During our most recent monthly VC-Connect Leadership session, the Chair of the University Council, Bishop (Dr) Zac Niringiye, reminded us that a healthy university is one where ideas continually develop and thrive. When the well of ideas runs dry, so does our relevance and influence. He asked three crucial questions: What kind of future are we heading toward? What is our destination? What are the signals and signposts? For me, the main takeaway was that the Charter, important as a milestone, is not our destination. Treating it as such risks giving a false sense of “arrival.”

Our past accomplishments undoubtedly form part of our proud legacy. However, we must continue to demonstrate our relevance in a world driven by artificial intelligence (AI), digital transformation, evolving learner needs, and societal expectations. The world is changing rapidly, and as a university, we cannot afford to stand still. The challenge now is to adapt to change at a pace that aligns with these developments. In his article, Driving Academic Innovation: Can we apply business school change-management models to the academy, Mintz (2021) argues that higher education struggles with change partly because of cultures that prioritize tradition over innovation, and he calls on academic leaders to establish “a climate of change that values innovation and improvement regardless of tradition.” For our community, this is a crucial call to action. From a change management perspective, our key milestones should serve as launchpads for the next phase of the CIU transformation. Therefore, our leadership efforts must turn milestones into a sense of urgency, short-term wins into more substantial system change, and achievements into institutionalized practices and new norms (Mintz, 2021). We know that meaningful change is necessary and a responsibility we all share.

Students Must Change

Given the evolution of work and learning, students cannot rely on traditional, exam-centered mindsets. Data from the World Economic Forum shows that employers expect significant shifts in the skills they require, including increased emphasis on analytical thinking, technological literacy, and self-management (WEF, 2025). One key area of adaptation for students is adopting a competency mindset. Students should focus less on accumulating credits and more on demonstrable capabilities, clinical skills, data literacy, teamwork, problem-solving, ethical reasoning, and leadership. In other words, shift focus from what you know to what you can do with what you know.

The university constantly balances the written curriculum with additional learning opportunities to ensure that our students develop across all necessary domains. Second, students must not only talk about lifelong learning but also actively participate in it. Lifelong, stackable learning is like building your education with Lego blocks, one skill at a time. The shift from “degree then career” to “career with ongoing learning” means students should expect to engage with micro-credentials, short courses, and continuous upskilling. Students must also develop the discipline to be active, self-directed learners. Competency-based and blended approaches require taking responsibility for their own learning pace, setting clear learning goals, and using feedback to improve. Simply receiving information in lectures is no longer adequate. Finally, students need to develop transversal skills by prioritizing leadership and other essential soft skills (communication, adaptability, and collaboration across contexts). These are core outcomes, not “extras” (Moldoveanu & Narayandas, 2019). I encourage students to re-prioritize what and how they learn.

Faculty Must Change

Our faculty and staff must also pursue change. We recently received the Minimum Standards for Competency-Based Education (CBE) from the National Council of Higher Education (NCHE). CBE is not new at CIU, but new policies underscore the need to reevaluate current practices. CBE fundamentally alters academic work. Lieberman (2019) reports that in CBE formats, instructors shift from primarily delivering content to more frequent interaction with students, clarifying learning outcomes, and providing individualized feedback and guidance. Implications for faculty include a deliberate shift from content coverage to learning design. Teaching faculty should design clear competencies, performance criteria, and authentic assessments (e.g., OSCEs, portfolios, simulations) aligned with real-world practice. A greater emphasis on feedback and mentoring is expected in CBE formats. This moves faculty roles closer to coaching and mentoring, not just lecturing.

There is also a greater need to work in instructional teams: The “unbundled faculty” model, in which different specialists handle course design, content, facilitation, and assessment, is increasingly associated with CBE implementations (Lieberman, 2019b). This challenges traditional expectations of the solitary lecturer while improving quality and scalability. Crucially, faculty must engage in continuous professional development, including advances in pedagogy, educational technology, and learning analytics (the practice of using data to understand how students learn and to make better decisions that support their success). Moldoveanu & Narayandas’s (2019) work on leadership development notes that effective professional learning is increasingly tailored, practice-based, and continuous rather than episodic.

Notably, faculty can no longer rely on past knowledge to prepare future learners. The rapid changes in science, technology, health, and the workforce demand ongoing updates to content, teaching strategies, and assessment methods. This reality has become a key driver of change in higher education. Without this continuous evolution, institutions (including CIU) risk graduating students whose skills do not align with societal and labor-market needs. This is why we have prioritized reforms to teaching, learning, assessment, and faculty development as part of our Goal One, Year One, in the Thrive Strategic Plan 2025–2029/30.

Administrators and Academic Leaders Must Change

During our VC-Connect leadership discussion, we examined the concept of becoming the university of the future and the signals and signposts that would indicate it. Bishop Zac emphasized that leaders must adopt and operate within a new paradigm that acknowledges technological change, encourages systems thinking, and draws on multiple perspectives. Leadership behavior is a key factor in whether institutions can adapt. Eckel (2023) argues that effective leaders must (a) create time and space for strategic change, (b) rethink existing commitments, and © align processes and structures with new priorities. In this new season, the call to action for leaders cannot be overstated: CIU leaders must signal that innovation, experimentation, and evidence-based improvement are not only expected but also fully endorsed. Establishing and maintaining a climate of change and innovation must remain central to “what and how we do things at CIU.”

The goals of our Thrive Strategic Plan 2025–2029/30 (T: Excellence in Teaching and Learning; H: Holistic research, innovation, and dissemination; R: Robust partnerships and collaboration; I: Institutional strengthening and sustainability; VE: Visionary expansion and diversification) should become practical realities rather than merely aspirational documents. More importantly, leaders must confront inertia (the tendency of an object, system, person, or institution to resist change) and consistently work to change mindsets to steer the university toward a desired future. In their article The Power to Change, Michaels & Murphy (2020) argue that changeability is the “new normal” and that organizations must learn to weather change, adapt to current crises, and anticipate future waves of uncertainty. CIU leaders need to continue leading change through purpose, connection, and clear direction. These intentional steps are key to disrupting old patterns and embracing change as an opportunity.

The challenge for education leaders is to create an ecosystem that fosters growth, pushes boundaries, reimagines what excellence means in the chartered CIU, and rewrites our story. This year, we are running with PRINT — principled and intentional. Roger Federer, one of the greatest tennis players, once said: “When you are playing a point, it has to be the most important thing, and it is. But when it is behind you, it is behind you. This mindset is really crucial, because it frees you to fully commit to the next point… and the next point after that with intensity, clarity, and focus.”

# ChangeWeMust

References

1. Eckel, P. (2023). Making time for change. Inside Higher Ed. Retrieved from https://www.insidehighered.com/opinion/career-advice/2023/09/14/how-college-leaders-can-make-time-strategic-change-opinion

2. Lieberman, M. (2019). Helping Students Develop Competencies, Teachers Hone Their Own. Inside Higher Ed. Retrieved from https://www.insidehighered.com/digital-learning/article/2019/02/06/competency-based-education-requires-instructors-alter-teaching

3. Lieberman, M. (2019b). Team Players in Teaching. Inside Higher Ed. Retrieved from https://www.insidehighered.com/digital-learning/article/2019/04/24/instructional-teams-challenge-tradition-dividing-teaching-roles

4. Michaels, D., & Murphy, K. (2022). The power to change. Bain & Company. Retrieved from https://www.bain.com/insights/the-power-to-change/

5. Mintz, S. (2021) Driving Academic Innovation: Can we apply business school change-management models to the academy? Inside Higher Ed. Retrieved from https://www.insidehighered.com/blogs/higher-ed-gamma/driving-academic-innovation-0

6. Moldoveanu, M., & Narayandas, D. (2019). The Future of Leadership Development: Gaps in traditional executive education are creating room for approaches that are more tailored and democratic. Harvard Business Review. Retrieved from https://hbr.org/2019/03/the-future-of-leadership-development

World Economic Forum (2025). Future of Jobs Report 2025: The jobs of the future — and the skills you need to get them. Retrieved from https://www.weforum.org/stories/2025/01/future-of-jobs-report-2025-jobs-of-the-future-and-the-skills-you-need-to-get-them/

Clarke International University (CIU) recently honored one of our long-serving lecturers, Mrs. Wafula, who is in the process of transitioning to retirement. I was asked to write about our relationship as mentor and mentee, having been her mentee for a long time. I am posting this on my blog to inspire others who strive to mentor others.

Ten years ago, after finishing my PhD at Yale, I chose to go back to Uganda, a decision many of my mentors called “career suicide.” Their worries weren’t unfounded. I was giving up a clear career path for uncertainty, passing up better-paying jobs, and leaving behind top-notch research facilities and a strong network of mentors ready to support my career.

Uganda’s academic environment was very different from what I was used to in the United States. Resources were scarce, mentorship programs were less structured, and opportunities for career growth seemed uncertain at best. Still, I was driven by something deeper than professional convenience, a desire to meaningfully contribute to a system that needed to be rebuilt from within, not from a distance.

Soon after taking on my role at CIU, I realized many of my mentors’ warnings were true. The support systems I depended on, such as peer reviewers, writing groups, and proactive mentors who guided, critiqued, and supported me, were no longer available. I faced professional isolation and felt unsure about how to grow in this new environment. Finding colleagues with similar interests was difficult, deepening the feeling that I had entered uncharted territory.

My first day as Deputy Vice Chancellor (DVC) at CIU went smoothly but quietly. There was no welcoming committee, no formal handover; I was establishing the position as the first appointed DVC. The shift from Yale’s academic prestige to the uncertainties of university leadership in Uganda happened almost unnoticed, yet the difference was striking. With no precedent or guidance, I had to build a supportive community quickly.

During my first 100 days, I intentionally set the tone for my leadership by securing key mentors and focusing on critical issues. Among these mentors was Mrs. Elizabeth Merab Wafula, affectionately known as “Mama Wafula”, a woman of faith and a distinguished midwifery lecturer whom I had known since I was 19. Our reconnection brought me great joy, as she had seen my growth from a somewhat aimless young nurse to a successful educator, supporting me with prayers along the way.

Nevertheless, our relationship was firmly rooted in mentor and mentee. I never expected the complexity that would emerge when I suddenly became her supervisor. Our established dynamic was about to shift significantly, posing an unexpected challenge in my new leadership role.

The Awkward Role Reversal

Our first official meeting in this new dynamic was truly awkward. Although the script had changed, neither of us seemed to know our new lines. Mama Wafula kept her characteristic warm, professional smile, but I sensed we were both crossing the invisible boundary between our past and present relationships. I struggled with how to address her, finally settling on the familiar “How are you, Mama?”

The role reversal felt unexpectedly strange. As I sat across from her as the new DVC, I found myself wishing I could go back to our previous dynamic, sitting in her office with a notebook in hand, absorbing her accumulated wisdom. While I couldn’t read her thoughts, she never hurried me, never made me feel I needed to prove myself or that I didn’t belong. We both reflected on this odd turn of events: she was so much older and well-established. And I was now her supervisor. Our context in Uganda calls for a certain degree of deference for our elders.

Nothing prepares you for becoming the boss of someone who is both a legend and who once guided you as a young professional. After our meeting, I wondered how to manage such a reversal without damaging our relationship. Was it possible to lead with authority while maintaining the deference that once came so naturally? This question lingered as I navigated my new responsibilities.

Finding Mentorship in Unexpected Places

Despite the initial awkwardness, my encounters with Mama Wafula changed my expectations about mentorship in Uganda. Although the professional environment was quite different from what I knew at Yale, it wasn’t empty; just different. Mama Wafula served as an unexpected mentor who didn’t fit the usual mold I was used to in the United States. This realization pushed me to look beyond traditional sources for guidance. Slowly, I found a quiet yet strong community of local scholars, practitioners, and leaders who were equally dedicated to making a difference. Like Mama Wafula, they weren’t mentors in the traditional way, but they shared a common goal of transformation. Some were senior colleagues, while others were peers; some had formal titles, while others led by example simply through their actions.

What we lacked in formal structure, we made up for with mutual support, shared purpose, and a collective sense of responsibility to our communities. Through Mama Wafula’s example, I learned that mentorship is not only essential but also takes different forms in different settings. The mentors I desperately needed weren’t absent; they were right there in Uganda, offering guidance in ways I hadn’t initially recognized.

Mama Wafula’s Quiet Leadership

My first months at CIU brought significant change and, naturally, resistance to it. During this tough time, Mama Wafula showed her remarkable character once again. She would quietly come into my office to offer a simple greeting, a gentle reassurance that I was doing well. It was the same calming voice I had depended on years earlier, but now it reinforced my leadership. Her steady support and affirmation of my role rewired something essential in how I saw leadership and mentorship. Instead of fighting the institutional changes or my authority, she respected and strengthened both. Through her actions, she revealed a deep truth: good mentors don’t need to lead forever. The best ones gracefully step aside when it’s your turn to lead, offering encouragement just behind you. That’s precisely what Mama Wafula did for me and, I believe, for many others over her career. Her way of shifting roles taught me that proper mentorship goes beyond hierarchical roles. It’s about seeing potential, fostering growth, and having the wisdom to know when to lead and when to support others’ leadership.

Since those early days of navigating our reversed roles, I’ve stopped trying to prove I deserve my position in Mama Wafula’s presence. I’ve come to understand that I already earned my seat at the table. Now, my focus has shifted to honoring the journey that brought us both here — her decades of service and my path from student to leader — and embracing the delicate dance of leadership, which sometimes means letting go while staying present.

Through Mama Wafula’s example, I’ve learned several invaluable lessons about leadership and mentorship. First, that mentorship isn’t always presented the same way in every setting; it can be formal or informal, direct or subtle, but it’s always impactful when genuine. Second, the best mentors understand when to step back and allow those they’ve guided to grow independently. And third, leadership transitions, even when they involve role reversals, can strengthen rather than weaken relationships when approached with mutual respect.

These lessons have profoundly shaped my approach to mentoring others. I strive to create environments where guidance is offered gently, where potential is recognized and nurtured, and where changes in authority are managed with grace and respect, just as Mama Wafula exemplified in our relationship.

Honoring Mama Wafula’s Legacy

This year, we honor Mama Wafula, mentor, midwife, leader, teacher, colleague, and friend. Her influence goes far beyond her official roles at CIU. Through her quiet strength and steadfast support, she has shaped generations of healthcare professionals and leaders in Uganda, generating positive change that continues to spread throughout the healthcare system and academic community.

What makes Mama Wafula’s mentorship so remarkable is its authenticity and flexibility. She never sought recognition or praise for her guidance; instead, she offered wisdom generously, tailored her approach to meet individual needs, and celebrated others’ successes as if they were her own. When institutional roles changed and I became her supervisor, she showed the rare ability to transition smoothly, maintaining our mentorship bond while respecting new professional boundaries.

As we honor her contributions at CIU, we also pledge to uphold her legacy of authentic mentorship. In a world that often values formal credentials and structured programs, Mama Wafula reminds us that some of the most influential mentoring occurs in quiet moments of affirmation, through consistent demonstrations of values by action, and in the willingness to lead and follow as needed.

Article by: Assoc Prof. Rose Clarke Nanyonga

Vice Chancellor, Clarke International University

MIND THE GAP: BRIDGING RECOGNITION AND INVESTMENT IN NURSING

Authors: Rose Clarke Nanyonga (PhD) (Associate Prof of NLMP, Vice Chancellor, Clarke International University) and Tracey Kobukindo (Senior Manager, Last Mile Health)

Nurses are celebrated worldwide as the backbone of healthcare systems, a sentiment reflected in international campaigns, national commemorations, and recent policy discussions. This year’s International Nurses Day theme, “Our Nurses. Our Future. Caring for Nurses Strengthens Economies,” conveyed a similar message. From providing frontline care during pandemics to advocating for maternal and child health in underserved and hard-to-reach areas, nurses remain central to improving health outcomes and enhancing community well-being. Their contribution to social and economic development is equally significant, as noted in the WHO (2020) report, which highlights the economic returns and societal benefits associated with a well-supported nursing workforce. (bolded for emphasis) The implication here is that nurses can only be a backbone if they are well supported, yet, despite the well-documented value they add, there exists a troubling disconnect between the accolades they receive every year and the tangible investment in their education, jobs/employment, and leadership development. (WHO, 2020; ICN 2021).

Over the last two decades, numerous landmark reports (See Table 1) have documented the critical role of nurses in healthcare systems worldwide and made important recommendations for investing in nurses. The publications have also tracked evolving challenges, including chronic shortages, geographic maldistribution, educational standards, working conditions, and policy frameworks that shape the profession. A quick appraisal of these reveals both progress and patterns of persistent challenges (See Summary of Select Landmark Reports 2006–2025, Table 1).

Table 1: Landmark Reports on Nursing 2006–2025

But, as the adage goes, “No Health, No Wealth”: if nurses are central to our health, healthcare delivery, economic growth, and stability (as is well established in all these reports), why are countries failing to fund the systems that sustain them? The paradox is undeniable: we celebrate nurses as heroes, yet fail to match policy rhetoric with appropriate resources. Despite their contributions, nurses, although highly visible in practice, remain invisible in policy. This lack of visibility leads to the undervaluation of their contribution and persistent neglect in national health strategies. The contradiction is especially visible in LIMCs, where many governments continue to underfund nursing education and workforce strategies. The Global Strategic Directions for Nursing and Midwifery 2021–2025 (WHO, 2021) calls attention to this underinvestment, urging targeted policy action. Yet many national plans remain underfunded or poorly implemented. Even as nurses carry the weight of fragile health systems, their voices are frequently absent in policy development and budget negotiations.

The justification is most likely related to critical disparities between high-income countries and low- and middle-income countries (LMICs), which limit LMICs’ capacity to deliver on their promise. Many LMICs continue to grapple with fragile health systems, inconsistent health financing, and chronic workforce shortages, all of which hinder their ability to implement annual priority recommendations effectively. The State of the World’s Nursing Report (WHO, 2025) projects a global shortfall of 11 million nurses by 2030 and highlights a stark imbalance in workforce distribution: 78% of nurses are concentrated in high-income countries, which represent just 49% of the global population. This inequity leaves LMICs particularly exposed, not only due to insufficient staffing numbers (Africa has only 1.3 nurses per 1,000 people, far below the 3 per 1,000 thresholds needed for effective health coverage) but also due to limited capacity to translate global recognition into sustained, strategic investments where they are most needed.

All landmark reports indicate that underinvestment in nursing workforce development leads to high turnover, declining care quality, and rising long-term healthcare costs. Delays in treatment and preventable complications further strain health systems and reduce economic productivity. Addressing this requires a holistic approach that meets both professional and personal needs: fair and competitive pay, safe work environments with adequate supplies and mental health support, career advancement through education and leadership opportunities, and meaningful inclusion in policy and decision-making structures. (WHO, 2020).

Imagine waking up in a world where, for just one day, there are no nurses or midwives. No one to monitor ICU patients, administer life-saving medications, assist mothers in labor, respond to emergencies, or offer comfort to the dying and those grieving. On any given day, nurses are essential to the strength and functionality of the health system. They are a vital link, connecting patients with doctors, hospitals with communities, and preventive care with treatment (Hassmiller & Wakefield, 2022). Their absence, even for a single day, would be felt beyond hospital walls, impacting public health, economic stability, and societal well-being. This is no surprise, given that nurses represent nearly 59% of the global health workforce (WHO, 2020), reminding us that behind every health statistic stands a nurse making it possible. In many LMICs, nurses are often the primary healthcare providers, especially in rural and underserved communities. Without them, hospitals and clinics would cease operations; emergency services would be paralyzed; maternal and child health would be jeopardized; and vaccination and public health programs would stall, increasing vulnerability to disease outbreaks.

The economic consequences of a single day without nurses would be immediate and measurable. Delayed or missed care would force millions of patients and informal caregivers to miss work, leading to significant productivity losses. Healthcare costs would rise as untreated conditions escalate into emergencies requiring prolonged hospitalization. Beyond the health sector, the impact would be felt across education systems, long-term care facilities, and community health programs, all of which rely heavily on nursing professionals. In the United States, nurses contribute over $1 trillion annually to the economy (ANA, 2020). Extrapolated globally, a one-day disruption could cost billions in lost productivity and healthcare expenditures.

To yield powerful returns, countries must address the ongoing mismatch between recognizing the value of nursing and prioritizing policy actions that strengthen these professionals’ capacity to deliver (Nanyonga & Kobukindo, 2024). The consequences of even a single day without a nurse highlight the urgent need to strengthen economies by investing in and supporting the nursing workforce.

Relatedly, a critical shift is needed from treating nurses as a staff cost to long-term investment in nurses, which directly contributes to economic growth through job creation, better population health, and increased productivity (WHO, 2020). Nurses help reduce the economic burden of illness by managing disease, promoting prevention, and providing cost-effective care, resulting in improved patient outcomes, reduced mortality, and fewer readmissions. (Aiken et al., 2014; Twigg et al, 2013). In LMICs, nurse-led interventions have improved maternal outcomes, raised immunization rates, and successfully managed chronic diseases at the community level (Massimi et al., 2017; Terry et al., 2024). These interventions reduce absteeism, boost labor force participation, and mitigate poverty-related health shocks.

Moreover, nursing investment supports formal employment, particularly for women, reduces inequality, and advances gender equity, aligning with the Sustainable Development Goals (SDGs). (Bonio et al., 2019). In countries facing high youth unemployment, nursing education and deployment can provide pathways to dignified work and upward mobility, especially with the adaptation of digital learning tools and technologies. Well-supported nurses also reduce reliance on expensive hospital care by emphasizing prevention, early intervention, and health promotion, hallmarks of cost-efficient health systems (Liu et al., 2021).

Lastly, you can’t invest in what you don’t measure. In many LMICs, data on the nursing workforce is fragmented or incomplete, making it difficult to develop informed policy or budget decisions (WHO, 2020). Governments face multiple competing demands, including infrastructure, security, and debt servicing. To facilitate incremental integration of nurses into health policy design and governance, leveraging evidence and workforce data to enhance strategic investment is essential.

Caring for nurses is an investment in the future of health, equity, and economic growth. In LMICs, where resources are stretched and health burdens are significant, nurses offer an impactful, scalable solution. They are not just caregivers; they are health innovators, community leaders, and economic enablers. One day without nurses would be one day too many. Their absence would not only endanger lives but also destabilize the systems we all depend on. But the pathway to stronger health systems and more resilient economies begins with closing the gap between accolades and bold policy action and sustained investment in nurses, the backbone of health systems.

References

1. Aiken, L. H., Sloane, D. M., Bruyneel, L., Van den Heede, K., & Sermeus, W. (2014). Nurse staffing and education and hospital mortality in nine European countries: a retrospective observational study. The Lancet, 383(9931), 1824–1830.
2. American Nurses Association. (2020). Nurses: A Voice to Lead — Nursing and the Economy.
3. Boniol, M., McIsaac, M., Xu, L., Wuliji, T., Diallo, K., & Campbell, J. (2019). Gender equity in the health workforce: analysis of 104 countries (Vol. 8). Geneva: World Health Organization.
4. Frenk, J., Chen, L., Bhutta, Z. A., Cohen, J., Crisp, N., Evans, T., … & Zurayk, H. (2010). Health professionals for a new century: transforming education to strengthen health systems in an interdependent world. The lancet, 376(9756), 1923–1958.
5. Hassmiller, S. B., & Wakefield, M. K. (2022). The future of nursing 2020–2030: Charting a path to achieve health equity. Nursing Outlook, 70(6), S1-S9.
6. ICN, 2006. Global Nursing Shortage: Priority Areas for Intervention. Geneva: International Council of Nurses, 2006
7. International Council of Nurses (ICN). (2021). The Global Nursing Workforce and the COVID-19 Pandemic: Sustain and Retain in 2022 and Beyond. Available at https://www.icn.ch/resources/publications-and-reports/sustain-and-retain-2022-and-beyond
8. Liu, J.X., Goryakin, Y., Maeda, A., Bruckner, T., & Scheffler, R. (2021). Global health workforce labor market projections for 2030. Human Resources for Health, 15(11).
9. Massimi, A., De Vito, C., Brufola, I., Corsaro, A., Marzuillo, C., Migliara, G., … & Damiani, G. (2017). Are community-based nurse-led self-management support interventions effective in chronic patients? Results of a systematic review and meta-analysis. PloS one, 12(3), e0173617.
10. Nanyonga, R.C., and Kobukindo, T. (2024). The role of think tanks in framing policy and ‘knowledge regimes’; the case of Uganda Nurses and Midwives Think Tank (NMLTT). Available at https://medium.com/@nanyongaclarke/uganda-nurses-and-midwives-newsletter-issue-3-vol-2-1a48d836429e
11. Nanyonga, R.C., and Kobukindo, T. (2024). Framing the value of nursing and midwifery in healthcare systems: Challenges and opportunities. Nursing and Midwives Leaders Think-tank. Available at https://medium.com/@nanyongaclarke/reframing-the-value-of-nursing-and-midwifery-in-healthcare-systems-challenges-and-opportunities-39fce4ee0c47
12. Terry, D., Hills, D., Bradley, C., & Govan, L. (2024). Nurse‐led clinics in primary health care: A scoping review of contemporary definitions, implementation enablers and barriers and their health impact. Journal of Clinical Nursing, 33(5), 1724–1738.
13. Twigg, D., Duffield, C., Bremner, A., Rapley, P., & Finn, J. (2013). The impact of the nursing workforce on patient outcomes. Journal of Nursing Management, 21(3), 379–388.
14. WHO, 2008. Scaling up, saving lives: Task Force for Scaling Up Education and Training for Health Workers, Global Health Workforce Alliance. Available https://www.who.int/publications/m/item/scaling-up-saving-lives-2008-report
15. World Health Organisation (2025). State of the World’s Nursing Report, Geneva: WHO. Available at https://www.who.int/publications/i/item/9789240110236
16. World Health Organization (2021). Global Strategic Directions for Nursing and Midwifery 2021–2025. https://www.who.int/publications/i/item/9789240033863
17. World Health Organization. (2006). The World Health Report 2006: Working Together for Health. World Health Organization. Available https://www.who.int/publications/i/item/9241563176
18. World Health Organization. (2020). State of the World’s Nursing Report: Investing in education, jobs, and leadership. Geneva: WHO. Available at https://www.who.int/publications/i/item/9789240003279
19. Zuzelo, P. R. (2019). Nursing Now: Unleashing the Power of the Triple Impact: Report. Holistic nursing practice, 33(1), 66–67.

Authors

Dr. Rose Clarke Nanyonga is an Associate Professor of Nursing Leadership, Management, and Policy and Vice-Chancellor at Clarke International University

Ms. Tracy Kobukindo Kamau is a Nurse & Public Health Specialist serving as Senior Manager of Education at Last Mile Health, where she supports efforts to strengthen the health system through the training of Frontline Health Workers, Community Health Workers, and Health System Leaders in Africa & Globally.

Article originally published in the Uganda Nurses and Midwives Leaders Thinktank Newsletter Issue 8 Vol. 2 June 2025

By Nanyonga, R.C., and Kobukindo, T.K

Not too long ago, we celebrated the International Day of the Midwife and the Nurse (IDM and IDN), significant occasions that highlight the indispensable roles of nursing and midwifery professionals in healthcare systems worldwide. The two international days serve as important reminders to prioritize the support and recognition of nurses and midwives (NM) within comprehensive health system strengthening strategies on a global scale.

But how do we amplify advocacy when the value of nursing and midwifery care is not routinely accounted for or documented in some basic instruments such as hospital bills? I believe a pivotal aspect demanding NM leaders’ attention is the need to reframe the value of NM from an economic dimension (Dick et al., 2017) which requires the effective capture of the value of nursing and midwifery care through the appropriate costing of nursing and midwifery activities. This entails developing systems that allow organizations to not only track how NM contributes to patients’ recovery and improves prognosis but also quantify and allocate appropriate financial resources in acknowledgment of their education, experience, expertise, and organizational and societal contributions.

In this article, we argue that by accurately capturing nursing activities, organizations can gain insights into the diverse areas where nurses and midwives excel, including activities related to acquiring, deploying, and maintaining resources; activities related to transforming resources into services, and activities related to producing changes in patient conditions and impacting health and organizational outcomes (Dubois et al., 2013).

This data-driven approach not only illuminates nursing and midwifery impact but also provides a foundation for enhancing remuneration packages that reflect their level of skill, dedication, and positive influence on healthcare outcomes. Furthermore, prioritizing the appropriate cost of nursing activities fosters a culture of continuous improvement, encouraging ongoing enhancements in healthcare delivery and outcomes (Keepnews, 2011). It encourages investments in professional growth, advanced education, and innovative approaches, which are advantageous for patients, healthcare institutions, and the broader society.

Nonetheless, it’s crucial to heed the wisdom shared by Keepnews (2011, p. 3) over a decade ago, emphasizing that while recognizing nursing’s economic worth is important, it should not overshadow the core human values integral to nursing such as caring, compassion, respect, advocacy, and social justice. Put differently, our push to quantify the economic worth of NM activities should not minimize the fundamental values of empathy, care, and compassion inherent in these professions. As we celebrate these important occasions, it remains crucial to acknowledge the pivotal role that nurses and midwives play in shaping efficient healthcare systems and to adopt strategies that uphold and reinforce their indispensable contributions (WHO, 2022).

As noted, one way to capture nursing and midwifery care activities is through quality care metrics and billing. Hospital billing and reimbursement policies often reflect priorities and valuations, including Human Resources for Health (HRH). During a recent visit to a sick friend, one of us naturally found herself examining the hospital bill and was struck by the stark contrast in value allocation across billable items. For context, the itemized bill included 58 charges ranging from syringes, infusion sets, medication, theater fees, anesthetist fees, admission fees, hospital room charges, nursing care, procedure fees, and surgeons’ fees. Nursing care was charged at just 15,000/- per day (around $4 for 24 hours). In contrast, the overnight admission (room) was billed at 200,000/($55), anesthetist fees for a major procedure at 800,000/−($218), and the Surgeons’ fee at 1,500,000/- ($409).

After reviewing several other hospital bills from different city hospitals, we found that the highest charge for 24-hour nursing care was 100,000/- ($27). While there is no intention to advocate for hospitals to increase their prices to reflect the value added by nurses, this discrepancy prompted reflection on the complex value distribution in our healthcare systems. If these bills are any indication, it becomes apparent that the true value added by nursing care is significantly undervalued. Nursing care encompasses a range of responsibilities beyond tasks, such as symptom recognition, safe medication administration, fall prevention, symptom alleviation, first aid administration, bedside care including safe practices to prevent bedsores and secondary infections for long-stay patients, counseling, referrals, and collaboration with healthcare teams. Nurses serve as frontline advocates, meeting patients’ physical, emotional, and psychological needs. Recognizing nurses’ crucial role in patient outcomes and healthcare quality, hospital billing policies should accurately reflect the value of nursing care through fair compensation and resource allocation. Revisiting value distributions can also lead to more equitable practices and a culture of appreciation for nursing professionals’ expertise and impact (Keepnews, 2011).

Following the examination of the hospital bills, we discussed them with other nonmedical colleagues and asked what they thought of the perceived value of different items based on their prices. They all emphasized the high value of the doctors, and the room, followed by services like x-rays, lab tests, medications et cetera, placing nursing care at the bottom of the pile. This highlights a prevalent mindset favoring tangible, costly items over essential but intangible services like nursing care. It raises concerns about the eventual disconnect between recognizing the indispensable role of nurses and midwives and potentially undervaluing their contributions in practice. Given that this was a somewhat high-level facility, we wonder if the response would have been different in a lower-level facility, where the rooms were basic, x-ray machines were unavailable, access to hospital sundries was nothing short of a miracle, and the only available service is nursing care, would nurses be more valued and appreciated then?

Even though nurses and midwives spend the most time with patients, organizations often overlook the revenue-generating potential of nursing care, viewing it as a liability rather than an asset. This mindset leads to disparities in how nurses are valued and compensated compared to other healthcare professionals. Subsequently, nurse leaders encounter challenges in advocating for fair pay and securing investments in and for nursing and midwifery. The traditional categorization of nursing care costs as fixed hospital overheads, for example, hinders the recognition of their true value. Similarly, health systems face challenges in correlating their established and growing quality care metrics in nursing and midwifery with both direct and indirect nursing care expenses. This situation inadvertently impacts workforce morale and complicates compensation negotiations.

Indeed, research demonstrates that traditional approaches fail to capture the value of nursing care in terms of:

Intangible Value: As noted, nursing care encompasses a range of responsibilities beyond direct patient care, including advocacy, education, and coordination of care. These aspects of nursing contribute immensely to patient outcomes and satisfaction but are often overlooked or undervalued when captured as fixed overhead costs.

Complexity of Nursing Work: Nursing work is multifaceted and dynamic, involving varying levels of intensity and complexity depending on patient acuity and care needs. Using simplistic metrics like hours per patient per day may fail to capture the nuanced nature of nursing care delivery.

Impact on Workforce Morale: When contributions are not properly recognized and valued, it can lead to frustration, burnout, and disengagement, ultimately affecting the quality of patient care. In many hospitals in Kampala, Uganda, for example, an expectant woman will typically see both a nurse/midwife and a gynecologist during each antenatal visit, and during delivery, both professionals are present. While the attending gynecologist receives a fixed fee of UGX 1,000,000, regardless of the outcome, nurses and midwives are not compensated based on their contribution but must rely on their regular salary. In contrast, other healthcare cadres receive payments based on the number of patients they attend to. This disparity in compensation contributes to feelings of underappreciation and impacts morale.

Negotiation and Advocacy: Without clear recognition of the true cost and value of nursing care, nurses have limited leverage when negotiating for competitive pay, benefits, and improved working conditions. As a result, many nurses in Uganda are forced to take on 2 to 3 jobs at different health centers just to make ends meet.

To address these challenges and foster a more equitable and sustainable approach, healthcare organizations must shift towards recognizing nursing as a profit center rather than just a cost center. This involves:

1. Implementing robust systems for capturing the full scope of nursing activities and outcomes, including both direct and indirect contributions to patient care and organizational success.
2. Engaging nurses and nurse leaders in decision-making processes related to resource allocation, staffing models, and performance metrics.
3. Investing in technologies and data analytics that enable accurate measurement and evaluation of nursing productivity, efficiency, and impact on outcomes.
4. Advocating for policies and practices that ensure fair compensation, professional development opportunities, and recognition of nursing expertise and contributions within the healthcare ecosystem.

As healthcare delivery evolves to prioritize team-based care, wellness, population health, care coordination, patient-centeredness, data analytics, and quality improvement, nurses are primed to drive and spearhead these transformative changes through various nurse-led services and interventions. (Salmond and Echevarria, 2017). Relatedly, as we continue to celebrate nurses and midwives globally, “mere accolades may not suffice” if there’s a systemic gap between recognition and tangible support, especially in resource-limited settings like Uganda. There’s a need for intentional actionable changes including revisiting remuneration policies, investing in professional development, improving working conditions, and fostering a culture of appreciation to truly elevate the status and compensation of nurses and midwives in healthcare systems. Our advocacy narratives must strive to make a compelling investment case for nurses and midwives to address these disparities and shift the paradigm toward recognizing their true value.

1. Dick, T.K., Patrician, P.A., & Loan, L.A. (2017). The Value of Nursing Care: A Concept Analysis. Nursing Forum, 52, 357–365.
2. Keepnews, D. M. (2011). Mapping the economic value of nursing. Commissioned by the WSNA Professional Nursing & Health Care Council Washington State Nurses Association, 6. Available at: https://cdn.wsna.org/assets/entry-assets/3215/economic-value-of-nursing-white-paper.pdf
3. Brownie, S.M. (2018), The economic impact of nursing. J Clin Nurs, 27: 3825–3826. https://doi.org/10.1111/jocn.14182 Available at: https://onlinelibrary.wiley.com/doi/epdf/10.1111/jocn.14182
4. Salmond, S. W., & Echevarria, M. (2017). Healthcare transformation and changing roles for nursing. Orthopaedic Nursing, 36(1), 12–25. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266427/
5. Institute of Medicine. (2011). The Future of Nursing: Leading Change, Advancing Health. National Academies Press.
6. World Health Organization. (2022). The nursing and midwifery workforce in the African Region: optimizing and accelerating investments for resilient health systems: a regional technical report. Available at: https://www.afro.who.int/publications/nursing-and-midwifery-workforce-african-regionoptimizing-and-accelerating-investments
7. Clarke, I. (2019). Nursing Care Value: A Paradigm Shift in Healthcare Economics. Journal of Nursing Management, 27(5), 1063–1072
8. Institute for Healthcare Improvement. (2022). Nursing as a Profit Center: A Business Case for Investment in Nursing. IHI White Paper.
9. Dubois, C. A., D’Amour, D., Pomey, M. P., Girard, F., & Brault, I. (2013). Conceptualizing performance of nursing care as a prerequisite for better measurement: a systematic and interpretive review. BMC Nursing, 12, 1–20. Available at: https://link.springer.com/article/10.1186/1472-6955-12-7
10. Lancet (2020). Unleashing the full potential of nursing. Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)32794-1/fulltext

Authors

Dr. Rose Clarke Nanyonga is an Associate Professor of Nursing Leadership, Management, and Policy and Vice-Chancellor at Clarke International University

Ms. Tracy Kobukindo Kamau is a Nurse & Public Health Specialist serving as Senior Manager of Education at Last Mile Health, where she supports efforts to strengthen the health system through the training of Frontline Health Workers, Community Health Workers, and Health System Leaders in Africa & Globally.

In April, we received a letter from the National Council of Higher Education (NCHE) recommending Clarke International University to the Minister for the grant of a Charter. To say that we were elated is an understatement. One buzzword that had been part of our discussions at the start of the new year was “thrive”. With the letter from NCHE, thriving took center stage in the ensuing interactions with faculty and students. We recognize that this year marks a transformative chapter in the journey of Clarke International University (CIU) as we look forward to new opportunities while also embracing the empowering theme of “iThrive.” This initiative is more than a slogan; it is a commitment to fostering an environment where every member of our university community — students, faculty, and staff — can flourish. In a rapidly evolving world, thriving is not just about survival; it’s about excelling, innovating, and leading.

Higher education institutions play a pivotal role in shaping future leaders, innovators, and change-makers. For CIU to fulfill its mission of developing students for global leadership to be catalysts for transformation, and to progress in a new world of work, we must cultivate an ecosystem that supports growth at all levels. Thriving means staying ahead of educational trends, embracing innovation, and nurturing the potential within our community. It ensures we remain competitive, relevant, and capable of providing an exceptional educational experience that prepares our students for the challenges of an old and a new world.

What will iThrive look like this year?

Enriching Student Experiences

To thrive, our students need to personalize their learning journey. While faculty strive to implement learning schedules and plans that cater to individual student strengths and career aspirations, large classrooms often undermine these efforts. We want to encourage students and faculty to leverage emerging adaptive learning technologies that can enable customized resources and support, ensuring students receive the mentoring support they need while also taking ownership of their educational and leadership journeys.

We recognize that learning extends beyond the classroom. This year, the university will expand its range of extracurricular programs, including monthly leadership series with outstanding leaders (#LIT), clubs, sports, and volunteer opportunities, to foster holistic student development. We encourage students to fully participate in these activities which are designed to complement our curriculum and to help students build soft (transferrable job) skills including adaptability, problem-solving, teamwork & collaboration, time management & organization, emotional intelligence, and communication…et cetera.

Understanding the pressures students face, the university has introduced comprehensive wellness programs that address mental health, stress management, and physical well-being. This includes counseling services, wellness workshops, and fitness initiatives to ensure our students and staff are healthy and resilient.

Enhancing Teaching and Learning Strategies

In terms of teaching and learning, the university will continue to expand our capacity for innovative pedagogy that promotes active and experiential learning as well as critical thinking — essential skills in the modern workforce. This year our new partnerships with universities in Greece, Estonia, and Eastern Finland will bolster our international academic corporation and will enhance our collaborative online international learning (COIL).

Importantly, in pursuit of a comprehensive and continued Integration of Technology in Education (ITE), we hope to continue investing in advanced educational technologies, including virtual labs and interactive platforms to enrich our teaching and learning experience. This integration allows for more engaging, practical, and accessible education for all students.

Relatedly, the implementation of the student information system is well underway. By digitizing administrative processes, we can improve efficiency, reduce paper usage, streamline and expand ease of access to resources and tools needed for learning and information management, enable collaborative decision-making, and allocate resources more effectively. This includes online registration systems, digital libraries, and virtual learning and meeting platforms. To benefit fully from these systems, we must all engage in change management necessary to ensure their successful adoption.

To keep our programs and teaching relevant, the Quality Assurance Office has established regular program and curriculum review processes involving students, industry experts, and alumni feedback. This ensures that our courses meet current market demands and equip students with up-to-date knowledge and skills. Mid-semester evaluations will allow us to address emerging concerns students and faculty may have and will contribute to a more satisfying experience at CIU. We want to encourage students and faculty to fully participate in these activities to enable evidence-based amendments where necessary.

Our staff and faculty are the backbone of our institution. This year, we are committed to fostering a culture of mentorship by pairing seasoned educators with newer faculty members. Additionally, we will encourage interdisciplinary collaboration to promote diverse perspectives and innovative solutions in teaching, research, and community service.

Amplifying Campuswide Engagement

As noted, at the start of this year, we established 10 Thrive Pods made up of staff and students. Each Pod is led by enthusiastic champions. Key areas to champion include (1) Research Supervision; (2) Alumni Engagement Activities; (3) Awareness, Dissemination, and Adoption of University Policies; (4) Strategic Partnership and Collaboration; (5) Events Management; (6) Internships and Placements; (7) Infrastructure Improvements; (8) Campus Facilities; (9) Curriculum Development; and (10) Strategic Planning. We hope that through the intentional engagement of these pods, our overall CIU experience will be greatly enriched. This also demonstrates the collective and continued commitment of the university to engage and empower faculty to participate in impactful and shared governance

Embrace iThrive

Clearly, the “iThrive” initiative embodies a comprehensive approach to elevating Clarke International University to new heights of excellence. By enriching student experiences, enhancing our teaching and learning strategies, and amplifying campus-wide engagement, we are laying the foundation for a thriving community. Together, we can cultivate an environment where everyone at CIU not only succeeds but excels — empowering our students, inspiring our faculty, and solidifying our institution’s legacy of excellence

Join us in embracing the #iThrive Spirit

iThrive: Cultivating Excellence at Clarke International University was originally published in CIU Magazine on Medium, where people are continuing the conversation by highlighting and responding to this story.

In recent years, Sub-Saharan Africa (SSA), including Uganda, has witnessed a remarkable surge in the number of nurses and midwives achieving the pinnacle of academic achievement — a Doctor of Philosophy (PhD). This transformative shift carries profound implications for the future of healthcare professions, the robustness of health systems, advancements in nursing scholarship and science, as well as the overall well-being of nations like Uganda. In our previous editorial published in Issue 2, Vol 2, April 2023, we spotlighted the achievement of two colleagues and reported 18 nurses and midwives who had earned PhDs. We also shed light on the challenges they encounter related to finding good mentors and adequate funding for program completion. In this current issue, we delve into the potential future paths and advantages of fully integrating these highly qualified professionals into the healthcare system. Between 2000 to-date, there are over 38 nurses and midwives in Uganda who hold PhDs from various Universities across the globe with doctoral studies in advanced nursing and midwifery science, research, leadership & policy, and clinical practice. This is an updated list following the previously reported 18 (The Nurses and Midwives Leaders Think Tank, Uganda, will continue to update the database).

Elevating the Nursing and Midwifery Professions:

The future trajectory of the nursing and midwifery professions will rely significantly on the pivotal role played by PhD-prepared nurses and midwives. A Doctor of Philosophy (PhD) signifies a dedication to philosophical inquiry and scholarly rigor, representing the highest academic achievement across all fields of study. These professionals serve as the driving force behind the integration of cutting-edge research findings into clinical practice, policy formulation, and implementation. In the face of evolving healthcare landscapes characterized by aging populations, a surge in chronic conditions, (as is the case in Uganda), and persistent staff shortages, the expertise of PhD-prepared nurses and midwives becomes indispensable. Their research endeavors will not only enhance the quality of patient care but also contribute extensively to the development of evidence-based workforce and clinical practice policies that will shape the direction of healthcare delivery systems. (AACN, 2016) As the healthcare sector continues to navigate complexities and challenges, the knowledge, skills, and leadership of PhD-prepared professionals will remain instrumental in driving innovation, improving patient outcomes, strengthening the education of nurse and midwife scientists, and advancing the overall effectiveness and sustainability of nursing and midwifery. (Cashion et al., 2019)

According to van McNelis et al., (2019), the infusion of advanced education brings with it a new era of leadership and influence within the nursing and midwifery professions, while their scarcity poses a significant hurdle in the progression of the professions, impacting both the education and the delivery of care. There is a pressing need for an increased number of PhD-prepared nurses and midwives to lay the scientific groundwork for the disciplines and to facilitate the expansion of nursing and midwifery education programs to accommodate new cultures of learning and practice, innovations, and the changing demographics of new students. (Cashion et al., 2019) This shortage not only affects the depth of research and knowledge generation within the fields but also limits the capacity to train the next generation of nursing and midwifery professionals adequately. Addressing this scarcity is crucial for the sustainable growth and advancement of nursing and midwifery as robust and impactful disciplines.

Strengthening Health Systems:

Nurses, constituting about half of the global health workforce, serve as the primary access point for nearly 90% of healthcare consumers worldwide. Bvumbwe and Mtshali (2018) In every health system, they are widely acknowledged as the backbone. Attaining ambitious health objectives such as Universal Health Coverage (UHC), the Sustainable Development Goals (SDGs), and the emerging One Health (OH) concept necessitates maximizing their involvement at all levels of the healthcare system. (WHO, 2021; Mendes et al., 2020; iAHO-HWF, 2023; MoH, 2020) Despite their essential roles, nurses and midwives continue to encounter challenges, including inadequate representation in high-level policy decision-making positions, leadership, and governance (Bvumbwe and Mtshali, 2018).

More acutely, barriers related to regulation, leadership, education, and practice for nursing and midwifery professionals have led to a devaluation of their worth, relegating them to a frequently low social status. The Plan of Action for Scaling up Quality Nursing and Midwifery Education and Practice for the African Region 2012–2022 provided a framework for the transformative and scale-up of health professions education for Sub-Saharan Africa. In their integrative review examining “Nursing education challenges and solutions in Sub-Saharan Africa” Bvumbwe and Mtshali (2018) report six critical themes that emerged: curriculum reforms, profession regulation, transformative teaching strategies, collaboration and partnership, capacity building, and infrastructure and resources. This underscores the critical role of PhD-prepared nurses and midwives. Their integration into the healthcare workforce strategies for the Sub-Saharan African countries would benefit not just the professions but also the healthcare systems immensely as they will strengthen the capacity to address ongoing challenges. Their advanced knowledge and skills, obtained in most cases from other continents, can not only create pathways for their inclusion in critical policy decisions but also contribute to more effective patient care interventions, thereby improving health outcomes for all. PhD-prepared nurses and midwives have a proven ability to implement evidence-based practices based on the clinical needs of the nation. (Dagne and Beshah, 2021) The result is a practice that is not only evidence-based but forward-thinking and responsive to evolving healthcare needs. The diversification of expertise within this healthcare workforce augurs well for health systems’ overall resilience and adaptability.

Fostering Nursing Scholarship and Science:

A core impact area for these cadres is the acceleration of nursing scholarship and scientific inquiry. (Dagne and Beshah, 2021) With the capacity to conduct rigorous research, these professionals can delve into healthcare challenges unique to their contexts and regions. This has the potential to give rise to a body of knowledge that is not only relevant, informs practice but also contributes to the global advancement of nursing and midwifery care. Additionally, nurses and midwives with PhDs play a crucial role in building research capacity through mentoring and supervising others, fostering a culture of inquiry and evidence-based practice. This type of research can lead to innovative solutions, improved patient outcomes, and a better understanding of health disparities.

Policy Development and Advocacy:

Nurses and midwives with PhDs are often at the forefront of leadership positions within healthcare institutions, academic settings, and policymaking bodies. Their input and influence can shape policies, guidelines, and strategies to improve healthcare delivery, especially in areas such as maternal and child health, infectious diseases, and non-communicable diseases. In addition, with their advanced knowledge and research findings, they can actively participate in the development of healthcare policies and guidelines. (Costa Mendes et al., 2020) They advocate for policies that prioritize public health, equity, and access to essential services. Their input helps shape policies that are evidence-based and responsive to the needs of underserved populations. (Cashion et al., 2019)

Enhancing Absorption and Relevance

It’s crucial to recognize that PhD-prepared nurses and midwives encounter notable challenges concerning their practice, role acceptance, research funding, administrative support, reimbursements, and career advancement (Negarandeh and Khoshkesht (2022). To recognize and optimize the contributions of these professionals in countries like Uganda, it is imperative to establish an environment that fully utilizes and values their expertise. This involves creating supportive cultures and robust structures that elevate the roles of nursing and midwifery professionals: (van Dongen et al., 2022; WHO, 2020).

1. Policy Frameworks: Implementing policies recognizing the value of advanced nursing and midwifery roles is essential. Governments should develop clear guidelines for the integration of PhD-prepared nurses and midwives into healthcare systems, outlining their responsibilities, scope of practice, and career pathways.
2. Professional Recognition: Establishing professional recognition programs and incentives can motivate nurses and midwives to pursue PhD education. Recognition through awards, promotions, and leadership opportunities can encourage others to advance their education and contribute to the field.
3. Research Funding: Governments and institutions should allocate funding specifically for nursing and midwifery research. This includes grants, scholarships, and fellowships to support PhD candidates in conducting research that addresses local health challenges and informs evidence-based practice.
4. Career Development: Creating clear career progression pathways for PhD-prepared nurses and midwives is crucial. This includes opportunities for academic positions, research leadership roles, policy advisory positions, and clinical specialization.
5. Collaborative Partnerships: Encouraging collaborations between nursing and midwifery professionals, healthcare institutions, universities, and research organizations can enhance knowledge exchange and research dissemination. Collaborations also facilitate interdisciplinary approaches to healthcare challenges.
6. Continuing Education: Providing continuous learning opportunities, such as workshops, seminars, and conferences, ensures that PhD-prepared nurses and midwives stay updated with the latest advancements in their fields. This also fosters a culture of lifelong learning and professional development.
7. Leadership Training: Offering leadership development programs equips PhD-prepared nurses and midwives with the skills to lead teams, manage projects, and advocate for policy changes. Leadership training empowers them to drive innovation and influence healthcare decisions.
8. Public Awareness Campaigns: Educating the public about the roles and contributions of nurses and midwives with PhDs can change perceptions and promote respect for their expertise. This includes media campaigns, community engagements, and public lectures.
9. Mentorship Programs: Establishing mentorship programs pairs experienced PhD-prepared nurses and midwives with early-career professionals. Mentorship fosters career guidance, skill development, and knowledge sharing, creating a supportive network within the profession.
10. Quality Improvement Initiatives: Encouraging PhD-prepared nurses and midwives to lead quality improvement projects enhances patient care outcomes. These initiatives focus on evidence-based practices, patient safety, and healthcare efficiency.

By implementing these strategies, Uganda and other countries can harness the full potential of nurses and midwives with PhDs. This not only improves healthcare delivery but also elevates the status of the nursing and midwifery professions, ultimately benefiting the health and well-being of their populations.

In conclusion, the growing number of nurses and midwives attaining PhDs in Uganda and other Sub-Saharan African countries is a harbinger of positive change. It represents a shift towards a more dynamic, knowledgeable, and influential nursing and midwifery workforce. As these professionals continue to make their mark, the ripple effects will be felt across health systems, scholarly endeavors, scientific advancements, and, most importantly, in the quality of care provided to communities throughout the region. However, this requires the intentional integration of their roles, skills, and expertise within healthcare systems.

References

1. AACN (2016). Advancing Healthcare Transformation: A New Era for Academic Nursing. Retrieved March 30th from https://www.aacnnursing.org/Portals/42/Publications/AACN-New-Era-Report.pdf
2. Cashion, A. K. , Dickson, V. V. , & Gough, L. L. (2019). The value and importance of PhD Nurse Scientists. Journal of Nursing Scholarship, 51(6), 611–613. https://doi.org/10.1111/jnu.12525
3. McNelis, A. M. , Dreifuerst, K. T. , & Schwindt, R. (2019). Doctoral education and preparation for nursing faculty roles. Nurse Education, 44(4), 202–206. 10.1097/NNE.0000000000000597
4. Global Strategic Directions for Nursing and Midwifery. WHO. 2021. Retrieved March 30th 2024, from: https://www.who.int/publications/i/item/9789240033863
5. Bvumbwe, T., and Mtshali, N. (2018) Nursing education challenges and solutions in Sub-Saharan Africa: an integrative review. BMC Nurs 17, 3. https://doi.org/10.1186/s12912-018-0272-4
6. WHO (2021). One Health. Retrieved March 29th, 2024, from https://www.who.int/healthtopics/one-health#tab=tab_1
7. iAHO-HWF (2023). Nursing and midwifery workforce: a key component in achieving UHC. Retrieved 13th March 2024 from: iAHO_HWF_regional_Factsheet.pdf (who.int)
8. Ministry of Health, Uganda Health Sector Development plan 2015/16–2019/20 Assessed via Https://Www.Health.Go.Ug/Cause/MinistryOf-Health-Strategic-Plan-2020-21-2024-25/
9. Dagne, A. H., & Beshah, M. H. (2021). Implementation of evidence-based practice: The experience of nurses and midwives. Plos one, 16(8). https://doi.org/10.1371/journal.pone.0256600
10. Mendes, I.A.C., Ventura, C.A.A., Silva, Í.R. et al. Alignment and contribution of nursing doctoral programs to achieve sustainable development goals. Hum Resour Health 18, 86 (2020).
11. Van Dongen LJC, Hafsteinsdóttir TB. (2022) Leadership of PhD-prepared nurses working in hospitals and its influence on career development: A qualitative study. J Clin Nurs. 2022 Dec;31(23–24):34143427. doi: 10.1111/jocn.16168.
12. Negarandeh, R., & Khoshkesht, S. (2022). Expected roles of PhD graduated nurses: a scoping review. Florence Nightingale journal of nursing, 30(2), 202. https://doi.org/10.54614%2FFNJN.2022.21233
13. WHO (2020). State of the World’s Nursing Report. WHO. 2020. https://www.who.int/publications/i/item/9789240003279

All I want for Christmas is some Emotional PPE! No, not some. Loads of it. The Pastor of the Worship Harvest Church in Naalya, often says that Church begins on Monday and Sunday is garage time. It made me reflect on what this Christmas season ought to be about — getting fixed! I do not know a single friend, family member, colleague, or even a stranger who isn’t in desperate need of renewal. At the time of writing this article (December 23rd) nearly 77 million total cases of COVID-19 had been reported around the world., 43 million had recovered and 1.7 million deaths had been registered. Here at home, the tally is at 31+thousand cases; 10+ thousand recovered, and 230+ deaths have been reported. Among the reported cases in Uganda, a little over 1000 are nurses and clinical officers (see Health in Africa Dec. 13, 2020). On October 28th, the International Council of Nursing (ICN) reported at least 1500 nurses from 44 countries had died of Covid-19. With the total number of health workers COVID-19 fatalities estimated at more than 20,000 (ICN, 2020).

But the major impact of Covid-19 is not seen or felt just in numbers, it is the degree to which our lives are inextricably affected. I recently asked people to describe the year 2020 for me in one word or a sentence. The answers were not surprising and represented a collective mix: from hope to despair. Grief to opportunity. Here are a few ways of how people described it:

“It has been a twisted year”

“A year of grief and despair, and of lockdowns and loneliness.”

“I see no end in sight… it’s quite hopeless”.

“It has been a year of weeping”

“It has been physically, mentally, and psychologically exhausting”

“Catastrophic”

“Apocalyptic”

“Unprecedented”

“It has been a very, very, dark year”

“Simply depressing”

“Traumatic”

Other people described the year in more positive terms:

“It has been hard, but there are opportunities as well”, one person said.

“I feel extremely clean” (referring to all the handwashing and sanitizing).

“We are discovering what we can achieve with technology. I think that is good”

“It brought nurses and midwives together in a way that has never happened before”

“I hope for a vaccine”

“We need renewal; and you know, for once, it feels as though we are all the same — this disease does not discriminate”

“We are resilient, we will overcome this” … et cetera.

So, I used some of these words to create a graphic named “A Twisted Year” and in that creative process, I zeroed in on Resilience and Renewal.

Over the last nine months, nurses, midwives, and other healthcare providers have shown up to work every day. They have pushed back against fear, trauma, depression, exhaustion, and lack of safety and resources. They have demonstrated an admirable collective strength and solidarity. They have mobilized communities towards preventive practices, kept hope alive for many families who couldn’t get to their COVID-19 isolated patients, cried with colleagues who were dying, delivered healthy babies, and sent home many other patients with positive health outcomes. If this isn’t the hallmark of resilience, I don’t know what else is.

Emotional PPE is a Survival Toolkit for All

Psychologists define resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress — such as family and relationship problems, serious health problems, or workplace and financial stressors…That’s the role of resilience” (APA, 2020). This is not to say the resilient individual will not experience extreme grief, pain, and despair. But building resilience requires intentional practices or disciplines that renew, restore, and rejuvenate our physical, psychosocial, and mental health well-being. This may be a challenge for busy people and nurses, midwives and doctors are the worst culprits when it comes to prioritizing their wellness. Most of their work is driven by purpose, passion, and often a grand goal of saving the world one patient at a time. But let’s be honest: you simply won’t be able to save anyone if you ignore the principal disciplines of rest and renewal. One thing is true for sure, our mental reservoir of strength (and resilience) is not an endless fountain from which we can dip again and again without the necessary refills.

The pandemic has taken its toll and both our bodies and minds “keep the score” (I recommend Van Der Kolk’s, book (2015): The Body Keeps the Score: Brain, Mind and Body in the Healing of Trauma) of all the stress, trauma, anxieties, uncertainties and fatalities we encounter and therefore must endure. This holiday season do not just endure. Healthcare providers need more than medical supplies, they need “Emotional PPE” and taking active steps towards rebuilding and sustaining your resilience is one way to foster emotional wellness and ultimately a healthy workforce.

Look for Bucket Fillers

Active steps require mindfulness and intentionality. The internet is full of advice of what healthcare providers need to do to sustain their mental health wellness. We have had more than our share of webinars on this. And yet, it is so easy for us to go through these emotions, attend every webinar, listen to podcasts, read every WhatsApp message, and “hang out” with people without really getting what we need from those encounters. This means we need to intentionally connect with others who add value; or seek only those events that are lifegiving. And it wouldn’t hurt to pace our social media/WhatsApp encounters and instead identify persons or events that trigger joy, happiness, relaxation, and stress relief.

The “Bucket Man” Merrill Lundgren popularized the idea that people carry invisible buckets (also referred to by Covey as emotional bank accounts). According to Lundgren, a bucket filler is an individual who fills the buckets of others with kindness, empathy, love, and consideration; while a bucket dipper is an individual or event that empties our bucket (dips and takes) — leaving us feeling empty and sad. A children’s book by McCloud and Messing (2016) illustrates this concept very well. Nurses and midwives fill and protect other people’s buckets every day. That’s the job. But who is filling your bucket? I encourage you to seek those persons out or engage in 5-minute daily disciplines or routines that restore your emotional reservoir.

The NMLTT recognizes that this has been a year of collective woundedness. We have all experienced waves and waves of emotions. Despite these challenges, nurses and midwives have shined brightly. We hope that the holidays whether celebrated at work or home, would inspire renewal for every one of you.

The Author, Dr. Rose Clarke Nanyonga, is the Vice Chancellor of Clarke International University and a member of the NMLTT Executive Team

References

APA (2012). Building your resilience. Available at https://www.apa.org/topics/resilience

Health in Africa (2020). Uganda confirms 1200 health workers tests for COVID-19, majority Nurses and Clinical Officers. Available at https://healthinafrica.world/2020/12/13/ugandaconfirms-1200-health-workers-tests-for-covid19-majority-nurses-and-clinical-officers/

ICN (2020). Press Release: October 28th, 2020: ICN confirms 1,500 nurses have died from COVID-19 in 44 countries and estimates that healthcare worker COVID-19 fatalities worldwide could be more than 20,000. Available at: https://www.icn.ch/news/icn-confirms-1500-nurseshave-died-covid-19–44-countries-and-estimates-healthcare-worker-covid

McCloud, C. (2016). Have you filled a bucket today?: A guide to daily happiness for kids. Bucket Fillers.

Van der Kolk, B. A. (2015). The body keeps the score: Brain, mind, and body in the healing of trauma. Penguin Books.

By Tracy Kobukindo Kamau and Assoc Prof. Rose Clarke Nanyonga, Editors, NMLTT Newsletter

Background

Think Tanks have evolved over the last century into well-respected, autonomous, non-governmental, not-for-profit, independent ‘institutes’ whose influence spans across sectors of health, education, economics, and although usually ‘politically neutral’ (1) or non-partisan (2), Think Tanks continue to have a significant impact on governments, politics 3, often affecting policy environments, reforms that affect how people live, trade or access health care. Today, there are about 7000 Think Tanks worldwide, but only 500 of those are in Africa (1). The USA has the highest number of Think Tanks, Washington D.C. alone has 400 (1).

This phenomenon isn’t unexpected, considering that Think Tanks typically flourish in more developed regions. Moreover, they often thrive in places where intellectual respect is synonymous with settings where political stability supports freedom of speech, ‘freedom of criticism,’ and an environment conducive to embracing alternative ideas, research, critical thinking, problem-solving, and constructive criticism. These locations often have authorities open to diverse perspectives, possessing both influence and financial resources that favor innovation and new approaches.

However, owing to their political impartiality and their independent role in research, policy formulation, problem-solving, and critical analysis, Think Tanks are increasingly sought after, even within authoritarian regimes like China (4). Other BRIC nations have also experienced an increase in Think Tanks; Russia, Brazil, and India (4). According to the Rift Valley Institute, EAC has 117 Think Tanks with only 29 of them emanating from Uganda. Despite the low numbers in Uganda, Think Tanks are becoming more eminent with research being conducted on a global scale to determine their impact on policy as well as influence.

Defining Think Tanks

Sometimes seen as “devices for gathering authority’ (4); Think Tanks are groups of experts in their professions or field although sometimes membership can be multidisciplinary — with diverse backgrounds and experience who offer independent insight into issues arising, conduct research, brainstorm solutions to problems, and relay information to the public through workshops, media, conferences, research papers (3), etc. And in so doing, shape the ‘knowledge regimes’, contributing to bodies of research and knowledge. The information generated from Think Tanks has been utilised by governments to inform policy (3), drive strategic direction, and set health agendas. They establish connections with real individuals and networks, gathering data and information vital for decision-makers at the upper echelons who might be detached from the everyday challenges faced by people. In this capacity, they serve as advisors, providing essential and pertinent guidance. Although they participate in advocacy, they are not to be confused with advocacy institutions, because as the name implies, they mainly ‘Think’, generate ideas, and information/data, and share it for the betterment of communities (1), inadvertently they are highly influential across many societal spheres (4). Additionally, they help raise awareness of issues, encourage public debate, and build capacity, they will, if they choose to, play a critical role in the implementation or evaluation of initiatives. They may also play an advisory role as appointed members of governmental commissions, parliamentary committees, and public deliberations.

Characteristics of Think Tanks

Studies of Think Tanks from the 1980s and 1990s characterized Think Tanks as mainly nonpartisan and politically neutral (2). Think tanks, frequently centered on policy and the public interest, comprise experts and professionals renowned for their research capabilities and high intellectual acumen. They maintain robust ties with the media, utilizing these connections to disseminate their ideas and research findings. Operating independently and autonomously, they champion evidence-based decision-making, offering advice, shaping problem definitions, and advocating policy solutions (3)

In Ghana, for example, Think Tanks were influential in the crafting and implementation of Ghana’s first transitional (3). In the USA, a 50-person invitation-only Think Tank conversation in 2018 at the University of Kansas School birthed the Professional Identity in Nursing Initiative where 4 domains of professional identity and competencies for each were formulated (5). In Canada in 2015, The Canadian Nursing Simulation Research Collaboration was formed as a result of the Canadian Nursing Think Tank, they identified five primary themes that will help to direct future simulation research (6). Another group formed a think tank in the USA to help devise means of increasing the retention of minorities (7). Another Think Tank led to the establishment of the Nursing and Artificial Intelligence Leadership (NAIL) Collaborative, comprising interdisciplinary experts in AI development, biomedical ethics, AI in primary care, AI legal aspects, philosophy of AI in health, nursing practice, implementation science, leaders in health informatics practice and international health informatics groups, a representative of patients and the public, and the Chair of the ITU/WHO Focus Group on Artificial Intelligence for Health in 2019 (8).

The Uganda Nurses and Midwives Think Tank (NMLTT)

Founded on 12th April 2020, the Uganda Nurses and Midwives Think Tank (NMLTT) was the first of its own, a Nurses-led TT (as it is informally known) comprising about 91 nurses and midwives leaders from the following institutions:: Ministry of Health, Department of Nursing, Ministry of Education and Sports (Health Education and Training), Uganda Nurses and Midwives Council (UNMC), Uganda Nurses and Midwives Examination Board (UNMEB), Uganda Nurses and Midwives Union (UNMU), Professional associations like Critical Care Nursing Association of Uganda, Association of Graduate Nurses and Midwives, Nurses and Midwives Society, Nurses and Midwives in the Private Sector, Leaders from Training Institutions and Academia, Nurse leaders from respective National and Regional Referral Hospitals among others. Nurses and Midwives from the Department of Nursing MoH, UNMC, HET, Heads of Training Institutions, as well as nurse leaders from National/Referral and Regional Hospitals both public and private, etc. Influential figures shaping and informing healthcare and global policies concerning nurses/midwives, and others serving as inspirations to individuals of all ages, from the young to old. Initially, the NMLTT was founded to represent the interests of Nurses and Midwives on the National COVID-19 Task Force at the Ministry of Health (MoH). The primary focus during the COVID-19 crisis was to support nurses and midwives at the frontline so that they are enabled to deliver appropriate care to suspected or confirmed patients suffering from COVID-19. During the pandemic, Think Tank was tasked with various issues and prioritized personal protective equipment (PPEs) for frontline Healthcare providers in our objectives. We were able to raise a total of 19,700,000/= in the first fundraising drive in May. PPE items (Gloves, Surgical Masks, N95 Respirators, Aprons) were procured and were delivered to three locations:- Mulago National Referral Hospital, Entebbe Grade B Hospital, and Arua RRH (see 2nd edition and 5th of our newsletter attached for pictorial evidence).

Other notable Achievements include the following:

2020–2023

• Successfully conducted advocacy for the basic needs and protection of the Nurses and midwives, uplifting the Nursing and Midwifery profession whilst uniting various leaders at the National and Regional Levels
• Members of TT were appointed to the National task force in the Management of Covid-19 and supported surveillance.
• Demanded the appointment of a new Commissioner of Nursing at the MOH Department of Nursing and later worked with the office to organize capacity-building workshops, fundraisers, etc.
• Conducted multiple workshops on writing for nurses (creative and research writing), in collaboration with National Healthcare Conferences Uganda (NHCC) and Clarke International University (CIU).
• Created virtual platforms on Zoom and WhatsApp for nurses and midwives to discuss issues and raise these with appropriate bodies e.g. The Nurses Union, Nurses Council, other Nursing Associations etc.
• Members of NMLTT made up executive editor composition for the Uganda Nurses and Midwives Magazine Council at 100 Issue
• The establishment of the Nurses and Midwives Newsletter — A bi-monthly Nurses and Midwives news bulletin, the first in Uganda, allows the NMLTT to continue to deliver expert information and enables knowledge sharing 15 Issues have been published to date, some on the MOH website
• Leaders’ monthly meetings via Zoom facilitated by Seed Global Health.
• An initial fundraising drive for PPE in which we raised 19.7m. We procured some of these items and distributed them to two COVID-19 sites.
• Two successful webinars to run monthly from June 2020 (to enhance continued knowledge sharing and learning).
• A rapid national Nursing and Midwifery survey to assess the impact of COVID-19 on the workforce — is currently underway.
• Members of the TT published several articles in national newspapers, totaling X number making a case for investment in Nurses and Midwives as well as advocacy for PPE, inclusion indecision-making at the national level, etc.
• Conducted dissemination webinars to understand the scope of practice and understanding the different pillars of the Nursing Fraternity.
• Created a platform to recognize members’ achievements.

Challenges that Think Tanks face

Globally, Thinktanks persistently encounter the challenge of limited funding. The NMLTT has received no funding from any entity since its founding. The newsletter, hosted on ISSUU exceeded the basic package which meant we couldn’t publish additional letters, a member of NMLTT has selflessly paid $242 annually for the last 2 years to have the letter hosted. We hope to find funding for this so that more nurses, midwives, and healthcare leaders can access more letters (free of charge) from the ISSUU publication site.

Some Think Tanks exist in unsupportive political environments. Worse still, there is a lack of awareness or vagueness in recommendations for Think Tank establishment that fosters a learn-as-we-go attitude towards their formulation and day-to-day operations. While most rely on Think Tanks to present evidence from research conducted, there is not enough funding available for research despite widespread expectations of Think Tanks to conduct research and share findings that inform policy and add to the body of knowledge in their respective sectors. The “epistemic crisis” where there is a loss of faith in experts and information overload exerts further unnecessary pressure on Think Tanks to set themselves apart with data and evidence-based solutions to problems governments and societies face today (4).

Furthermore, due to the prolonged nature of policy and advocacy impacts, Think Tanks often find themselves in the position of needing to consistently justify their efforts, even when the results are not immediately quantifiable or tangible in terms of measurable output (4). There is also competition from other research organizations that may be better funded. The NMLTT is not immune to the above problems and also continues to have the challenge of no funding, despite running activities — often members contribute to the cause (as was the case during the COVID-19 pandemic), and will self-facilitate meetings, etc. Some organizations, notably Seed Global Health, and MoH have provided support in kind, to the activities of the Think Tank, but NMLTT continues to survive due to the kindness and generosity of its selfless members. Another hurdle arises from the perception of NMLTT solely as a platform for lodging all complaints within the Nurses and Midwives profession. To tackle this, we’ve implemented measures such as redirecting these concerns to relevant institutions or arranging webinars/spaces for public interaction.

Conclusion/Recommendations for the Future

As devices of influence, Think Tanks can play an even bigger role in shaping policy, building the capacity of the public, and influencing system reform. Maintaining the core characteristics of autonomy, and nonpartisan positions, so that they can outlive political regimes and have a sustainable impact on systems.

By upholding diverse and multi-talented memberships while prioritizing research and evidence-based decision-making, they have the potential to elevate their standing within their sectors. Furthermore, they can transcend these sectors by establishing themselves as pioneers in setting standards, adept analysts, and exceptional communicators, whether through their writing or presentations at conferences.

Think Tanks can enhance their practices by bolstering the documentation of their activities and disseminating their learnings and Standard Operating Procedures (SOPs). This initiative could serve as a valuable guide for the formulation and sustainability of newer Think tanks. By convening Think Tank meet-ups and fostering inter-sectoral sharing, Think Tanks could organically unite to establish National Associations of Think Tanks, thereby augmenting their global impact and influence. This approach also offers a potential solution to the absence of Think Tank registries, both nationally and globally. The lack of formal structure in organizational registries is a challenge as Think Tanks, neither being organizations nor companies, political groups, or religious entities, are essentially constituted by individuals volunteering their time, resources, expertise, and intellect to propel development and ensure a balanced narrative.

Ultimately, the Think Tank network could inaugurate a culture of conducting Think Tank audits, creating an environment conducive to addressing persistent challenges. This includes establishing a standardized framework to gauge Thank Tanks’ impact on policy or research, whether by quantifying research papers published or measuring the integration of ideas into national policies

References

1. New Africa, September 22, 2019, Insight: What role do African Think tanks play in development? Author: Anon. Retrieved December 22nd, 2023 from: https://newafricanmagazine.com/19832/
2. Enrique Mendazabal, 2011: How can think tanks be agents of social change? Retrieved October 4th 2023 from: https://onthinktanks.org/articles/think-tanks-research-findingsand-some-common-challenges/
3. Ohemeng F, Parku K, & Asiedu EA et al (2019). The changing face of Policy Development in a democratic developmental State: The role of Think Tanks and Policy Advocacy in Ghana. A paper presented at the 4th International Conference on Public Policy (ICPP4)June 26- 28, 2019 — Montréal, Canada. Panel: T01P14 — Public Policymaking in Developing Countries. Retrieved December 22nd 2023 from: https://www.ippapublicpolicy.org/file/paper/5cfa6cd9ee9ae.pdf
4. Pautz, H. (2020). Think Tanks and Policymaking. Oxford Research Encyclopedia of Politics. Retrieved 3 Oct. 2023, from https://oxfordre.com/politics/view/10.1093/acrefore/9780190228637.001.0001/acrefor e-9780190228637-e-1420
5. Brewington, J., & Godfrey, N. (2020). The professional identity in nursing initiative. Nursing education perspectives, 41(3), 201. | DOI: 10.1097/01.NEP.0000000000000667
6. Goldsworthy, S., Sears, K., Luctkar-Flude, M., Harder, N., & Wilson-Keates, B. (2018). Gaining momentum through collaboration: results of a Canadian nursing simulation research think tank. Clinical Simulation in Nursing, 15, 61–64, ISSN 1876–1399, https://doi.org/10.1016/j.ecns.2017.09.001 (https://www.sciencedirect.com/science/article/pii/S1876139917300658)
7. Julion, W., Reed, M., Bounds, D. T., Cothran, F., & Gamboa, C. (2019). A group think tank as a discourse coalition to promote minority nursing faculty retention. Nursing Outlook, 67(5), 586–595.ISSN 0029–6554, https://doi.org/10.1016/j.outlook.2019.03.003
8. Ronquillo, C. E., Peltonen, L. M., Pruinelli, L., Chu, C. H., Bakken, S., Beduschi, A., … & Topaz, M. (2021). Artificial intelligence in nursing: Priorities and opportunities from an international invitational think‐tank of the Nursing and Artificial Intelligence Leadership Collaborative. Journal of Advanced Nursing, 77(9), 3707–3717. https://doi.org/10.1111/jan.14855

The NMLTT Newsletter: 15 Issues so far Can be accessed here: https://issuu.com/nmltt

Article Source

https://issuu.com/nmltt/docs/issue_4_vol_2_nmltt-december_2023-final/s/41903911

Uganda Nurses & Midwives Newsletter Issue 3 Vol.2. Editorial by Dr. Safinah Kisu Museene

Midwifery has long been a cornerstone of maternal and newborn healthcare, playing a vital role in ensuring safe pregnancies, deliveries, and postpartum care (pre, intra, and postnatal services). In Uganda and across Sub-Saharan Africa, midwives are essential frontline healthcare providers, always providing critical service but also often working under challenging conditions to save lives and promote the well-being of mothers and infants. As we visualize the future, it becomes evident that the landscape of midwifery in Uganda and the great African region is poised for transformative changes that will revolutionize maternal and neonatal care.

The future of midwifery in Uganda and Sub-Saharan Africa is marked by a convergence of emerging trends and ongoing challenges. Rapid population growth, limited resources, high numbers of teenage pregnancies, inadequate infrastructure and machinery for midwifery services, and geographical barriers and transportation limitations have historically posed obstacles to the effective delivery of maternal healthcare services. In response, governments, organizations, and healthcare professionals are coming together to innovate and address these challenges head-on. Governments and their partners are putting in place strategies to improve the referral systems, human resources, stock management and supplies, and information systems management and utilization of such information.

One of the most promising developments in the future of midwifery is the integration of technology and telemedicine. Mobile health (mHealth) applications and teleconsultations hold tremendous potential to connect midwives with expectant mothers, even in remote areas. This digital revolution allows midwives to provide crucial guidance, monitor pregnancies, and offer postpartum support from a distance. By extending the reach of midwifery services, technology is helping bridge the gap between urban and rural healthcare. However, appropriate skills are required for the operation of this wonderful advancement in technology and telemedicine. As the Health sector looks into infrastructure improvement to accommodate such, universities and educational institutions should embrace innovative curricula that cater to such advancements.

Investing in the education and empowerment of midwives is a key focus for shaping the future. Enhanced training programs, continuing professional education, and capacity building are all contributing to a more skilled and competent midwifery workforce. Governments and international partners are recognizing the need to elevate the status of midwives, ensuring they have the necessary skills to handle complex cases and provide comprehensive care.

Community-based approaches are gaining traction, fostering a sense of trust and collaboration between midwives and the communities they serve. Midwives are not just healthcare providers; they are also educators, advocates, and supporters. By involving local communities in maternal health initiatives, midwives are able to address cultural norms, improve awareness, and promote healthy practices.

The future of midwifery relies on robust policy frameworks, improved financing for maternal and child health, and advocacy efforts. Governments and stakeholders are increasingly recognizing the pivotal role midwives play in achieving Sustainable Development Goal 3 — ensuring healthy lives and promoting well-being for all at all ages. By advocating for increased investment in midwifery services and policies that prioritize maternal health, the trajectory of care delivery can be transformed.

As we look ahead to the future of midwifery in Uganda and Sub-Saharan Africa, a sense of optimism prevails. The convergence of technology, education, community engagement, positive political will, and advocacy is propelling midwifery into a new era of excellence and positive impact. By embracing innovation, prioritizing empowerment, and fostering partnerships, we can work together to ensure that every woman, adolescent, child, and expectant mother receives the care and support they deserve, regardless of their location or circumstances. The future of midwifery is a future of hope and happiness, where every birth is safe, every mother is empowered, every newborn has the opportunity to thrive and every teenager and adolescent has an opportunity to visualize the future family and childbearing positively. As we read this issue 3 volume 2 of the MMLTT Newsletter, I encourage you to think of how better we shall have the best midwifery services in our country and beyond.

By Dr Safinah K Museene (PhD). Commissioner of Health Education and Training, Ministry of Education and Sports, Uganda. Chairperson: Nurses and Midwives Leaders Think Tank (NMLTT)

Reprinted: In November last 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 it allowed me to reflect on the journey of NM 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 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 college-based education which was supported by new standards and policies. Education institutions and NM scholars focused on curricula 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 the diversification of cadres (ULII, 1996). This critical update was subsequently followed by 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 NM 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 NM education and practice for the African Region 2012–2022 also provided a framework for the World Health Organization (WHO) member states to ensure quality NM 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?

Nurses and Midwives 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.

Recommended Key Domains of Competencies for current and future NM include but are not limited to

• Quality and Safety: We must have a nurse/midwife who can drive the cost of care down while driving the safety and quality of care up.
• Knowledge Development: We need a nurse/midwife who is not just a consumer of knowledge for evidence-based practice; but can engage meaningfully in developing and disseminating nursing/midwifery knowledge and science through research and innovation.
• ICT in Health: We must have a nurse/midwife who is not averse to the utilization and integration of information technology in the care/management of patients and prevention of disease — but one who will run to it and readily embrace it.
• Healthcare Reforms: We need a nurse/midwife who can lead the next generation of healthcare reforms in Uganda.
• Business of Healthcare: Key factors driving healthcare reforms in Uganda include healthcare disparities, demographic shifts, the dual burden of disease, resource scarcity and unsustainable costs of care, access issues, suboptimal outcomes, improvement in quality of care, fee-for-service systems, insurance-driven health systems, etc. To be a major player in shaping healthcare reforms, we need an NM who understands the business of healthcare
• Accountable: We need a nurse/midwife who is accountable for their own actions while working autonomously, and as an equal partner within interdisciplinary teams
• Visionary/Strategi Leader: We need a nurse/midwife who is strategic; can envision the future including understanding challenging environments, the burden of disease including non-communicable diseases (NCDs), different modes of care, innovation, rapidly evolving demographics, etc.
• Cultures of Health: We need a nurse/midwife who can lead the primary healthcare agenda and who is engaged in building a culture of health and developing effective nursing practices for eliminating gaps and disparities in healthcare.
• Compassionate: And we need them to do all these things while remaining compassionate, evidence-based, and person-centered.
• Wellness: Above all we need a nurse/midwife whose well-being to execute these duties is highly prioritized in government budgets year after year for the next century (NAM, 2021)

In Sum: Nurses and midwives constitute the largest health workforce. From a business perspective, this strength also translates into the largest expenditure, an issue that continues to plague the capacity of the profession to garner necessary investment and funding. This subsequently has an impact on the capacity to rigorously pursue the production of an efficient workforce with relevant competencies — a critical role of not just the nursing and midwifery education sector, but also the regulator (Bvumbwe & Mtshali, 2018).

Of note, it is important to rapidly address intractable challenges that continue to stand in the way of pragmatic strategies for advancing the nursing and midwifery agenda in Uganda:

• To build on what the country has achieved so far and to drive future transformation, there is a need to bolster strategic leadership at all levels.
• Transitioning from vocationally trained nurses and midwives (who are the majority) to basic and higher degrees requires innovative curricula, education investment and funding, and enabling regulation — these are critical ingredients. Past-century experiences of underinvestment in these groups of professionals will not yield the type of NM the country seeks to have.
• Documented critical shortages of regulatory staff need urgent attention.
• There is a need to address the continuing inadequate productive capacity of NM training institutions — including critical shortages of learning resources and investing in faculty development for nursing and midwifery education, training, and research (Mitchell et al., 2014).
• Nurses and midwives are part of the human capital development agenda for Uganda. A key group for achieving Universal Healthcare Coverage. If the country wants better, highly qualified (both in quantity and quality), efficient nurses and midwives, they must be empowered to practice to the full extent of their training.

It is all going to take coordination, collaboration, and support. And I hope that as we reflect on this recent centennial, we can all make some commitments and engage in the required heavy lifting.

References

UNMC (2022). UNMC 100 years anniversary. November 2022. Centenary Magazine

Uganda Legal Information Institute (1996). Nurses and Midwives Act 1996. Accessed at https://old.ulii.org/ug/legislation/consolidated-act/274

Bvumbwe, T., & Mtshali, N. (2018). Nursing education challenges and solutions in Sub Saharan Africa: an integrative review. BMC nursing, 17(1), 1–11.

Mitchell, A., Zuber, A., Quain, E., Hall, C. M., Foradori, L., & Lim, C. K. (2014). Building capacity of training institutions and Ministries of Health in sub-Saharan Africa: The PEPFAR approach. Annals of Global Health, 80(3).

Associate Prof Rose Clarke Nanyonga

Vice Chancellor

Clarke International University