Why are nurses given a raw deal?
Jun 15, 2009
EDITOR—I am moved enough to write in response to a recent letter submitted by an anonymous nurse. In a way she invited public reaction to the plight of enrolled/comprehensive nurses (ECN) in this country.
EDITOR—I am moved enough to write in response to a recent letter submitted by an anonymous nurse. In a way she invited public reaction to the plight of enrolled/comprehensive nurses (ECN) in this country.
According to the letter, the Uganda National Minimum Health Care Package (UNMHCP) II envisaged that an ECN would be able to work competently in rural areas of the country with minimum supervision, offering a mix of critical preventive, curative and rehabilitative service skills to implement the minimum healthcare package.
Indeed this is what it was meant for to get this cadre down to Health Centre III or II levels at least. In my own observation of Uganda’s healthcare policy, the frameworks and packages are superb, but mainly on paper.
Study after study in this country has shown that there is a wide gap between policy and what actually takes place, as far as operationalising implementation of these policies and packages are concerned. I know of at least two studies on quality of care and/or client satisfaction that have identified large gaps in terms of addressing manpower shortages.
In those studies, issues of staff training, recruitment and professional advancement featured highly, in as far as they substantially affect the delivery of quality care and satisfaction of clients or service users. Time and again the Ministry of Health has promised to fill vacant posts in critical areas, such as nursing and midwifery, but the situation is far from being addressed.
District health units, especially at the lower levels – from HC IV, III and II are teaming with nursing aides and/or nursing assistants who have clogged recruitment opportunities for trained staff (especially enrolled nurses and midwives).
Some of the latter have upgraded to registered levels, but have for years not been appointed to appropriate grades. Many more qualified nurses and other cadres of staff have not been confirmed in their initial service positions.
Instead, most of the auxiliary (unqualified) nurses are appointed mainly on political basis in districts by their District Service Committees to take charge of some of the health units! I think it was a mistake to have transferred the training of nurses and other healthcare professionals to the Ministry of Education in the first instance, for that ministry seems to produce en masse mostly for the open market (by levying fees on private students, etc), without necessarily tailoring manpower training to needs of the parent technical ministry.
The Ministry of Health through the Directorates of Manpower and Planning should have overall oversight of its manpower requirements in all areas of staff training, setting standards, recruitment, supervision, and opportunities for professional advancement.
I support the recent move and resolve by the Minister of Health to have this role reversed, so that his ministry assumes full responsibility without further delay. This will ensure skilled service delivery is progressively re-established and improved.
John Arube-Wani
Kampala
According to the letter, the Uganda National Minimum Health Care Package (UNMHCP) II envisaged that an ECN would be able to work competently in rural areas of the country with minimum supervision, offering a mix of critical preventive, curative and rehabilitative service skills to implement the minimum healthcare package.
Indeed this is what it was meant for to get this cadre down to Health Centre III or II levels at least. In my own observation of Uganda’s healthcare policy, the frameworks and packages are superb, but mainly on paper.
Study after study in this country has shown that there is a wide gap between policy and what actually takes place, as far as operationalising implementation of these policies and packages are concerned. I know of at least two studies on quality of care and/or client satisfaction that have identified large gaps in terms of addressing manpower shortages.
In those studies, issues of staff training, recruitment and professional advancement featured highly, in as far as they substantially affect the delivery of quality care and satisfaction of clients or service users. Time and again the Ministry of Health has promised to fill vacant posts in critical areas, such as nursing and midwifery, but the situation is far from being addressed.
District health units, especially at the lower levels – from HC IV, III and II are teaming with nursing aides and/or nursing assistants who have clogged recruitment opportunities for trained staff (especially enrolled nurses and midwives).
Some of the latter have upgraded to registered levels, but have for years not been appointed to appropriate grades. Many more qualified nurses and other cadres of staff have not been confirmed in their initial service positions.
Instead, most of the auxiliary (unqualified) nurses are appointed mainly on political basis in districts by their District Service Committees to take charge of some of the health units! I think it was a mistake to have transferred the training of nurses and other healthcare professionals to the Ministry of Education in the first instance, for that ministry seems to produce en masse mostly for the open market (by levying fees on private students, etc), without necessarily tailoring manpower training to needs of the parent technical ministry.
The Ministry of Health through the Directorates of Manpower and Planning should have overall oversight of its manpower requirements in all areas of staff training, setting standards, recruitment, supervision, and opportunities for professional advancement.
I support the recent move and resolve by the Minister of Health to have this role reversed, so that his ministry assumes full responsibility without further delay. This will ensure skilled service delivery is progressively re-established and improved.
John Arube-Wani
Kampala