Strengthening Healthcare’s Frontline in Africa

One-quarter of the world’s disease burden lies in Africa. Yet while the continent battles HIV/AIDS, malaria, tuberculosis, a rising tide of chronic diseases, and a host of other health challenges, it has only 3% of the global health workforce. Nurses and midwives, who provide upwards of 90% of patient care, bear the brunt of this reality. They are overburdened, undertrained, and often underappreciated.

A nurse tends to mothers waiting for their children to be vaccinated at the ICAP-supported Kashai Dispensary in Western Tanzania. (Photo by Jamal Kalumna)

“It’s an unimaginable situation,” says Jennifer Dohrn, DNP, Project Director for the ICAP Global Nurse Capacity Building Program. “Nurses and midwives are on the frontline, facing huge challenges. They are often burned out, unable to take care of their patients and their families. And patients’ health suffers because the community depends on the nurse knowing everything and serving all.” At the same time, salaries are limited and gratitude for the work they do is not always evident. In response, nurses are leaving their jobs, changing professions, or leaving the country.

For the last three years, ICAP has worked to remedy the problem by equipping nurses and midwives with the right skills and necessary incentives to satisfy their professional needs and to retain them in their key role. This work will extend another five years, thanks to a new $40 million grant—perhaps the largest ever for nursing in Africa—from the U.S. Department of Health and Human Services/Health Resources and Services Administration (HRSA) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

The funding will allow ICAP to expand its Global Nursing Capacity Building Program from current efforts in South Africa, Swaziland, Rwanda, Ethiopia, Lesotho, and Kenya to Cote d’Ivoire, Nigeria, and Tanzania. ICAP will also continue to serve as coordinating center for the Nursing Education Partnership Initiative in five countries—Zambia, Malawi, Lesotho, Democratic Republic of Congo, and Ethiopia.

Working with ministries of health and education, nursing associations, and colleges, ICAP will assist in the creation of curricula that give nursing students the latest information on HIV and advanced training in critical skills like midwifery. And for nurses already in practice, whether at clinics or hospitals, the program will emphasize in-service training and mentorship that won’t take them away from their workplaces. The goal is to raise the standard of nursing education and training, and to enhance the regard and appreciation for the profession.

So far, it has been a success. For example, a pilot program in Swaziland found that nurses could effectively initiate and manage HIV care as well as doctors, expanding the role of nursing within the health team and judiciously reserving the few available physicians for complex cases.

With an eye to the future, ICAP is fostering a pan-African network of nurses to share skills, particularly around HIV care, and build a sense of camaraderie and solidarity. At one ICAP-sponsored meeting, nurses from Rwanda observed their counterparts in Ethiopia prescribe antiretroviral drugs, and even conduct small surgical operations like male circumcisions. “These partnerships raise the stature of nursing and point to an exciting and vibrant future for the profession,” says Dohrn.

As more nurses and midwives receive high-level training and gain key skills, they, in turn, will train others, creating a snowball effect benefitting the many communities where they are needed.  “We embrace this opportunity to continue to work to make nursing and midwifery a key focal point for strengthening health systems,” says ICAP Director Wafaa El-Sadr, MD, MPH.