Africa suffers 24% of the global disease burden but possesses only 3% of the world's health care workers and 1% of its financial resources. The effectiveness of health care delivery is closely linked to the availability and quality of nursing. Yet there is little investment in the support and training of nurses. Without recognition and a clear career path, many leave to take up opportunities overseas. In East Africa, over 40% of nurses leave after graduation. In a region where nurses makes up 85% of the health workforce (vs 25% in the UK), this represents a considerable challenge to health systems.
The out-migration of nurses (and other medical professionals) represents a huge challenge to the East African Community.
Stemming the flow
To arrest this drain of talent, as well as address the issue around the quality of nursing, the EAC invited the Aga Khan University (AKU) to respond to this challenge. Taking its pioneering approach to nursing education from its School of Nursing and Midwifery in Pakistan - which revolutionised the profession and, with it, health outcomes in the country - AKU opened campuses in Dar es Salaam, Kampala and Nairobi in 2001.
AKU began implementing a large-scale in-service training programme designed to upgrade nursing skills across the East African region. Led by Professor Yasmin Amarsi the founder of AKU's much heralded nursing school in Pakistan, the AKU School of Nursing and Midwifery (SONAM) has begun to make a considerable impact on the profession - from the community to the ministry level - and on health outcomes in East Africa.
Making it happen: Professor Yasmin Amarsi, Founding Dean (l), and Joseph Mwizera, Academic Head, (r) AKU School of Nursing and Midwifery, East Africa
Studying on the job
AKU SONAM became the first institution in East Africa to offer working nurses the opportunity to enhance their nursing qualifications by earning a masters degree while working (by studying two days a week and working for the rest). Through its dynamic model of professional education, the programme builds on the knowledge, skills and experience that individual nurses bring to it.
This innovative, part-time study programme allows practising nurses to learn and apply the new skills needed to improve the management and quality of patient care. At the same time, the programme enables the nurses to accumulate academic credits needed for career advancement.
AKU's work-study programme, the first and only of its kind in East Africa, allows students to apply newly learned skills as they work and provides them with greater financial security.
Opportunity for all
AKU takes a needs-blind, merit-based approach to education to ensure that talented students from all backgrounds can benefit from high quality education. Consequently, 98% of nursing students receive a scholarship that covers 30-80% of their postgraduate degree. Approximately one third of students come from government institutions, one third from the private sector and the one third from faith based organisations. Roughly 50% are based in rural areas and 50% in urban areas.
AKU student talking about receiving a scholarship and how this motivates her.
Ensuring the talented are nurtured regardless of their socio-economic background; AKU committees in each country decide on the needs of individual students and then the scholarship fund is divided up.
Empowering the next generation of nurses
Both AKU SONAM students and alumni readily enthuse about the unique impact of the programme both in terms of their skills development and, significantly, in terms of their personal development, especially in terms of leadership and critical thinking. Students are encouraged to think creatively about problem solving and to question conventional wisdom. This aims to endow students with both the confidence and the skills required to take responsibility and, ultimately, to lead by example. Students graduate equipped to respond to local health concerns and empowered to make a difference.
AKU student talks about critical thinking skills she has learnt.
"I feel with the knowledge I have acquired here, I can make a difference and I can do better, and I can help others do better so that we can offer a higher quality of health services. I feel that this is a great opportunity"
AKU students learn new practical skills but also develop their critical faculties and leadership qualities
Since 2001, nearly 2,000 nurses have graduated across East Africa. The majority of these nurses were promoted on completion of their studies, and many now hold key positions in nursing education, policy and practice throughout Kenya, Tanzania and Uganda. AKU alumni include: Winnie Shena, the Deputy President of the 12,000 member National Nurses Association in Kenya; the chief nurses of Uganda and Tanzania; and various nurses working in Ministries of Health across the EAC.
AKU alumni are also showing extraordinary leadership and impact at the community level. In Pemba, Tanzania, one nurse reduced the incidence of diarrhoea in her local community from 30% to 3%, and another reduced maternal deaths from 24 a month down to 2.
Perhaps the most remarkable aspect of this programme is that 90% of its graduates stay in their countries. And 60% go on to work in the public sector.