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Prof Leana R
Uys FUNDISA
THE ROLE OF THE
NURSE IN AFRICA
44 countries in the WHO Africa region
Most are French-speaking, and based their nursing system on
Belgium and French systems
Even English-speaking countries use mainly textbooks from
developed countries
Current formulations on the roles of the nurse were produced
by expert panels, not on empirical studies
Many of these formulations are based on historical and
theoretical perceptions
BACKGROUND TO THE STUDY
What is needed from nurses and midwives in terms of health
service needs and burden of disease?
What do stakeholders expect from nurses and midwives?
What are nurses and midwives currently doing?
AIM
To develop a model of nursing and midwifery roles in Africa
based on empirical study of the real situation.
STUDY QUESTIONS
Selected seven African countries 4 Francophone and 4
Anglophone from East, Central West and Southern Africa
Had focus group discussions with stakeholders in each
country asking them about their expectations
Did a document review to identify the top 10 diseases in
adults and children in each country, as well as the structure
and staffing of the health service to establish health needs
Did a survey of current nursing practice using a task list which
100 nurses in each country completed to establish what
nurses are doing and not doing
All this information was then put together to develop a model
of nursing and midwifery roles.
METHODS
Total population 1.8 (1) to 144 (6) 37.5m
Population annual growth rate 1.2 (1) to 3.5 (5) 2.4%
Population proportion under 15
years
30 (1) to 48 (5) 43%
Population proportion over 60
years
4 (4) to 6 (7) 5%
THE POPULATION
Population in urban areas 17 (5) to 58 (1) 37%
Population with sustained access to
improved drinking water sources
42 (5) to 90 (1) 62%
Population with sustained access to
improved sanitation
7 (5) to 52 (9) 36%
Adult literacy 28.7(5) to 81.2 (1) 62.7%
HEALTH PROMOTION FACTORS
Gross national income per capita
(PPP international $)
830 to 12250 2359
Without 1 =
1123
General government expenditure on health as % of
total government expenditure
3.5 to 18.2 9.5%
Total expenditure on health as % of gross domestic
product (GDP)
3.8 to 8.3 5.1%
Out-of pocket expenditure as % of private
expenditure on health
27.7 to 100 80.3%
Private expenditure on health as % of total
expenditure on health
21.6 to 72 54.8%
FINANCIAL INDICATORS
Adults 15-59 Years Children 0-14 Years
Condition Condition
1 Cardiovascular Disease 84 1 Respiratory Infections 91
2 HIV/AIDS 81 2 Perinatal Conditions* 90
3 Unintentional Injuries 69 3 Malaria 75
4 Maternal Conditions 65 4 Diarrhoeal Diseases 65
5 Tuberculosis 64 5 HIV/AIDS 48
6 Malignant Neoplasm’s 35 6 Unintentional Injuries 45
7 Respiratory Infections 28 7 Childhood cluster diseases** 26
8 Intentional Injuries 25 8 Congenital Anomalies 25
9 Respiratory Diseases 20 9 Nutritional Deficiencies 19
10 Diarrhoeal Diseases 11 10 Malignant neoplasms 9
BURDEN OF DISEASE MORTALITY PER
1000
Adults 15-59 Years Children 0-14 Years
Condition Condition
1 Maternal Conditions 87 1 Peri Natal Conditions 93
2 Neuropsychiatric Illness 83 2 Respiratory Infections 80
3 HIV/AIDS 79 3 Diarrhoeal Diseases 72
4 Unintentional Injuries 67 4 Malaria 59
5 Cardiovascular Diseases 54 5 Unintentional Injuries 50
6 Tuberculosis 46 6 HIV/AIDS 49
7 Sense Organ Diseases 44 7 Nutritional Deficiency 44
8 Intentional Injuries 41 8 Congenital anomalies 28
9 Respiratory Diseases 14 9 Childhood cluster disease 27
10 Digestive Diseases 10 10 Neuropsychiatric Illness 23
TOP TEN CONDITIONS DALYS
Nurses and
Midwives
Physicians Pharmacy
personnel
Laboratory
technicians
Other
Botswana 27 4 2 2 5
Cameroon 16 2 <1 1 <1
DRC 5 1 <1 <1 <1
Kenya 12 1 1 2 <1
Niger 2 <1 <1 <1 <1
Nigeria 17 3 <1 1 <1
Senegal 3 <1 <1 <1 <1
Tanzania 4 <1 <1 <1 8
Zambia 20 1 1 1 3
HEALTH WORKFORCE
Country Category 1
Category 2 Category 3 Midwives Entry level
Botswana 3/4 years* - - + 1-2 years 12 years
Cameroon 3/4 years 2 years 1 year + 1-2 years 12/10/10
DRC 3/4 years 2 years - 10/12/12
Kenya 3/4 years 2.5 years 1 year + 1 year 12/12/12
Niger 3 year 3 years 2 years 3 years 13/10/6
Nigeria 3/5 years 2 years 1 year + 1 year 12/10/10
Senegal 3 years after 2 years 1 year 3 years** 13/10/10
Tanzania 3/4 years
2 years - 2 years
(Enrolled
Midwife)
12 or
14/10/-
Zambia 3 years 2 years - 2 years 12/12
PREPARATION OF NURSES
Regulatory body Nursing Association
Present Legislated Compulsory
registration
Renewal % of nurses
belong
Belong to ICN
Botswana Yes Yes Yes Annual 50% Yes
Cameroon Yes No No No 55% In process
DRC No No No No 50%* Yes
Kenya Yes Yes Yes 3 years 40% Yes
Niger No No No No Do not know In process
Nigeria Yes Yes Yes 3 years 17% Yes
Senegal No No No No 70% Yes
Tanzania Yes Yes Yes 2 years 23% Yes
Zambia Yes Yes Yes 1 year 80% Yes
THE ORGANIZED PROFESSION
CURRENT ROLE ACHIEVEMENT IN
HOSPITALS
COMPARISON BETWEEN FRENCH AND
ENGLISH COUNTRIES
1. Providing care
2. Providing health education
3. Managing the care environment
4. Advocating for patients, services and policies
5. Providing emergency care
6. Collaborating
7. Providing midwifery care
8. Making a diagnosis and providing treatment
THE ROLES
Showing respect
When this patient is received well and ensured of good treatments from a nurse, he or she starts to feel peace and become comfortable. The nurse must honor the patient and treat them well by providing information and guide the patient step by step, nurse should not be very harsh, but be friend to the patient and this will make patient to express their problem and finally become satisfied and regain lost peace. For the person who is sick his peace comes when he feels he has got right care and treatment. A nurse must play a role of receiving patient nicely and show empathy and respect.
Assessing and monitoring the condition of the patient
Providing care and treatment
Psychosocial counselling
DISSENSUS: Who does basic nursing care?
1. PROVIDING CARE
As a nurse you must also do the preventive and promotive
care to the clients and the community at large. This one must
be through education where we are supposed to give
educational preventive measures of conditions like diarrhoea,
cholera, and dysentery. We tell them the measures they are
supposed to employ or use so that they can avoid infections .
Aspects:
Individuals with an illness
Families and groups about caring for a person with a disease
Communities to prevent illness and promote health
2. PROVIDING HEALTH EDUCATION
At times when they enter in a ward and find people there they
should understand that it is their place to clean the ward
instead they start pouring insults on the patients that the way
the patients are dir ty is just a reflection of how dirty they are
in their homes.
Aspects:
Make sure all equipment and provisions are available and in working
order
Make sure the environment is clean
Make sure procedures and practices serves the best interest of
clients
Promote quality of care
3. MANAGING THE CARE ENVIRONMENT
There is no emergency fund (in the clinics) and it is an imperative in an underdeveloped country like ours. The State has a great responsibility: it must make drugs available, provide hospitals and continuously inputs including its role in safeguarding the fundamental principle of access to public service and continuity. The nurses, however, must raise this issue or at least participate, enlightening because they have a duty to inspire public policies in their f ield .
Aspects:
Advocate with other health professionals
With other sector role-players
For policies to change or be implemented
For new or changed services
4. ADVOCATING FOR PATIENTS, SERVICES
AND POLICIES
Nurses are on night duties and an emergency situation arises
but they are always very reluctant to react to the emergency. I
think that is a serious problem that is supposed to be
addressed.
Aspects:
Emergency care in communities
In health care settings
Being the first port of call
5. PROVIDING EMERGENCY CARE
You may also stay for the whole day waiting to be seen by a
doctor and he does not show up, and the nurses do not do
anything about it. They must help each other, what is
important is that we get the assistance we need
Aspects:
Nursing team
Health care team
Other health facilities
Other sectors
Other role-players in the community
6. COLLABORATING WITHIN AND
WITHOUT THE SECTOR
When it comes to women’s health it is the responsibility of the
midwife to care for the woman during pregnancy and delivery,
to make sure that the pregnancy is safe, and the delivery is
also safe to prevent death for the mother and her baby.
7. PROVIDING MIDWIFERY CARE
Nurses have been taught to do many things, depending on the
communication between the nurse and the patient. I think the
first thing is for the nurse to take vital signs, and I think the
nurse can do that. The second thing is consultation, which I
think the nurse can also do. I mean where a nurse asks a
patient about the history of his/her illness and examines the
patient. The nurse can do that. The 3 rd thing is for the nurse to
see what the patient needs to cure the illness, and prescribes
the medicines. I think the nurse can also do that so that the
patient can be helped. If the nurse suspects some things that
require further investigation, she/he can order blood and
other laboratory investigations and send them to the
laboratory. I believe that nurses can carry out all these duties.
8. MAKING A DIAGNOSIS AND PROVIDING
TREATMENT (DISSENSUS ROLE)
Policies had practices that support role performance
of the nurse and midwife
A regulatory framework that ensures a competent
and diverse nursing and midwifery workforce
An education system that prepares the nurse
appropriately for practice, for research and for
management
CONTEXTUAL CONDITIONS
Embrace diagnosis and treatment as a nursing role in Africa
Value and support the elements of professional development
that is in place in South Africa
Promote all roles in your health care setting and in your
nursing education
RECOMMENDATIONS
We should take less things for granted
We should claim the role of diagnosis and treatment as part
of the nursing role in Africa
We should ensure that our nursing education prepares a nurse
for all roles.
CONCLUSION
Collaborators: Dr Naomi Seboni, Dr Thecla Kohi, Dr Chika
Uguchukwo, Ms Jennifer Chipps
Funders: STTI, University of Botswana, South African NRF,
Rockefeller Foundation
ACKNOWLEDGEMENTS
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