NationalRegulatoryCapacityandNursesandMidwifeLeaders’PerceptionsoftheAfricanHealthProfessionRegulatoryCollaborativeforNursesandMidwives(ARC):EvaluationofFourYearsofARCEast,CentralandSouthern

MaureenKelleyCNM,PhD,FAANClinicalProfessorEmoryUniversity

ARC:ProjectOverview

• 4-yearinitiativefundedthroughPEPFAR

• Regionalcollaborative– sub-SaharanAfrica

• Supportsnursingandmidwiferyleaders

• ImprovingregulationforHIVservicedelivery

• Utilizescross-countrycollaboration

KeyARCParticipants:“TheQuad”

•NursingandMidwiferyProfessionalAssociation

•HealthProfessionalTrainingInstitutions

•NursingandMidwiferyRegulatoryCouncil

•MinistryofHealthChiefNursingOfficer(CNO)

Servicedelivery,healthpolicies

Professionalstandards

andcompliance

Voice toGovernmentforhealth

workersandmembers

Pre-service and

continuingeducation

The Quads of Africa: http://emorynursingmagazine.emory.edu/issues/2016/spring/features/quads-of-african/index.html

TheARCApproachAdaptedfromtheInstituteforHealthcareImprovement(IHI)

modelforbreakthroughorganisationalchange

FEB 2015 FEB 2016

End

Nov-Feb

Nov 2015July 2015

Jul-NovMay-Jul

TheARCApproach• Cross-CountryCollaboration• AnnualSummativeCongress• Twolearningsessionsforcountriesawardedgrants• Platform:lessonslearned,exchangetools,technicalassistance

• RegulationImprovementGrants• Annualcompetitiveprocesswithexternalpeerreview• Supporttoaddressanationally-identifiedregulationpriority

• TargetedTechnicalAssistance• Forgranteesandcountrieswithoutgrants

• Evaluation• RegulatoryFunctionFramework- stagesofchange

Objectivesofevaluationresearchstudy

• Categorizecountriesacrossfivestagesofdevelopmentofregulatoryfunctionfromplanningtooptimizing

• Describeinter- andintra-organizationalrelationshipandnetworkinggainsachievedthroughtheARC-ECSinitiative

RegulatoryFunctionFramework(RFF)

TheRFFcomprisessevenregulatoryfunctions1. Legislation– creatingorrevisingnursing/midwifery2. Registration– systemsanddatause3. Licensure4. ScopeofPractice5. ContinuingProfessionalDevelopment(CPD)6. Pre-serviceAccreditation7. MisconductandDisciplinaryPowers

McCarthy,C.F.,Kelley,M.,Verani,A.,St.Louis,M.,&Riley,P.(2014).Developmentofaframeworktomeasurehealthprofessionregulationstrengthening.EvaluationandProgramPlanning,46,17–24.http://dx.doi.org/10.1016/j.evalprogplan.2014.04.008

EachFunctionhasFiveStages

RegulatoryFunctionFramework(RFF)

ContinuingProfessionalDevelopment

MultipletypesofCPDavailable.CPDcontentalignswithregionalstandardsorglobalguidelines.RegularevaluationsofCPDprogramcarriedout.

Stage5

Electronicsysteminplacetrackcompliance.PenaltiesexistforCPDnon-compliance.AvailableCPDincludescontentonHIVservicedelivery.

Stage4

CPDprogramisfinalizedandnationallydisseminated.CPDismandatoryforre-licensure.Strategyinplacetopromoteandtrackcompliance.

Stage3

CouncilhasamandateinlawtorequireCPD.NationalCPDframeworkhasbeendeveloped.CPDinpilotphases.

Stage2CPDdoesnotexist.CPDisvoluntary.CPDframeworkfornursingmaybeinplanningphases.

Stage1

RegulatoryFunctionFramework(RFF)

InitiativeImpact

ARCGrants– NationalInvestments

• 7countries– EstablishCPDprograms• 12countries– AdvanceCPDprograms• 5countries– ReviewandreviseSOPs• 3countries– Reviewandupdateacts/regs• 1country– Decentralizecouncilservices• 2countries– Developentrytopracticeexams

ARCImpactonCPD:Y1-Y4

ARCYear4Grantees• ContinuingProfessionalDevelopment– Ethiopia,Kenya,Rwanda,Tanzania,Zambia,Lesotho,Seychelles,Zimbabwe

• Licensure– Mozambique(OSCE)

• Accreditation– SouthAfrica(SpecialtyLicense– HIV/AIDSCare)

• ScopeofPractice– Botswana

AdvancementbyRegulatoryFunctionStageforARCYear4Grantees

Teamwork,NetworkingandInter-OrganizationalRelationships

• Toolwasdevelopedthataskedthe17countriestowhatextenttheyengagedintheseactivitiespriortoinitiationofARCandduringyear4(usinga5levelscale)

• Openendedquestionswerealsoaskedabouttheseaspectsoftheirworktogether

• Questionnairewasself-administeredtoeachcountryteam

QUALITATIVERESULTS

TeamworkamongNationalNursingLeaders

• Teamwork:QuadmemberstendedtoworkinisolationfromeachotherpriortoARC– “priortoARCeachnursingpillaroperatedindividually.Therewasmiscommunication,alackofcoordinationandwastedresources…currentlythepillarsareworkingtogetherwithacommongoal”

Relationship-buildingbetweenQUADorganizations

• RelationsbetweenQuadorganizationspriortoARCweredescribedasbeingpoortomoderate,with5countriesindicatingweakorveryweakties.

• AttheendofARCY4,allbut3Quadsdescribedinter-organizationalrelationshipsasstrongorverystrong.

Relationshipbuildingwithotherorganizations

• PriortoARC,5Quadsreportedhavingmoderatetiestonon-ARCorganizations,and8reportedthattheserelationshipswereweakorveryweak

• After4yearsofARCengagement,Quadsreportedhavingmuchstrongerrelationshipswithotherorganizations,includinglocalCDCoffices,internationalNGO’sandUNgroups

NetworkingwithQuadsfromotherARCcountries

• ARChasalsopromotedregionalnetworkingbetweenQuadteamsfromparticipatingcountries.– “wenowattendfrequentandinteractivemeetings.Topicsofcommoninterestarepresentedanddiscussed,andguidanceisprovidedtostrengthenregulatorycapacity.Thereisconsultationwithothernurseleadersfromvariouscountries”

Summary

• ARCinitiativehasdemonstratedthatsustainedinvestmentinasouth-to-southregionalcollaborationcanyieldimportantandmeasurableimpactsonhealthworkforceregulation

• Thereweresignificantgainsinnursingleaders’teamwork,organizationalcollaborationandcross-countrynetworking

THANKYOU