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Enhancing Nursing and Midwifery Education in Africa for Equitable Maternal and Child Health Outcomes

Africa's progress in reducing maternal and infant mortality is lagging. Urgent investment in midwifery education and training is needed.
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MedPoint Medical Clinic Mwiki, Kenya.

While more women and children survive today than ever before, vast inequities exist worldwide in maternal and child mortality with progress in sub-Saharan Africa lagging behind all other regions in the world. According to the WHO, midwives educated to international standards could prevent over 80% of all maternal deaths, stillbirths, neonatal deaths and 50 other outcomes. However, the world is facing a shortage of 900,000 midwives, with more than half the shortfall in Africa, where urgent investment in midwifery education and training is needed.

Together with a consortium of partners, the Johnson & Johnson Center for Health Worker Innovation (the Center) is working to develop tools and knowledge products, carry out cross-country research, and facilitate learning to improve the quality of midwifery education and training globally. This includes ensuring they align with required competencies and encompass the latest evidence-based techniques, as well as developing standardized assessment and accreditation tools for training facilities, trainers, and graduates.

Below are some of the ways the Center—with support from the Johnson & Johnson Foundation—is working to strengthen nursing and midwifery in South Africa, Nigeria, Kenya, and across other countries in the region.

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Enhancing midwifery and neonatal services through scholarships for advanced studies

To address the shortage of specialized nurses in hospitals and clinics in South Africa, Johnson & Johnson Foundation set up a medical education fund in 2007 through the South African Institute of Race Relations (IRR) to provide bursary funding to financially needy students for post graduate midwifery and neo natal studies at the University of Stellenbosch. Nurses selected by IRR enroll in specialized healthcare programs designed to upskill their competencies, and which are aimed at improving midwifery and neonatal services in the country.

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Building nurse educator capacity through innovative teaching and learning strategies

The migration of nursing education to higher education, the distinctive move towards e-learning brought about by COVID-19, increased demand for the use of technology by millennials currently in training and the nursing shortage are key drivers for nursing education to adapt in South Africa. The Center is working with the Forum of University Nursing Deans of South Africa (FUNDISA) in South Africa on a program aimed at strengthening the capacity of nurse educators, with the goal of building a competent and confident nursing workforce.

Following a gap assessment completed by a core team, FUNDISA and the Center convened an active learning online workshop which was well attended by key stakeholders within the nursing landscape. The discussions delivered a set of key focus areas for nurse educators such as upskilling, for example, in digital literacy and innovative teaching strategies.

Investing in nurses and nursing to lead and deliver health for all

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The Organizational Development of National Nursing Associations (ODENNA) project by the International Council of Nurses (ICN) aims to address the need for stronger and more sustainable ICN member National Nursing Associations (NNAs) in Africa. This enables NNAs to effectively influence and positively impact improvements in healthcare delivery, disease prevention, health promotion and contribute to reinforcing the respect and attractiveness of the profession.

The ODENNA partnership is helping to bring together nursing organizations in Africa with the goal of improving protection, support, and advocacy for nurses on the ground as knowledgeable professionals and system navigators.

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Creating sustainable professional development through the Center of Excellence in Midwifery

Continuous professional development (CPD) is an ongoing and planned process that builds on and enhances existing education and experience for the benefit of the individual nurse and midwife, the patient, and the profession.

With support from the Johnson & Johnson Foundation, the Liverpool School of Tropical Medicine (LSTM) has supported Nigeria’s Kwara state since 2015, and helped establish a Centre of Excellence for Emergency Obstetrics and Newborn Care (EmONC) in conjunction with the Nursing and Midwifery Council of Nigeria and the Kwara state Ministry of Health (MOH). The Centre of Excellence is equipped for competency-based training in EmONC and serves as a mandatory continuous professional development centre for nurses and midwives, as well as a centre for doctors to update their knowledge and skills on EmONC.

A dedication to strengthening nurse and midwife education and leadership

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In collaboration with the Foundation for Professional Development (FPD) and the Sub-Saharan Africa FAIMER Regional Institute (SAFRI), the Center established a fellowship program for leadership development for nurse and midwife educators from Nigeria, Ghana, Kenya, Tanzania, Uganda, Ethiopia, Rwanda and South Africa—supporting them in playing a key role in bringing about much needed change in both the education of practitioners and overall improved functionality of health systems.

The Nurse Educator Leadership Development Programme is aimed at creating an environment in nursing education where all nurse educators, in addition to their subject matter expertise, can develop the educational competency and leadership skills required from educators working in the health academic sector in Africa to address the severe nursing skills shortage on the African continent.

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Upskilling health personnel and strengthening associations in East Africa

For more than 20 years, the Aga Khan University School of Nursing and Midwifery, East Africa (AKU-SONAM EA) and the Johnson & Johnson Foundation have partnered to promote and develop quality nursing and midwifery education in East Africa. This longstanding partnership has led to the graduation of more than 3,100 nursing and midwifery leaders across Kenya, Uganda, and Tanzania.

From 2014 to 2019, Johnson & Johnson Foundation, Aga Khan Foundation and AKU-SONAM EA supported the Strengthening Nursing and Midwifery Associations East Africa Programme to comprehensively strengthen and improve associations across Kenya, Uganda and Tanzania. The initiative helped to improve internal capacity across a range of fields, increasing inter-regional collaboration, strengthening the image and reputation of nurses, and enhancing the quality of services provided.

Furthermore, 2021 saw the launch of the Nurse & Midwife Alliance in Kenya, following the signing of a Memorandum of Understanding by AKU-SONAM EA, Kenya's Ministry of Health, and the Johnson & Johnson Foundation, alongside several other stakeholders. The Alliance convenes all nurses and midwives in the country to facilitate the professional growth of the healthcare practice.

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The Center is also working with the Liverpool School of Tropical Medicine’s Centre for Maternal and Newborn Health (CMNH) and key stakeholders such as the Nursing Council of Kenya (NCK), the Kenya Medical Training College and the Kenya Ministry of Health to strengthen nursing and midwifery by helping to build capacity of 25 accredited institutions to deliver high quality and standardized training curricula. The program aims to revise outdated nursing and midwifery syllabi to meet current international standards and supports the development and evaluation of continuous professional development for nursing and midwifery educators—thereby improving the capacity of these educators in Kenya to provide evidence and competency-based education for a skilled health personnel.