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

Abstract

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.

Are the Global Strategic Directions for Strengthening Nursing and Midwifery 2016–2020 being implemented in countries? Findings from a cross-sectional analysis

“…Our findings support existing literature on nursing and midwifery workforce development and progress on advancing UHC and PHC. High levels of completion in interventions related to regulation, accreditation and engaging professional associations are aligned with the published outcomes of the African Regulatory Collaborative, a 5-year initiative (2011–2016) focused on advancing nursing regulation through intraprofessional collaboration [39–41]. The Nursing Education Partnership Initiative (NEPI) established in 2011 by the U.S. President’s Emergency Plan for AIDS Relief [42, 43] also focused on strengthening nursing education and competency-based curricula.…”

Evaluation of the impact of the ARC program on national nursing and midwifery regulations, leadership, and organizational capacity in East, Central, and Southern Africa

“…For the remaining domains, less than 13% of countries scored intra-professional collaboration as strong or very strong before ARC, compared to 73% after the initiative; resource mobilization improved from 7% of countries scoring strong or very strong before ARC to 54% after the initiative. A more detailed and qualitative description of changes in the nursing and midwifery capacity domains is reported elsewhere [ 37 ].

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“…The survey included qualitative and quantitative Likert scale questions, which asked country teams to rate themselves in the five domains of leadership, collaboration, and organizational capacity both before and after their participation in the ARC program. A detailed description of the survey’s qualitative results has been published elsewhere [ 37 ].…”

Does improved postgraduate capacity shift the balance of power for nurse specialists in a low‐income country: A mixed methods study

“…There are several countries in the EU and Asia, reported by Ranchal et al () that have unregulated specializations in nursing, leading to titles not being protected and nurse specialists not being recognized in practice. The establishment of a nursing and midwifery regulatory body in Mozambique is in its infancy; however, there appears to be political support for and a legal mandate to establish a Council for Nurses through ARC—the African Health Profession Regulatory Collaborative (Kelley et al, ).…”