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As the elephants fight, where is the future of nurses?

By Vision Reporter

Added 18th March 2008 03:00 AM

TWO years after completing his diploma course in nursing and midwifery, Joseph Kikimani (not real name) has not received a practising certificate. This is because the Uganda Nurses and Midwives Council (UNMC), the professional body that is supposed to enroll successful candidates, rejected him.

TWO years after completing his diploma course in nursing and midwifery, Joseph Kikimani (not real name) has not received a practising certificate. This is because the Uganda Nurses and Midwives Council (UNMC), the professional body that is supposed to enroll successful candidates, rejected him.

By Stephen Ssenkaaba

TWO years after completing his diploma course in nursing and midwifery, Joseph Kikimani (not real name) has not received a practising certificate. This is because the Uganda Nurses and Midwives Council (UNMC), the professional body that is supposed to enroll successful candidates, rejected him.

“When I went to register with the council, they turned me down.” Kikmani is now stranded. “I cannot be employed without a certificate.” Today, the father of two is back home in Kumi, unable to take care of his family.

Kikmani is one of 1,449 nursing and midwifery students who successfully completed their exams in May and November 2006, but were denied certificates by the nursing council.
These students are at the heart of an unresolved conflict between the ministries of education, health and the nursing council over training and regulation of nurses and midwifery training institutions.

For the last two years, the conflicting parties have been struggling to reach a consensus over, among other issues, examinations, awarding of certificates, registration and the appropriate enrollment procedures for students who complete their courses.

Where does this leave the students?

“I tried to open a Class C drug shop, but was stopped because I did not have a certificate,” said a former student. It is particularly hard for those who paid their own way through the course. A three-year certificate course in Nursing and Midwifery costs about sh1.2m per semester, while a diploma course costs more. Students are demanding answers.

Joseph Abala Mundu, the assistant commissioner of Business, Technical Vocational Education and Training (BTVET), and member of a technical sub-committee handling the matters, says plans are under way to resolve the impasse.

“A ministerial committee and a technical committee comprising representatives from the ministries of health and education were set up, following the intervention of Parliament.

“This was done to iron out the problems affecting health training institutions. In consultation with the nursing council and student representatives, the committee has agreed to enlist the affected students for a three-month attachment programme to hospitals and then have them registered.”

Mundu added that sh500m has been budgeted for the exercise. But for an exercise that had earlier been estimated to cost sh2b, there is still concern about the adequacy of the funds and the sustainability of the programme.

“The second examination” controversy

This conflict started at the beginning of 2006 when the nursing council announced plans to administer another set of examinations to students who would have passed the national examinations set by the Uganda Nurses and Midwives Examinations Board (UNMEB).

Passing this exam, said the council, would determine students’ enrollment.
“Passing council examinations is a prerequisite to registration/enrollment to permit practice in Uganda and elsewhere in the world,” said Florence Rita Matte, the registrar.

The idea of sitting two sets of exams, however, did not go down well with the students.

“We clearly indicated that students would only be subjected to one exam regardless of which board set that exam,” wrote Wilber Tukamuhabwa and Justus Timbigamba, the president and vice publicity secretary of the Uganda National Association of Students Nurses and Midwives, respectively, in an August 13, 2006 petition to the education ministry.

In response to the students’ petition, F. X. Lubanga, the permanent secretary in the education ministry, wrote: “The registrar of the Uganda Nurses and Midwives Council has neither cause nor justification for subjecting students to a second examination.”

Lubanga explained that after being examined against a duly established Board (UNMEB), the second examination was not necessary. Consequently, the council refrained from enrolling students that sat UNMEB examinations that year.

Why the second examination?
The council insists that this exam was intended to enable them determine the students’ competence.
“The council is responsible for professional standards of nurses. We are, therefore, charged with ensuring that graduating students have the competence to practise and the only way to do this would be through a proficiency exam,” says Patrick S. Bateganya, a council member and the Secretary Uganda National Association of Nurses and Midwives. He said this has been the practice since 1954.

The ministry of education, however, argues that the councils’ role does not involve setting and giving exams.
“Their role stops at registering students, while the training, exams and award of qualifications is the concern of training institutions and the education ministry,” says Mundu.

Defective laws

Much of the blame in this misunderstanding has been attributed to the failure by the Government to streamline the regulation of health training institutions after the 1998 restructuring process. Then, the management of these institutions was transferred from the Ministry of Health to that of education.

Critics say the transfer was carried out without sufficient preparation and sensitisation of key stakeholders.
“The Ministry of Health was not prepared to handle the consequences of the transfer, nor was the ministry of education prepared to receive the schools,” says a report by the Parliamentary Session Committee on Social Services on training of nurses and midwives in Uganda.

The report further notes: “The hospitals where students are meant to do their practical and clinical training belong to the Ministry of Health, while the training institutions now belong to the ministry of education.”
Unfortunately, the transfer of these health training institutions did not put into place arrangements for joint management of operations between hospitals and health training institutions, especially in regard to training programmes and use of physical facilities in practical areas.

The Nurses and Midwives Act 1996 which gives the nursing council power to regulate health training institutions has, to date, not been amended to cater for the changes in management. The council has continued to use the law to wrongfully assert its authority over regulation of health training institutions.

It took seven years and several complaints from students before the creation of the national examination body for health training institutions.
Aggrey D. Kibenge, the education mnistry’s spokesman, agrees that there have been a few inconsistencies over which the ministry had no control.

“It was a decision of Cabinet to transfer the institutions. Adjustment has not been easy,” Kibenge said. He added that the education ministry was about to present a BTVET Bill to Parliament, which will address the existing inconsistencies.

Acute shortage

This impasse, ironically, comes at a time when the country is grappling with serious brain drain of health workers and an acute shortage of nurses.
The Global Health Workforce Alliance recently said out of 28,064 student nurses and midwives trained in Uganda since 1970, only 16,739 are registered. A total of 21,011 passed the exams, but were not registered.

The current nurse/patient ratio is 1:1,000, a far cry from the World Health Organisation standard of 1:2 for fatal illnesses and 1:5 for the common ones. To fill the gap, says an official from the nursing council, Uganda needs 68,000 nurses and midwives.

It is disturbing that in a country with such a glaring shortage of nurses and midwives 1,449 qualified students are idle.

As the elephants fight, where is the future of nurses?

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