Building paediatric nurse training capacity for Africa, in Africa
Authors: Minette Coetzee, Neil H McKerrow, Angela Chimwaza, Elizabeth Molyneux, Natasha North, Stephanie Sieberhagen
Journal: The Lancet Global Health (2016)

The scarcity of skilled nurses has been identified as one of the greatest obstacles to achieving an effective health-care system.1Kinfu Y The health worker shortage in Africa: are enough physicians and nurses being trained?.Bull World Health Organ. 2009; 87: 225-230Crossref PubMed Scopus (177) Google Scholar Strengthening paediatric nurse training has been recommended as a primary strategy to reduce mortality in children younger than 5 years in both South Africa2Committee on Morbidity and Mortality in Children2nd Triennial report of the Committee on Morbidity and Mortality in Children under 5 Years. National Department of Health, Pretoria2014Google Scholar and Malawi.3Global Healthcare Workforce Training Alliance task force on scaling up education and training for health workersCountry Case Study: Malawi's Emergency Human Resources Programme. World Health Organization, Geneva2007http://www.who.int/workforcealliance/knowledge/case_studies/CS_Malawi_web_En.pdfGoogle Scholar The importance of contextualised learning, in which new knowledge and skills can be swiftly applied in practice, and the benefits of aligning training with local population health needs, are both well understood. Yet historically, the education offered to paediatric nurses practising in African settings has been derived from material specific to Europe and North America. The creation of a truly sustainable paediatric nursing workforce requires careful consideration of both where and what nurses learn. In Malawi in 2010, there was no paediatric nurse training programme. A population of approximately 8 million children younger than 18 years was served by a single paediatric nurse. We used community-based participatory action research4Smith L Rosenzweig L Schmidt M Best practices on the reporting of Participatory Action Research: embracing both the forest and the trees.Couns Psychol. 2010; 38: 1115-1138Crossref Scopus (47) Google Scholar to develop, evaluate, and refine a programme to establish sustainable, locally relevant paediatric nurse training capacity in Malawi and South Africa. The initiative was a collaborative effort between education and health researchers in the University of Cape Town (UCT)'s Child Nurse Practice Development Initiative and Department of Paediatrics and Adolescent Health; Kamuzu College of Nursing (KCN) at the University of Malawi; and the Queen Elizabeth Central Hospital in Blantyre, Malawi. The intervention began with community engagement, the intention being to accurately identify the goals of the different national and institutional entities pertinent to nurse training and nursing workforce development. Stakeholders included the Nurses' Council of Malawi (responsible for professional licensing and regulation of nursing qualifications) and the Malawian Ministry of Health's Nursing and Human Resources Division (the main employer of nurses in Malawi, responsible for nursing workforce planning). Aligning the priorities of Malawi's health and education stakeholders necessitated the creation of a new Masters in Child Health programme combining clinical, academic, and leadership education. A blended programme was designed, making use of existing modules provided at KCN and UCT. A new module called Contextual Child Issues in Malawi was designed to ensure that students established a contextual profile of the sociopolitical, legal, and epidemiological context of child health in Malawi. Informed by stakeholder engagement, co-design ensured that each element of the curriculum served as a signpost to guide students along a path of clinical practice development and lead them back to the application of new knowledge and skills in their home clinical settings. This focus on contextualised learning embodied principles of quality improvement. The resulting programme has ensured that graduates receive a qualification that is compatible with national frameworks, informed by Malawi's Emergency Human Resources Training Programme3Global Healthcare Workforce Training Alliance task force on scaling up education and training for health workersCountry Case Study: Malawi's Emergency Human Resources Programme. World Health Organization, Geneva2007http://www.who.int/workforcealliance/knowledge/case_studies/CS_Malawi_web_En.pdfGoogle Scholar and the outcomes of a recent national review of the nursing curriculum. Importantly, the programme also leads to registration as a paediatric nurse with the national nursing council in Malawi. The dialogue that was facilitated between training providers, health-service employers, and both the health and education ministries was pivotal in securing this outcome. Aligning diverse stakeholder requirements is central to developing training and workforce capacity that is sustainable over the long term. Without it, programmes run the risk of educating nurses who have no clear place in their health-care systems, and may even inadvertently increase the risk of skills migration. Phased implementation has now seen 30 nurses graduate with a Masters in Child Health Nursing, involving the completion of modules in both Cape Town and Blantyre. All have returned to work at facilities in each of the Malawian health districts and are actively involved in the delivery of paediatric nurse training within Malawi, either as educators or clinical supervisors. New paediatric nurse training programmes have been designed and achieved institutional and national accreditation in Malawi, with the first students beginning their studies in January, 2016. Malawi now has the capacity to deliver complete paediatric nurse training and 50–60 nurses will graduate from these programmes annually from 2017. As UN member states revisit their strategies for decreasing infant and child mortality in the light of the Sustainable Development Goals, the question of whether existing approaches to training paediatric nurses for Africa are appropriate becomes more pressing. There is a clear need to develop training programmes for this group that are region-specific and continue to support improved outcomes for children in Africa. To be sustained, training interventions must match the characteristics, context, and priorities of the health-care system in which they are being implemented.5Buchan J Aiken L Solving nursing shortages: a common priority.J Clin Nurs. 2008; 17: 3262-3268Crossref PubMed Scopus (213) Google Scholar This is best achieved through the alignment of training programmes with educational and health policies. We declare no competing interests. The project was initiated as a result of a multi-disciplinary visit to QECH through the African Paediatric Fellowships Programme. The activities described here took place between 2009 and 2015. Funding was provided by the ELMA Foundation, awarded to and administered by the Child Nurse Practice Development Initiative (CNPDI). The CNPDI also receives financial support from the Children's Hospital Trust Foundation and the Harry Crossley Foundation. The Kamuzu School of Nursing received funding from the ELMA foundation and the Malawian Ministry of Health.