An Overview of Nursing Services in Uganda Uganda UK Alliance by Enid Mwebaza Assistant Commissioner health Services - Nursing Ministry of Health 12th February 2013

Focus of this presentation Brief background of the Nursing profession in Uganda The situation analysis Critical gaps in the nursing profession Future plans for Uganda UK Alliance

Background of nursing profession in Uganda (1914- 1918) The first healing and training centre 1919 Midwifery training under the Uganda Medical Services at Mengo. 1930 Nurses training at Enrolled level 1956 April 12th The Uganda Nurses and Midwives` Council was formed

Background 2 1952 Mulago hospital opened. 1961 Registered General Nursing 1967 Midwifery Course

Background 3 To date the total of practicing nurses in the public facilities : - No of nurses  - 6724 - No of Midwives - 4656 Serving a population of about 34m Very few highly specialized nurses

Situation analysis Nursing Department heads the largest health workforce (more than 60%) in the health sector. Nurses deliver 90% of the health services in the country covering curative, preventive and rehabilitative services. Strengthened nursing leadership with clear and specific policy guidelines in line with the implementation of Ministry of Health Strategic Plan.

SITUATION ANALYSIS 2 Mission To promote a health workforce that is appropriately skilled, well balanced, distributed, committed and performing efficiently and effectively in order to provide quality health care of individuals, families and communities in Uganda Mandate To strengthen nursing standards and maintain quality nursing services in the country, in accordance with the National Health Policy

SITUATION ANALYSIS Delivering on health priorities: Maternal Mortality Persistently high maternal mortality ratio of 438 per 100,000 (UDHS 2011) Estimated 26% of preventable maternal deaths caused by unsafe abortion Increasing access to post-abortion care by training more midwives and ensuring implementation of the current legal framework on abortion would save thousands of lives of pregnant women

Situation analysis 3 Health advocacy and Uganda’s Parliament Successful advocacy effort by Parliament and Civil Society to secure increased investment in health workforce FY2012-2013 allocation to health workforce increased as a result of advocacy demanding for an additional 6,172 professional health workers to be deployed at HCIII/IVs More than doubling of the wages of medical doctors at HCIVs

Critical gaps to be addressed in the nursing profession Nursing Education and career building Nursing Practice Nursing Leadership/advocacy Social Positioning of Nursing profession -Balancing of Nurses’ Association and Nurses’ Union Nursing Regulation, and standards Resources for Nursing Nursing Research Nursing Policy

Critical gaps in the nursing profession 2 The country is experiencing a sharp decline in the standards and quality of nurses - a need for specialized nurses at various levels - insufficient in quality and quantity - Training of many nursing cadres at various levels - Training is not well coordinated between MoH and Ministry of Education

Critical gaps in the nursing profession 3 2. Strengthening of the Nursing practice Improvement in Service delivery- setting of standards Quality of service – evidence based care Human resource issues (attraction and retention) Improved working environment - Ensuring patient safety Streamlining ‘Scope of practice’ Harmonization and accreditation of CPDs programmes -

Critical gaps in the nursing profession 4 3. Development of a strategic direction for nursing and midwifery services: - Lack of succession planning - role models for nursing - senior nurses that young ones can look up to and learn from - enabling environment for nursing leaders in delivering meaningful change - developing structures supportive of nursing leadership

Critical gaps in the nursing profession 5 4. To address issues of Social Positioning of the Nursing profession- Nurses not satisfied with the public image The profession is not well positioned to attract the best candidates for training as future professionals Balancing the functions of a Nurses’ Association and Nurses’ Union as required by the international bodies (ICN, ICM, ILO)

Future plans for Uganda UK Alliance To address the challenges that have been highlighted as a potential threat for the nursing profession Through mentorship, exchange programmes, the nursing department in particular, will have an opportunity to implement the National Health Policy within the context of globalisation, liberalisation, and macroeconomic policy setting. To build consensus among stakeholders with regard to the strategic direction, products and services required to develop the nursing and midwifery services in Uganda.

Future plans 2 Creation of visible nursing services at institutional levels and in the primary health care sector responsible for managing, developing and implementing quality nursing services Strengthened and improved the capabilities of nurses through structured, sustainable continuing education programmes and research. Improved coordination between the Ministry of Health and the Ministry of Education to reduce the gaps between education and clinical service.

- Office of Commissioner Nursing - Officer of the Registrar FUTURE PLANS 3 Strengthened key leadership in the Nursing Profession through initiation of this Alliance: - Office of Commissioner Nursing - Officer of the Registrar - Office of Nurses Association - Principal Tutors – Ministry of Education and Sports - Regional leaders by implementing twinning arrangements both nationally and internationally

acknowledgements Thanks to Uganda UK Health Alliance and its Director, Maura Buchanan UHSM Academy for supporting my visit to UK To all UK volunteers who give of their time and expertise to support our efforts.