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Building meaningful partnerships is a critical step in achieving social justice in global health. UMSON's Office of Global Health is committed not only to advancing nursing skills, knowledge, and practice, but most importantly, collaborating with key institutions to meet identified nursing priorities. Together, the Office of Global Health strives to create programs to improve population health outcomes and address the professional development and capacity of health care workers. The shared vision of all of our partnerships is to strengthen the global health care workforce by making the nursing role more visible, recognized, and valued in the health systems of key countries.
Partnerships for Improving Primary Health Care
One of the primary obstacles in meeting the Millennium Development Goals is the scarcity of human resources for health, including the lack of a qualified health care workforce to provide for the needs of maternal and child health and populations with HIV/AIDS, malaria, and tuberculosis. In Nigeria, the main point of free, accessible health care is the primary health care center. Yet the quality of care available in these centers is often inadequate and contributes to the poor health outcomes found in the Nigerian population. Today, Nigeria has one of the highest mortality rates worldwide, particularly among women and children. The majority of these deaths are preventable. (See Table 1. Source: WHO Nigeria Country Profile, 2009 data)
|Table 1. Selected Health Indicators, Nigeria, 2009 Data|
|Maternal mortality ratio (per 100,000 live births)||840||620||260|
|Under-5 mortality (per 1,000 live births)||138||137||60|
|Neonatal mortality (per 1,000 live births)||48||49||30|
|Tuberculosis prevalence (per 100,000 population)||497||475||201|
Like many developing countries in Africa and throughout the world, nurses and community health officers (CHOs) are the backbone of Nigeria’s health care system. Nurses and CHOs are often asked to engage in clinical and public health leadership responsibilities for which they have no education or training. This is particularly common at the primary health care level, where a nurse and/or CHO is often the sole health care worker in the facility. Expanding the capacity of these frontline workers is a critical aspect of building sustainable health care systems and will require innovative educational programs based on the specific realities that exist in Nigeria.
One such innovative educational initiative is the Primary Health Care Specialist (PHC-S) Diploma Program developed by UMSON's Office of Global Health. Working closely with the University of Maryland School of Medicine’s Institute of Human Virology (IHV) in Baltimore and in Nigeria; Nigerian nurse leaders from Obafemi Awolowo University, Ile Ife; University of Nigeria, Nsukka; and Ahmadu Bello University, Zaria, this 12-month advanced diploma program is designed to rapidly and effectively address the immediate human-resource needs that exist in Nigeria and meet the need for greater competency and skill development in the primary health care sector. The PHC-S program specifically addresses the burden of disease in Nigeria, including essential aspects of prevention and treatment for HIV/AIDS, tuberculosis, malaria, infant and child health, as well as common adult health problems such as diabetes and hypertension. The PHC-S will serve primarily as an expert independent clinician who can conduct assessments and diagnoses and provide treatment and personalized health care for individuals and families.
For more information about the PHC-S program, please contact Yolanda Ogbolu, PhD, CRNP-N (firstname.lastname@example.org).
Institutional Strengthening Project, Haiti
The UMSON Office of Global Health has embarked on a new project in Haiti that brings together the University of Maryland Schools of Medicine and Nursing, UMIHV, and the University of Maryland Medical Center (UMMC), to develop an infectious disease training curriculum for Haiti’s principal nursing school. The Institutional Strengthening Project, Haiti (ISPH), will build the capacity of the nation’s nurse workforce, nursing education, and the health care system to cope with the dire need for services resulting from the January 12, 2010 earthquake and to respond to future disasters and epidemics.
The Basic Certification Training Program (BCTP) is one component of ISPH. It is an initiative led by UMSON that will expand the capacity of our faculty and School to engage in advancing nursing education and practice in global health settings. This program will be the first post-baccalaureate certificate program for nurses to be recognized by the Haitian Ministry of Health and will be housed in a renowned health sciences educational institution, University of Notre Dame of Haiti. The Infectious Diseases Nursing Certificate Program is the first BCTP which began January 2011.
There are partnerships on multiple levels of ISPH. The project is funded by HRSA, with Catholic Relief Services as the prime grant recipient and CDC, Haiti as in-country donor administrator. For the educational and training component of ISPH, Catholic Relief Services is partnering with multiple UMB partners: UMSON, School of Medicine's Institute of Human Virology and Department of Orthopedics, UMMC, and R Adams Cowley Shock Trauma Center. Partners on the ground in Haiti that will implement activities in the future are the University of Notre Dame of Haiti Schools of Nursing and Medicine and a network of four Catholic hospitals across the country: San Francois de Sales, San Bonifas, San Damien, and Sacred Heart. At least five UMB entities are engaged in ISPH with members from UMB schools and hospitals working together to implement various aspects of program.
Currently, two nurse cohorts have graduated and the third began in May 2013. With each cohort, the pass-rate and scores and pre-post test results improve. One formative evaluation with partner sites and UNDH faculty was conducted in July 2012 and the first evaluation of program graduates for quality improvement purposes will occur June 2013. A new component of the ISPH was added which includes a Refill Clinic training component – a task shifting approach where nurses are trained to intermittently manage stable patients (according to specified criteria) who are only in clinic for prescription refills. The first Refill Clinic training for site-based nurses will be conducted at St. Boniface July 2013.
For more information on this project, please contact Marik Moen, MPH, MSN, RN (email@example.com).
Partnerships for Filling the Health Care Workforce Gaps
The 14-year civil crisis in Liberia lead to the destruction of hospitals and clinics and the shut down of most educational programs, causing medical professionals to leave the country and a devistated economy. With a life expectancy of 57 years of age and an infant mortality rate of 17th in the world, Liberia is struggling to address the basic health needs of the current population. The scarcity of physicians and limited supply of human resources lead many nurses and midwives to practice outside of their scope of practice and guidelines. Advanced degree nurses are needed to fill this gap and address those needs.
The University of Maryland School of Nursing, in collaboration with the Mother Patern College of Health Sciences in Liberia, proposed to implement a Primary Health Care Specialist (PHC-CS) master’s program to increase the competence of workers and quality of patient care. A needs assessment was performed by the UMSON in May-June 2012. Through key interviews, curricula reviews, and site visits, it was deemed that a PHC-CS program would prove to be an effective recruitment and retention tool. The ultimate aim of the program is to reduce child and maternal mortality, improve maternal health, and battle major diseases ravaging the country.
Partnerships for Expanding Nursing Education Nationally
August 2012 marked the start of the Human Resources for Health (HRH) program in Rwanda, launched by the Rwandan Ministry of Health and the Clinton Health Access Initiative in collaboration with 23 U.S. medical, nursing, dentistry, and health management institutions, including the University of Maryland School of Nursing. The HRH program works toward building the health education infrastructure and workforce that is needed to provide high-quality sustainable health care in Rwanda.
The HRH program came into existence in response to the 1994 genocide, which left the country in dire need of health system restructuring and strengthening. The country continues to be faced with issues of maternal and child illness as well as diseases of poverty, including malaria and diarrheal disease, and an increasing burden of chronic diseases (diabetes, hypertension, etc.). The Rwandan government and Ministry of Health faces several challenges and obstacles in providing health care to the population including lack of an educated workforce, a shortage of skilled health personnel and equipment, and inadequate management of facilities. The HRH program serves to address these challenges through pairing Rwandan faculty, clinicians, and students with U.S. faculty in order to provide mentorship and increase knowledge and skill base in specific health fields.
The eight-year plan will attempt to increase the number of physicians, increase the number of nurses and midwives with Bachelor’s and/or Master’s degrees, introduce the role of health manager, launch the Rwanda School of Dentistry, and build the capacity of health education schools to sustain high quality education. After this time frame, U.S. involvement will be phased out and Rwanda will be left with the resources necessary to continue to build and sustain the health care system and workforce.
The platform for engagement in the Rwanda HRH Program is groundbreaking. Certainly, the gains of being part of this revolutionary process to address Human Resources for Health crises will be of significant value for participating U.S. institutions, however, the U.S. universities and faculty have agreed to commit their resources essentially at cost. This constitutes an unheard of commitment in global health partnerships to date. The participation on the Rwanda side is massive. The following institutions are involved in the HRH program:
|Rwandan Organizations||Referral Hospitals||District Hospitals and Schools of Nursing & Midwifery|
Ministry of Health
National Council for Nursing & Midwifery
Kigali Health Institute
School of Public Health
Centre Hospitalier Universitaire de Kigali (CHUK)
Centre Hospitalier Universitaire de Butare (CHUB)
King Faisal Hospital (KFH)
Rwanda Military Hospital (Kanombe)
Ndera Referral Hospital (for mental health)
Byumba District Hospital (DH)
Byumba School of Nursing & Midwifery (SNM)
Kabgayi DH & SNM
Kibungo DH & SNM
Nyagatare DH & SNM
Rwamagana DH & SNM
Soon to be added: hospitals and schools of nursing & midwifery in Ruli, Gitwe, and Kibogora
For year one of the program, UMSON has deployed seven faculty members to Rwanda, the second highest number of faculty members among participating schools of nursing. For year two, Maryland may have the most participating faculty members with 11 faculty members committed to serve in Rwanda.