essential to scaling-up HIV services in sub-Saharan Africa. Updating nursing and midwifery regulations to include task shifting and pre-service education reform can help facilitate reaching new HIV targets. Donor-supported initiatives to update nursing and midwifery regulations are increasing. However, there are gaps in our knowledge of current practice and education regulations and a lack of information to target and implement regulation strengthening efforts. We conducted a survey of national nursing and midwifery councils to describe current nursing and midwifery regulations in 13 African countries. Methods A 30-item survey was administered to a convenience sample of 13 national nursing and midwifery regulatory body leaders in attendance at the PEPFAR-supported African Health Profession Regulatory Collaborative meeting in Nairobi, Kenya on 28 February, 2011. The survey contained questions on task shifting and regulations such as registration, licensure, scope of practice, pre-service education accreditation, continuing professional development and use of international guidelines. Survey data were analyzed to present country-level, comparative and regional findings. Results Task shifting to nurses and midwives was reported in 11 of the 13 countries. Eight countries updated their scope of practice within the last five years; only one reported their regulations to reflect task shifting. Countries vary with regard to licensure, pre-service accreditation and continuing professional development regulations in place. There was no consistency in terms of what standards were used to design national practice and education regulations. Discussion Many opportunities exist to assist countries to modernise regulations to incorporate important advancements from task shifting and pre-service reform. Appropriate, revised regulations can help sustain successful health workforce strategies and contribute to further scale-up HIV services and other global health priorities. Conclusions This study provides fundamental information from which to articulate goals and to measure the impact of regulation strengthening efforts.
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