Promoting Regulatory Reform: The African Health Profession Regulatory Collaborative (ARC) for Nursing and Midwifery Year 4 Evaluation

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As countries across sub-Saharan Africa work towards universal health coverage and HIV epidemic control, investments seek to bolster the quality and relevance of the health workforce. The African Health Profession Regulatory Collaborative (ARC) partnered with 17 countries across East, Central, and Southern Africa to ensure nurses and midwives were authorized and equipped to provide essential HIV services to pregnant women and children with HIV. Through ARC, nursing leadership teams representing each country identify a priority regulatory function and develop a proposal to strengthen that regulation over a 1-year period. Each year culminates with a summative congress meeting, involving all ARC countries, where teams present their projects and share lessons learned with their colleagues. During a recent ARC Summative Congress, a group survey was administered to 11 country teams that received ARC Year 4 grants to measure advancements in regulatory function using the five-stage Regulatory Function Framework, and a group questionnaire was administered to 16 country teams to measure improvements in national nursing capacity (February 2011–2016). In ARC Year 4, eight countries implemented continuing professional development projects, Botswana revised their scope of practice, Mozambique piloted a licensing examination to assess HIV-related competencies, and South Africa developed accreditation standards for HIV/tuberculosis specialty nurses. Countries reported improvements in national nursing leaders’ teamwork, collaborations with national organizations, regional networking with nursing leaders, and the ability to garner additional resources. ARC provides an effective, collaborative model to rapidly strengthen national regulatory frameworks, which other health professional cadres or regions may consider using to ensure a relevant health workforce, authorized and equipped to meet the emerging demand for health services.

Section snippets

Methods

In ARC Year 4, 11 countries received $10,000 grants to address regulatory issues in continuing professional development (CPD), scope of practice (SOP), licensure, and accreditation to advance NIMART authorization and practice. During the February 2016 ARC Summative Congress, two evaluation tools were administered to nursing and midwifery leaders in practice, education, regulation, and policy from countries in the ECSA region. The first tool was a survey measuring regulatory advancement for the

Results

During ARC Year 4, eight countries (Ethiopia, Kenya, Lesotho, Rwanda, Seychelles, Tanzania, Zambia, and Zimbabwe) implemented CPD projects. Botswana revised its SOP, Mozambique piloted a prevention of mother-to-child transmission competency examination as part of the new graduate licensure process, and South Africa developed accreditation standards for HIV/tuberculosis (TB) specialty nurses. Table 2 describes the key achievements of each country’s project.

The stages and incremental criteria for

Discussion

The findings from ARC Year 4 demonstrate rapid, breakthrough change over a 1-year period, as multiple countries advanced their regulatory frameworks. Three countries (Lesotho and Zimbabwe for CPD, Botswana for SOP) ended the project year in a state of optimized regulatory function that aligns with global and regional standards (stage 5). Furthermore, two countries (Tanzania and Seychelles for their development of national CPD programs) advanced one full stage within the framework over the same

Conclusion

Regulation is an important mechanism to ensure the health workforce is authorized and equipped to deliver safe, high-quality servies that are relevant to the public’s evolving health needs. The ARC initiative proved to be an effective model to promote rapid regulatory advancements and improve the capacity of national nursing institutions. National regulatory boards and councils will continue to implement and advance these regulations, highlighting the sustainability of this investment. Other

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      Academic articles featured in the regulation, CPD, and public health cluster predominantly examined the changing nature of scopes of practice required to address public health challenges in developing countries. For example, literature concerning the African Health Professions Regulatory Collaborative (Gross et al., 2015; Gross et al., 2018; Kelley et al., 2017; Moetsana-Poka et al., 2014) supports the notion that regulation has an influence on enforcing changing scopes of practice to meet particular health needs of these countries. Academic publications in the professional development programming for the patient care cluster identify links between knowledge, strategy, and standards of CPD programs to achieve improved patient care outcomes.

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      These studies reach consistent findings and invariably conclude that RNs provide measurable benefits while working in hospitals on patient safety, quality of services, and the avoidance of adverse incidents. In Africa, regulators work across jurisdictions to change legislation to enable licensees to better address critical health needs such as maternal child survival, access to nurse-initiated and nurse-managed antiretroviral therapy, prevention of mother-to-child transmission of HIV, and treatment of drug resistant tuberculosis (McCarthy, Zuber, Kelley, Verani, & Riley, 2014; Kelley et al., 2017). The work of the African Health Profession Regulatory Collaborative (ARC) has been successful in learning from best practices and accelerating their implementation across jurisdictions so licensees can address priority health burdens (Gross, Kelley, & McCarthy, 2015; Dynes et al., 2016).

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    This research was supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC) under the terms of a cooperative agreement with the Association of Schools and Programs of Public Health (ASPPH) grant number 1U36OE000002. The findings and conclusions of this article are those of the authors and do not necessarily represent the official position of the CDC. This evaluation was supported by the National Council of State Boards of Nursing (NCSBN).

    The authors would like to acknowledge the contributions of the nursing and midwifery leadership teams across the ECSA region, especially their dedication to advancing the authorization and competency of the nursing workforce to support HIV epidemic control. The authors also acknowledge the staff support provided by the 15 CDC country offices to national nursing leaders as they worked to advance nursing regulations, including Dr. Fatma Soud and Dr. Peter Chipimo from CDC Zambia, and Dr. Patricia Oluoch, Dr. Abraham Katana, Dunstan Achwoka, and Dr. Lucy Ng’Ang’A from CDC Kenya. Acknowledgements are given to Angel Mendonça (JHPIEGO), Moises Matsinhe, and Hamido Braimo (ICAP), and Alfredo Vergara and Sonia Machaieie (CDC Mozambique) for their support of the nursing leaders in Mozambique to implement OSCE for new graduates and advance the national nursing act. We give special thanks to Michelle Dynes (CDC) for the initial development of the evaluation tool to measure changes in nursing and midwifery leadership capacity.

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