A MESSAGE FROM DR. SAFINAH KISU MUSEENE, THE CHAIRPERSON OF NURSES AND MIDWIVES LEADERS’ THINK TANK -UGANDA
It is a matter of immense pleasure and satisfaction for me that the first issue of the 2nd edition of the Nurses and Midwives Leaders’ Think Tank (NMLTT) newsletter is ready for the public. On behalf of the Nurses and Midwives Leaders’ Think Tank in Uganda and on my own behalf, I greet you all, welcome you to yet another new year of 2023 and wish you all the best. May I take this opportunity to thank NMLTT Executive and the editorial team for the work well done.
I as a person and a believer, I am very grateful and thankful to God! He has enabled us to survive and above all, he has given us the opportunity to serve humanity in our various capacities. May I register our appreciation as NMLTT to the frontline nurses and midwives and other health workers for managing the pandemic of COVID-19 and the Epidemic of
Ebola. It’s only God to reward you. The Health Sector Leadership right from HE the President of the Republic of Uganda, Honourable Ministers of Health, the Permanent Secretary, and all the technical Staff are highly appreciated.
This newsletter is met to improve communication and information sharing among nurses, midwives, health professionals, and the public. May I call upon all nurses and midwives to read this issue and remind you that the editorial team is receiving articles for the next issue.
A lot was achieved in the year 2022 including the celebration of 100 years of the Uganda Nurses and Midwives Council, the conduct of the 1St National Health Professional and Care Conference, attendance of the ECSACON quadrangle in Eswatini, the inauguration of the Federation of Uganda Nurses and Midwives Associations, recruitment and training of nurses and midwives at various levels including PhDs and as well as UNMC registration and licensure to practice. Last year saw one of us Prof Rose Clerk Nanyonga attaining an Associate Professor Position and two of our senior nurses completing their Doctorate studies. All these achievements create a reason for us to celebrate. The setbacks of the year formed very strong learning opportunities for all of us and we thank God for them.
From our last virtual interaction in December 2022, somehow a message was provided indicating that more interactions were needed. My Prayer for this year 2023 is for us to be more interactive virtually and physically. Let us continue to fulfil the rationale for why this NMLTT was formed. This year we shall hold monthly meetings and mainly we need to focus on policy, regulation, training, and association issues. With this, I hope that we will be able to impact positively on the nursing and midwifery profession.
As I conclude, May I congratulate all nurses and midwives for the successful provision of health services to humanity, and the NMLTT for successfully bringing out this newsletter, I hope besides providing information and improving communication among nurses and midwives, this newsletter would interest and create lasting memories.
Thank you, For God and My Country.
Dr. Safinah Kisu Museene Chairperson NMLTT
GOING THE EXTRA MILE - IN THE PERSPECTIVE OF WONYIMA O. ISAAC (MSC. HM, BNS, R/N, E/N)
ASSISTANT DISTRICT HEALTH OFFICER MATERNAL CHILD HEALTH/ NURSING, NWOYA DISTRICT LOCAL GOVERNMENT.
The year 2022 had been an exceptionally unique year with awards. A lot of things were achieved amidst challenges for example we saw significant improvements in maternal, neonatal child, and adolescent health indicators. To be precise, the responsive arm of MPDSR helped us reduce the number of mortalities for both mothers and children. Notably, we have registered an improvement in accountability for our individual and collective actions.
The two awards I received were not because of me but rather the collective efforts of each member of the community Nwoya District and the family of the ADHO/MCHN. First, to begin with the Nwoya district, as a team we analyzed our data and did a root cause analysis of the causes of maternal and perinatal mortalities, and we established the following:
1. Access to health facilities (those living within a radius of 5kms) is at 40.7% implying that most of our communities were living in distant places from the health unit.
2. Either as a result of long distances or community-related factors most mothers used to deliver at home or seek health care services late hence resulting in poor pregnancy outcomes.
Together as a team with support from my colleagues i.e., the late supervisor Dr. Janet Oola (DHO by then) and Okot Samuel Obonyo (ADHO-EH) and Ladwong Atim Mary (PNO) just to mention but a few, we decided to act on the following action points:
a. We conducted performance review meetings and made all the stakeholders (political and technical) at District and Lower Local Governments (Sub Counties/ Town Councils) and we made them to appreciate the challenges at hand and as a team we came up with resolutions such as procurement of Gas Cylinders to ensure that the immunization services are kick started in all health facilities, ensuring a 24/7 availability of ambulance service for timely referrals, we empowered the midwives to appreciate that timely referral is a treatment too which can yield good outcomes.
b. Secondly on referrals we decided together with the hospital team to have two pools for fuel. Pool 1 is for routine hospital services running and administrative activities. Pool 2 is
strictly for referrals and generators. It is imperative to note that if fuel from pool 2 is over, fuel from pool 1 could be picked but the reverse was not allowed when fuel is over from pool 1.
c. Intensive community sensitization was made, and patients/ clients were made to know the dangers of home deliveries and were encouraged to go early to health units for skilled care.
d. Another thing we did was thorough wage analysis which helped inform our decisions and we recruited The Principal Medical Officer (MS), 2 Medical Officers Special Grade (OBGY and Community Health) 4 Medical Officers. Regarding Nursing and Midwifery, we managed to fill the position of Principal Nursing Officer, Enrolled Nurses, and Midwives to 100% amongst others. In a nutshell, our staffing level rose from 56% in 2017 to 82% currently with all critical positions filled. Currently, all HC IIs have Enrolled Nurses and Midwives hence skilled care provision.
e. Overall, we did community engagements, advocacy, capacity building of staff, and periodic exit interviews to ascertain client satisfaction. All these helped improve our service delivery and for the first time between 2018 to 2021 (about 2 years), we did not register a maternal death. All these were not a oneman’s show but rather a collective effort of all the stakeholders.
f. To the family of the ADHO/MCHN, being entrusted with the responsibility as the Chairperson, it impacted me in two folds: one to lead by example and walk the talk, and second to support colleagues and be supported by my colleagues the ADHO/MCHN. Thus, it was a two-way event and the synergy built helped us to move as a team. We advocated, mobilized resources, and engaged as a team with a focus on leaving none behind. I greatly benefit from the support of my colleagues, and they build me every day.
g. To the MOH leadership, I owe them great gratitude for they are always available for us to reach them and often act in a timely manner. I cannot forget to mention some of my role models being Dr. Diana Atwine (Permanent Secretary MOH), a person of my aspiration Dr. Jane Ruth Aceng Ocero (Minister of Health), one whom daily I would love to emulate Dr. Mugahi Richard (Assistant Commissioner Reproductive and Infant Health). Finally, I owe Assoc. Prof. Dr. Rose Nanyonga Clarke who is always a source of inspiration, great respect and honor.
Challenges
Having briefly talked about the successes allows me to express some challenges we encounter with limited resources and limited involvement of nurses in decision-making in most districts and facilities across the country.
Conclusion
Colleagues, until we appreciate that each of us is gifted differently and that each and every one of us has unique and inherent excellent good abilities to impact positively in our lives and communities, then the teamwork talk of is a dream that will never come true. The bottom line let's tap into the good of each and every one of us and build synergies to improve the healthcare profession.
The Ministry of health through its initiative, National Safe Motherhood Expert Committee (NASMEC) held its second 2nd National Safe Motherhood conference from 25th to 28th October 2022 under the theme “Strengthening Health Systems, A Responsive Health workforce for Safe Motherhood, saving lives”
The goal of the conference was to assess progress and review the role of a strong health workforce in addressing the leading causes of maternal and perinatal mortality and share strategies to improve outcomes in all elements of the health workforce.
The 4 day Conference targeted national, district level and facility MNH partners, stakeholders
and implementers such as ADHOs, Regional Champions, Regional Ips, Ministries, Departments and Agencies, MoH Secretariat and Organizing committee, Hospital Directors and Human resources experts and stakeholders (Chair HSC, Commissioners HR, parliament)
selected district Chief Administrative Officers among others.
The event took place at Golf Course HotelKampala and was presided over by the Permanent Secretary for the Ministry of Health Dr Diana Atwiine as the chief guest.
National Safe motherhood awards
2. Lamwaka Mercy: Recognition of dedication to improving new-born lives in Uganda –Midwife
3. Ketty Atube Aneno from Bugiri: Midwife of the Year.
4. Acayo Innocent: Moroto RRH Adolescent Clinic: Best Performing Health Worker in ADH.
5. Katami Barbara: Moroto RRH, Adolescent Clinic: Best Performing Counsellor in ADH.
6. Rev. Nathan Mugalu Balirwana: Best community leader in ADH
7. Mirembe Sarah: Malongo HC III: Award of Recognition for Exemplary Health Service Delivery
8. Nabakawa Sarah: Mayuge District: Award of Recognition for Exemplary Health Service Delivery
In a bid to continue motivating and celebrating champions across the country who work effortlessly to ensure proper service delivery for all mothers and babies, NASMEC launched the 1st National Safe Motherhood awards and they were given to the best performers over the last year.
Think tank is happy to announce that a number of nurses and midwives were among those who were rewarded for their tireless efforts towards improving Maternal and Child Health.
The stars who were awarded include; -
1. Akong Jennifer: Recognition of dedication to improving new-born lives in Uganda –Nurse
9. Christine Abuut: Atiira HC III: Award of Recognition for Exemplary Health Service Delivery
10. Aliwayatya Florence: Kityerera HC IV: Award of Recognition for Exemplary Health Service Delivery
11. Acak Phiona Janet: Gulu RRH: Award of Recognition for Exemplary Health Service Delivery
12. Ivan Akugizibwe: Kabarole: Award of Recognition for Exemplary Health Service Delivery
13. Tuhirirwe Irene: Kabarole: Award of Recognition for Exemplary Health Service Delivery
14. Kebirungi Lilian: Kamukira HC, Kabale: Award of Recognition for Exemplary Health Service Delivery
NURSE TO NURSE GLOBAL INITIATIVE
BY DR. SCHOLA MATOVU
Nurse-to-Nurse Global Initiative (NTNGI) was founded in July 2013 by two then-nursing doctoral students from the University of California, San Francisco. NTNGI is facilitated by nurses who are driven by the desire to support the nursing community through education and professional development. Through collaborative engagement, NTNGI is committed to the development of the nursing workforce and the empowerment of nurses as leaders, clinicians, scholars, and research scientists. We aim to contribute to the advancement of the nursing profession and the well-being of patients in the global village through Practice, Scholarship, Leadership, and Research. This non-profit organization is driven by a passionate belief in utilizing grassroots efforts to foster collaboration and empowerment among nurses, allowing them to contribute to alleviating problems of global disease, lack of access to care, and poor health outcomes, particularly among vulnerable and underprivileged patient populations.
Mission: Our mission is to promote the health and dignity of marginalized patient populations by empowering and advancing the leadership and professional development of the nurses that serve them.
Vision: We envision a world in which nurses reach across boundaries to empower each other in the delivery of safe and quality nursing care. We want to ensure that all nurses have the infrastructure they need to perform patient care in a safe environment and a strong voice to advocate for their patients and for themselves. To that end, we advocate for the empowerment of nurses as critical members of the interdisciplinary health team that shapes health policy and holistic care of patients and their families.
Services
NTNGI services are geared toward training, supporting, and empowering professional nurses, nursing students, and those considering joining the nursing profession. Our offerings include but are not limited to: Professional Development and Training through individualized and portfoliobased training, annual workshops, coaching, mentoring, and leadership skill-building; and Scholarships and Awards through meritorious awards for academic achievement and
professional contribution. NTNGI also offers community education through its Wellness Clinic Program.
Significance
Nurses play a vital role in global health, and they represent the largest professional sector of the global healthcare workforce (about 45 to 60%). Yet, nursing workforce shortages and lack of education/training opportunities have had a notably negative impact on healthcare around the world. This inability to develop a sustainable workforce is influenced by other professional barriers, such as inadequate educational advancement, lack of promotion and leadership opportunities, unsafe practice environments and poorly funded healthcare systems. Global efforts need to address and solve these problems more adequately. NTNGI believes that when nurses take advantage of evidence-based education and professional development opportunities, they can provide more effective care that leads to improved health outcomes and enhanced quality of life for patients and their families all over the world. It’s against this background that NTNGI is committed to the development of workforce capacity and empowerment of nurses as leaders, scholars, and research scientists in the global community.
Collaborations
NTNGI is committed to initiating collaborative engagements in Uganda, East Africa, and other parts of the world. In the summer of 2013, it initiated the first contact with Makerere University’s Department of Nursing in Uganda. This summer workshop was one of the first steps towards NTNGI’s mission of fostering international collaborations through collegial dialogue and exchange of knowledge between nurses. Other NTNGI activities have also included annual workshops that foster interactive dialogue and skill-building exercises.
The University of Utah College of Nursing in the United States, Aga Khan University (AKU) School of Nursing and Midwifery and Clarke International University (CIU) are just a few of the other institutions with whom connections have been established and future engagement and potential
partnerships are planned to ensue. NTNGI is currently facilitating a pilot program to promote cultural humility through collaborative online transcultural education and leadership development for nursing students from the Utah College of Nursing, Aga Khan University (AKU) School of Nursing and Midwifery and NTNGI nurse members. NTNGI also offers a series -Of nursing Empowerment Talks- to nursing students, nurses and nurse leaders including the Utah Organization of Nurse Leaders, nurses of Rotary Club International-Kampala (multi-chapter event), students and staff of Clarke International University, etc. More talks are planned as NTNGI endeavours to continue building nursing capacity and foster the art of leading self, leading (with) others and leading change/organizations.
For more information on the Nurse-To-Nurse Global Initiative (NTNGI), contact Dr. Schola Matovu at schola.matovu@nurs.utah.edu or Dr. Linda Gregory at lindadphd@gmail.com or visit us at: https://nurse2nurseglobal.org
THE NURSES’ AND MIDWIVES’ MENTORSHIP PROGRAM BY LITTLE WINNIE FOUNDATION (LWF)
This is an online interventional program started and implemented under the umbrella organization of the Little Winnie Foundation (LWF) a social enterprise that provides integrated health rights education in SRHR and HIV among young girls and boys in schools.
It targets both students who are undertaking their health training and health workers already in service. It’s aimed at helping nurses and midwives to redefine their professional purpose in life, discover their passion, and purpose and turn it into profit.
Noticeably nurses and midwives tend to direct all their energy and time towards their professional skills and practice leaving out other personal life skills and activities.
This is tracked under the objectives we follow in our mentorship program in relation to the things that affect us as nurses and midwives including failure of having a work-life balance, lack of entrepreneurship skills, nurturing a positive attitude and priotization of our own personal health needs.
In this mentorship program, we work towards closing such existing gaps in life and the professional field; firstly, by making them understand and recognize these gaps in their day-today dealings and, secondly, we take them through ways to close the gaps. All this is done through our mentorship program.
We also have a sub-project for the nursing schools called –Career Guidance clinics in the nursing schools whose goal is to help students maximize their potential to gainful employment.
Additionally, on the 30th/10/22 LWF launched a campaign about “Attitude and mindset change” amongst the nurses and midwives in both the training institutions and the health facilities within the country.
This was officiated by the commissioner nursing an midwifery department at MOH. The main goal is TO REDUCE MATERNAL AND CHILD MORTALITY RATES TO IMPROVED QUALITY CARE.
THEME: NURSES AND MIDWIVES HAVING A POSITIVE ATTITUDE TO IMPROVE THE QUALITY OF CARE.
One realizes that tremendous efforts have so far been put in the health sector in terms of infrastructure and skills development, however, all these need people with the right/ positive attitude in order to deliver the best results in terms of the quality that a client deserves.
As Little Winnie Foundation, we are committed to making the right strides towards improved and quality health care provision within our jurisdictions as an NGO. It’s our greatest hope that every like-minded individual and partner joins us in this journey of transformation and impact in the healthcare system.
NURSING AND MIDWIFERY, A CENTURY OF LEARNING, GROWTH AND EVOLUTION
BY ASSOCIATE PROF. ROSE CLARKE NANYONGA. VICE CHANCELLOR, CLARKE INTERNATIONAL UNIVERSITY (Reprinted
In November this year, I was invited to deliver a talk at the Uganda Nurses and Midwives Council’s (UNMC) 100-year anniversary about the past, present, and future education of NM and implications for regulation. This was a monumental event, and as such, it was only fitting that we adopt a bidirectional lens: reflecting on the journey thus far noting candidly its highs and lows while looking to the future with hope, clarity, and purpose.
A little History: There is no doubt that NM education, regulation and practice in Uganda
have progressed at a steady pace since 1922. Our journey has not been so different from other countries in that the core of NM (from the outset) was (and to many still is) considered a calling. From this perspective, the educational preparation was kept to basic vocational training to enable basic skills for ensuring patient comfort (food, service, bathing and toileting, laundry etc.) (Bvumbwe & Mtshali 2018). In the early 1900s, many countries progressed NM learning to collegebased education which was supported by new
standards and policies. Education institutions and NM scholars focused on curricular that resulted in the mastering of skills and competencies. Significant escalation of regulation and standards of care have further driven reforms in education, regulation and practice in the 21st century.
In our context, the UNMC, recognizing that regulation is a key enabler of growth in the NM profession, has strived to keep pace with changes in the health sector that directly impact the education, training, roles, scope, and overall standards for NM practice. The initial Nurses, Midwives and Nursing Assistant Act was established in 1964. In 1996, the Act was revised to allow diversification of cadres (ULII, 1996). This critical update was subsequently followed with some reforms in the education and training of NM. However, it still took Uganda over 71 1922-1993) years to introduce baccalaureate degrees in nursing.
The present: Uganda currently sits at a cusp of opportunities and challenges in education, practice, and regulation. The country’s workforce (101,068 per UNMC data; includes 27,112 with expired licenses) is tipped to one end with the majority (70%) of NM at the Enrolled Nursing/Midwifery Certificate level, with a moderate number at diploma level (nearly 25%), and even fewer NM with baccalaureate degrees (2.3% BNS and 2.1 Bachelor of Science in Midwifery) (UNMC, 2022). Thus, while diversification in cadres has occurred, the new categories unearth complexities in defining practice standards and the scope of practice for each level. It does also raise concerns about whether the current portfolio of the workforce is what the country needs for a rapidly changing and complex health sector.
It has been 10 years since the Geneva Declaration adopted at the SIDIEF General Assembly encouraged countries to adopt the undergraduate program as the entry requirement for the nursing profession. Relatedly, the Plan for Action for scaling up nursing and midwifery education and practice for the African Region 2012-2022 also provided a framework for the World Health Organization (WHO) member states to ensure quality nursing and midwifery education and training. Perhaps it’s time to plan for the workforce with these key recommendations in mind.
Looking to the Future: As we look to the next 10, 20 or 100 years, key questions that the UNMC and other relevant stakeholders must grapple with in terms of the overall improvement of the portfolio of the nursing and midwifery workforce include:
1. What is the future of healthcare in Uganda?
2. What are the critical health needs of our communities?
3. How do we position nurses and midwives (and other healthcare providers) to meet the health needs of the country?
4. What kind of Nurse/Midwife should we have now and in the future?
5. What level of training?
6. And how do we align our regulatory tools to match these aspirations?
NM operate in an increasingly complex work environment with multiple competing priorities. Answering these questions will inform the next strategic undertaking in aligning vocational and professional cadres
and defining specific needs for education and training, regulation, and practice. And it will enable education institutions to tailor NM curricula to current and future demands placed on nurses and
midwives so that the country consistently produces a workforce fit for purpose.
Key Domains of Competencies for current and future NM include but are not limited to:
