AFRICA AND THE NURSING CRISIS

And we Need Herd Immunity

AFRICA AND THE NURSING CRISIS

The COVID 19 pandemic that has put the entire globe on its knees amidst the already existing health care challenges has posed an overwhelming demand for nurses world over. Nurses have been so pivotal in the prevention and treatment of COVID 19 patients on the ICU beds and many have also succumbed to the disease in line of duty. With the current COVID 19 pandemic and its severity in many of the high-income countries, the numbers of nurses migrating from Africa to practice in the western world is expected to exponentially grow. With many of the African countries still struggling with shocking shortages of nurses, poor working conditions, low salaries for nurses, the current trends in the global demand for nurses is set to devastate such health care systems even further because of the likely increase in the international nurse migration and mobility. According to the State of the World’s Nursing 2020 Report that was recently published by the World Health Organization and the International Council of Nurses (ICN), there is significant reliance on foreign-born nurses in high-income countries, where 15.2% of nurses were reported to be foreign born or foreign trained.

The global shortage of nurses is estimated to be 5.9 million with over 89% of this shortage concentrated in lowand middle-income countries where the growth in the number of nurses is barely keeping pace with the population growth. In many African countries, the nurse – patient ratio is several times a multiple of the WHO

recommended nurse – patient ratio of 3:1000. In a country like Uganda, the ratio stands at 1: 11,000. Such trends jeopardize the implementation of quality nursing care yet nurses play a critical role in primary health care that encompasses prevention and management of communicable and non-communicable, emergency preparedness, patient safety and delivery of integrated people-centered care.

Although African countries are striving to train more nurses, they are still challenged with the ever-growing numbers of locally trained nurses migrating to practice in higher-income countries in America and Europe that produce low numbers of nurses vis-à-vis the demand of nurses within their health care systems. Such countries have the capacity to employ and offer better and attractive pay packages to foreign nurses from low-and middleincome countries. This is further exacerbating shortages in many African countries.

As we celebrate this year’s international nurses’ day, African countries need to take keen interest in the current and future shortage in the nursing workforce and intensify efforts to bridge the gap. There is need to invest more in nursing education through increasing state sponsorship for nurses at all levels to increase the number of nurses annually produced. Of recent, there are many nursing training schools opening up thus the need for close supervision and regulation to ensure that the nurses produced have the knowledge and skills to meet the local and global health demands. Devise strategies to attract, increase recruitment and retention of locally produced nurses or else, Africa will continue training nurses for the rest of the world. Governments need to invest more in improving working conditions, increasing salaries, and creating professional development opportunities for nurses. Professional development will enable advanced practice nursing roles and quality nursing patient care. However, in a country like Uganda, specialized nurses have not been given the due attention and not allowed to practice to the full scope of their training. On the other side, many enrolled nurses in public service have individually invested in their professional growth and training to acquire diplomas or even degrees but are still recruited and serve in capacities of lower cadres. Advanced practice nurses when supported and enabled to practice to the full scope of their training and skills can greatly increase access to primary health care even in the rural and remote areas. Its time nurses participated in decision making since they play an influential role on the effectiveness of health care system. With the ever-increasing international mobility of nurses, African countries ought to establish partnerships with international regulatory bodies to monitor, govern and regulate the exportation of nurses. These will help to mitigate the excessive loss of their locally trained nursing workforce to the international labor market.

The authors are nurses based in Uganda. Lubega Martin is a BSN nurse and Author-My Pregnancy Handbook Lilian Nuwabaine Luyima is a specialized midwife (BSN, MSN-Midwifery & Women’s Health; CPD Coordinator Aga Khan University-Uganda)