Description of Nursing Regulation and Nursing Regulatory Bodies in East, Central, and Southern Africa

Abstract

Introduction: Many global health initiatives involve strategies to expand the capacity of the health workforce. Strategies, such as task shifting/task sharing and strengthening pre-service education institutions, have been instrumental in scaling up HIV services in sub-Saharan Africa and have advanced nursing and midwifery practice and education. Incorporating the advancements into nursing and midwifery regulation can increase the sustainability of the strategies and facilitate further scale-up of HIV and other health services. There is insufficient information on what practice and education regulations currently exist in sub-Saharan Africa, how to involve key stakeholders in adapting regulations, and how to measure the impact of efforts to adapt regulations. Methods: A survey of national nursing council registrars from 14 countries in east, central and southern Africa was conducted on February 28, 2011. The survey asked about what nursing regulations were currently enacted in their country and about task shifting to nurses. A survey of three regulation stakeholders from each of the 14 countries was also conducted on February 28, 2011. The surveyed asked about their roles and activities pertaining to national nursing regulation and about task shifting. An evaluation framework was developed to measure the impact of efforts to update and strengthen national regulations in the 14 countries. The framework was developed using focus groups with representatives from five African countries and pilot testing with three African countries. Results: 12 Nursing council registrars and 32 regulation stakeholders from 13 African countries responded to the surveys. The majority of all respondents stated task shifting to nurses is taking place yet regulations have not been updated to reflect task shifting. Major nursing regulations in the 14 countries are similar with regard to registration, licensure, continuing professional development and scope of practice. Nursing regulation stakeholders have complementary and strategic roles to play in updating regulations. The evaluation framework successfully documented actual stages of regulations in three pilot countries and accurately captured the progress of countries in updating regulations. Discussion: Many opportunities exist to assist countries to modernize regulations to incorporate important advancements from task shifting and pre-service reform. A regionally relevant, stakeholder vetted framework was created to measure the impact of efforts to update regulations in the region. Conclusion: Appropriate, revised regulations can help ensure the sustainability of successful health workforce strategies and play an important role in future scale-up of HIV services and other global health priorities.