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