Global Health Nursing & Midwifery

Being a researcher in maternal, prenatal and neonatal morbidity and mortality and a citizen of Sudan. I see the situation of Education of Professional Nurses and Midwives in the world is disastrous and it had been so for so many decades. We have got institutes, initiatives, moves, networking and frameworks. We are left with small step of more collaboration and continental coordination. The idea that I think of significance is the approach towards problems. It needs to be practical, feasible. Valid. Reliable. Objective, sustainable and measurable.
We do not need the government to be wholly collection of scientists, but we need to consider governmental health officials, policy makers, executive’s health ministries and institutes. The injection of that scientific inspiration and soul would satisfy the need for power and if possible under the umbrella of political patronage, so as to be introduced to the political Agenda. We should not forget to convince politicians that the cake will not be divided or shared by any partner, but solely for them and this is true, by the way when comes the role of women health activists together with other tools as media.
The motivation taken by any nation must arise from within ...

Being a researcher in maternal, prenatal and neonatal morbidity and mortality and a citizen of Sudan. I see the situation of Education of Professional Nurses and Midwives in the world is disastrous and it had been so for so many decades. We have got institutes, initiatives, moves, networking and frameworks. We are left with small step of more collaboration and continental coordination. The idea that I think of significance is the approach towards problems. It needs to be practical, feasible. Valid. Reliable. Objective, sustainable and measurable.
We do not need the government to be wholly collection of scientists, but we need to consider governmental health officials, policy makers, executive’s health ministries and institutes. The injection of that scientific inspiration and soul would satisfy the need for power and if possible under the umbrella of political patronage, so as to be introduced to the political Agenda. We should not forget to convince politicians that the cake will not be divided or shared by any partner, but solely for them and this is true, by the way when comes the role of women health activists together with other tools as media.
The motivation taken by any nation must arise from within, as always been taught in the history. There for it can not be accomplished by out side volunteers.
“We as African have to do it ourselves" concerning the Education of Professional Nurses and Midwives. I prefer to put some conclusive ideas in short phrases to explain my point of view, How to get out of it and what do we need?
We need to have:
* Community oriented medical education including the whole staff of health service and post graduate studies, addressing our community problems and health requirements.
* Continuous capacity building among the health sector, keep them up to date together with the maximum capacity of health research.
* Adequate partnership between universities and ministries of health.
* Collaboration, coordination and networking to every tool of information and data in the community.
* Full data and well recognition of community, public health, primary health care and endemic and epidemic morbidity and mortality.
* Stout advocacy, influence and social motivation by any available mean including health education, media, professionals, activists, social and community leaders.
* Extraction of full political support and invasion of policy and politicians so as to incorporate the human health and welfare among and inside the governmental agendas.
* Introduction of health agenda in the permanent and basal political sake, to get deeply rooted in the government frame, more over may have some scientists being ministers, the condition like us in Sudan.
* Obtain the maximum extension of education of applied medical sciences as much as possible. We have in Sudan, the largest number of universities and faculties of applied medical sciences in the region, more than 25 universities and several ministerial academies.
* Nationalization of the medical service so as to retain the medical staff in side the country.
* Governmental declarations, as in Sudan that the treatment of children under
* year is 100% free of charge and birth by cesarean section is also free of charge in all the country hospitals.
* Obtain presidential decisions about health, like Declarations which includes the up raising the midwifery level, education, jobs, vacancies and salaries.
* Adoption of many initiatives of maternal and child health initiated by scientists, researchers and medical professionals.
* Building effective partnership with the formal and governmental authorities, committees, policy makers and planners.
The issue needs dedication, transparency and hard working towards the undeserved population and the rural areas. Our medical education is addressing the rural areas as much as enough, the fact that we are the doctors supposed to serve that Rural of our own citizenship.

As a Nigerian trained nurse and midwife who proceeded to obtain a medical degree in the united states, I do totally agree with Elhassan that the standard of education for professional nurses and midwife has disiastrously depericiated. However, I disagree that it has been for many decades. My training for both the nursing and midwifery degrees in 1985 and 1987 respectively were all at associate degree levels and hospital based. Both trainings were of superior standard that laid a solid intellectual foundation that enhanced my ability to transition to obtain a medical degree here in the United States.
However, non of the current graduates from those institutions can brag of recoding quality education. Most of those institutions have lost their accreditations and barred from admitting new students by the National Council for Nurses and Midwives due to reasons ranging from poor staff strength, dilapidated infrastructures and poor performance of students at the standardized qualifying examinations.
I agree with Elhassan that we have got institutions, initiatives, ideas and frameworks but the lapses in standards are more evident in countries with poor governance with lack of transparency and accountability. Corruption evident in most African countries is accountable for falling standards in every ...

As a Nigerian trained nurse and midwife who proceeded to obtain a medical degree in the united states, I do totally agree with Elhassan that the standard of education for professional nurses and midwife has disiastrously depericiated. However, I disagree that it has been for many decades. My training for both the nursing and midwifery degrees in 1985 and 1987 respectively were all at associate degree levels and hospital based. Both trainings were of superior standard that laid a solid intellectual foundation that enhanced my ability to transition to obtain a medical degree here in the United States.
However, non of the current graduates from those institutions can brag of recoding quality education. Most of those institutions have lost their accreditations and barred from admitting new students by the National Council for Nurses and Midwives due to reasons ranging from poor staff strength, dilapidated infrastructures and poor performance of students at the standardized qualifying examinations.
I agree with Elhassan that we have got institutions, initiatives, ideas and frameworks but the lapses in standards are more evident in countries with poor governance with lack of transparency and accountability. Corruption evident in most African countries is accountable for falling standards in every sectors of these countries including health and education.
I admire and complement the progress and commitment being made by countries such as Sudan to improve and strengthen their health systems through improved standard of education for professional nurses and midwives.
In conclusion, Elhassan's road map for improved quality of professional education and health service provision is very cogenent and can be applied accross board to every health system.

Adanze has given a good panoramic view of pre-service training standards
and the facts are globally true though country specific. I have been the
President of the Cameroon Association of Nurses, midwives and Health
Technicians for eight years and I can say that the issue of training
standards in the country is an elephant one. There is a national curriculum
and that is the only common learning component in the learning package so
every school has its own reference manuals and the teachers use their own
training methods and learning tools, meaning nothing is really
standardized. However, this aside, the schools, particularly those from the
English-speaking regions still produce good nurses, abeit that their
practice may not be nationally harmonized.
The Ministry of Health is still to let the Association claim full authority
over the recruitment, training, certification and practice control which
for now is left in the hands of the MoH which has no clear cut monitoring
and evaluation plan for training, certifcation and practice of nurses,
midwives and health technicians. The day the Association will get full
authonomy over nursing, midwifery and health technicians training and
practice, things will change in the country. The medicolegal values of
the ...

Adanze has given a good panoramic view of pre-service training standards
and the facts are globally true though country specific. I have been the
President of the Cameroon Association of Nurses, midwives and Health
Technicians for eight years and I can say that the issue of training
standards in the country is an elephant one. There is a national curriculum
and that is the only common learning component in the learning package so
every school has its own reference manuals and the teachers use their own
training methods and learning tools, meaning nothing is really
standardized. However, this aside, the schools, particularly those from the
English-speaking regions still produce good nurses, abeit that their
practice may not be nationally harmonized.
The Ministry of Health is still to let the Association claim full authority
over the recruitment, training, certification and practice control which
for now is left in the hands of the MoH which has no clear cut monitoring
and evaluation plan for training, certifcation and practice of nurses,
midwives and health technicians. The day the Association will get full
authonomy over nursing, midwifery and health technicians training and
practice, things will change in the country. The medicolegal values of
the professions are being dragged into mud and those who do this still
remain in practice because there is no effective practice control. If
there are no set standards for pre-service training, how would those in the
field be monitored and evaluated and techhically supported?
To me, preservice training is the entry point into the professions and
should be given a very serious thought and the right stakeholders brought
on board and empowered to come out with deliverables and see them happen
the way they all agreed it should be. The Government cannot allow its
ministryof health to undermind people of a profession and allow another
groups of professionals to lord it over them. Here I am talking of Medical
Doctors who monoploize all high positions and usurp other peoples roles.
The nurses and midwives in Cameroon have no say in the decisions that
concern their professions even if among them there may be people with PhDs.
The day this stereotype will change new wine will enter the professional
wineskins and then sweet wine will begin to flow. Until then, what is going
on is coming through from poor governance hijacked by Medical Doctors. This
is the scenario in Cameroon, I don't know about other countries, but what I
know is that something has to change, but what and how? I can't exactly
say. Would it ever change? Or would there be someday a revolution towards
the right thing?. We can improve our standards but we must keep the fight
against the elephants that block change. I praise Ghana, Gambia, Nigeria
and other countries where their Nursing and Midwifery councils have the
full authority and are waxing strong. They should get even stronger so that
other countries with worse or worst scenarios could imitate them. We need
the training standards to get higher, we need standard values to creep into
the professional milieu, be it the training one or the practice one. The
sure thing is that we need improvement, Our Nursing and Midwifery
Councils need to test someone and say, you have come from that great school
but you have not met our standards to go and practice in the field like it
happens in America, Canada, to name only these two. For Cameroon the battle
has not even started. The Association's Council is still to be involved in
any of the processes that leads to certification and accredication. Another
professional dawn is indeed needed in Cameroon to reshape nursing and
midwifery training and practice.


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*Amungwa Athanasius Nche*
*Health and Development Certified Training Professional*
*P.O. Box 2157*
*Alakuma, Road-Mankon*
*Bamenda*
*North West Region *
*Cameroon*

*"Pain is temporary. It may last a minute, or an hour, or a
day, or a year, but eventually it will subside and something
else will take its place. If I quit, however, it lasts
forever."**Lance Armstrong***
**

The revolution of the standardization of nurses and midwives will most certainly make healthcare access and delivery more equitable. Do you all think that this equitability problem would be solved if the leadership and power was in the hands of the nurses and midwives, rather than the MoH and Medical Doctors, OR do you think that there needs to be comprehensive studies on the present nurse& midwife training models in order to develop one to ensure consistency? In other words, which woud be more beneficial- a) advocacy in the shift of leadership from MDs to nurses&midwives OR b) the research and development of a comprehensive training model for nurses and midwives?

I like how you think Catherine: I would like to think that having local/national nursing representation in a given MOH would possibly be more beneficial. Working with medical, HCW and nursing models would most effectively care for patients from the community to the bedside and back to the community. The work involved would be great, but the potential for consistency and sustainability would be outstanding on many levels.

Is anyone aware of any current MoH examples that have cohesive medical HCW, and nursing models? I am planning on doing field research about the consistency or lack there of, of nursing models in Sub-Saharan Africa next summer and have been trying to find documents that provide somewhat comprehensive list of various countries' MoH nursing models and have been having some difficulty. In order to formulate a proper thesis I need to gather whatever information there is so that I can make the research as valuable and the outcome as sustainable as possible. Does anyone have a suggestion as to where to find this information?

I thank Catherine for bringing up this issue. I can't say whether shifting
responsibility over nursing and midwifery pre-service training standards
from MoH and Doctors to nurses and midwives would be the magic pill without
the precedence of properly designed job, legal and procedural tools;
without a good vlue and ethical background and a human resource and
economic policy framework within which good governance that will respire
effective communication and leadership for standards to be weaved and
sustained to create good impacts in the popuations they serve. This I
agree with Catherine will need a total revolution in the way nursing and
midwifery leaders, actors and service users will think, act to harness
nursing and midwifery principles and practice for expected results and
this will need a complete review and strengthening of the nursing and
midwifery system globally.
**

--
*Amungwa Athanasius Nche*
*Health and Development Certified Training Professional*
*P.O. Box 2157*
*Alakuma, Road-Mankon*
*Bamenda*
*North West Region *
*Cameroon*

*"Pain is temporary. It may last a minute, or an hour, or a
day, or a year, but eventually it will subside and something
else will take its place. If I quit, however, it lasts
forever."**Lance Armstrong***
**