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NationalRegulatoryCapacityandNursesandMidwifeLeaders’PerceptionsoftheAfricanHealthProfessionRegulatoryCollaborativeforNursesandMidwives(ARC):EvaluationofFourYearsofARCEast,CentralandSouthern
MaureenKelleyCNM,PhD,FAANClinicalProfessorEmoryUniversity
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ARC:ProjectOverview
• 4-yearinitiativefundedthroughPEPFAR
• Regionalcollaborative– sub-SaharanAfrica
• Supportsnursingandmidwiferyleaders
• ImprovingregulationforHIVservicedelivery
• Utilizescross-countrycollaboration
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KeyARCParticipants:“TheQuad”
•NursingandMidwiferyProfessionalAssociation
•HealthProfessionalTrainingInstitutions
•NursingandMidwiferyRegulatoryCouncil
•MinistryofHealthChiefNursingOfficer(CNO)
Servicedelivery,healthpolicies
Professionalstandards
andcompliance
Voice toGovernmentforhealth
workersandmembers
Pre-service and
continuingeducation
The Quads of Africa: http://emorynursingmagazine.emory.edu/issues/2016/spring/features/quads-of-african/index.html
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TheARCApproachAdaptedfromtheInstituteforHealthcareImprovement(IHI)
modelforbreakthroughorganisationalchange
FEB 2015 FEB 2016
End
Nov-Feb
Nov 2015July 2015
Jul-NovMay-Jul
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TheARCApproach• Cross-CountryCollaboration• AnnualSummativeCongress• Twolearningsessionsforcountriesawardedgrants• Platform:lessonslearned,exchangetools,technicalassistance
• RegulationImprovementGrants• Annualcompetitiveprocesswithexternalpeerreview• Supporttoaddressanationally-identifiedregulationpriority
• TargetedTechnicalAssistance• Forgranteesandcountrieswithoutgrants
• Evaluation• RegulatoryFunctionFramework- stagesofchange
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Objectivesofevaluationresearchstudy
• Categorizecountriesacrossfivestagesofdevelopmentofregulatoryfunctionfromplanningtooptimizing
• Describeinter- andintra-organizationalrelationshipandnetworkinggainsachievedthroughtheARC-ECSinitiative
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RegulatoryFunctionFramework(RFF)
TheRFFcomprisessevenregulatoryfunctions1. Legislation– creatingorrevisingnursing/midwifery2. Registration– systemsanddatause3. Licensure4. ScopeofPractice5. ContinuingProfessionalDevelopment(CPD)6. Pre-serviceAccreditation7. MisconductandDisciplinaryPowers
McCarthy,C.F.,Kelley,M.,Verani,A.,St.Louis,M.,&Riley,P.(2014).Developmentofaframeworktomeasurehealthprofessionregulationstrengthening.EvaluationandProgramPlanning,46,17–24.http://dx.doi.org/10.1016/j.evalprogplan.2014.04.008
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EachFunctionhasFiveStages
RegulatoryFunctionFramework(RFF)
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ContinuingProfessionalDevelopment
MultipletypesofCPDavailable.CPDcontentalignswithregionalstandardsorglobalguidelines.RegularevaluationsofCPDprogramcarriedout.
Stage5
Electronicsysteminplacetrackcompliance.PenaltiesexistforCPDnon-compliance.AvailableCPDincludescontentonHIVservicedelivery.
Stage4
CPDprogramisfinalizedandnationallydisseminated.CPDismandatoryforre-licensure.Strategyinplacetopromoteandtrackcompliance.
Stage3
CouncilhasamandateinlawtorequireCPD.NationalCPDframeworkhasbeendeveloped.CPDinpilotphases.
Stage2CPDdoesnotexist.CPDisvoluntary.CPDframeworkfornursingmaybeinplanningphases.
Stage1
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RegulatoryFunctionFramework(RFF)
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ARCGrants– NationalInvestments
• 7countries– EstablishCPDprograms• 12countries– AdvanceCPDprograms• 5countries– ReviewandreviseSOPs• 3countries– Reviewandupdateacts/regs• 1country– Decentralizecouncilservices• 2countries– Developentrytopracticeexams
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ARCImpactonCPD:Y1-Y4
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ARCYear4Grantees• ContinuingProfessionalDevelopment– Ethiopia,Kenya,Rwanda,Tanzania,Zambia,Lesotho,Seychelles,Zimbabwe
• Licensure– Mozambique(OSCE)
• Accreditation– SouthAfrica(SpecialtyLicense– HIV/AIDSCare)
• ScopeofPractice– Botswana
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AdvancementbyRegulatoryFunctionStageforARCYear4Grantees
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Teamwork,NetworkingandInter-OrganizationalRelationships
• Toolwasdevelopedthataskedthe17countriestowhatextenttheyengagedintheseactivitiespriortoinitiationofARCandduringyear4(usinga5levelscale)
• Openendedquestionswerealsoaskedabouttheseaspectsoftheirworktogether
• Questionnairewasself-administeredtoeachcountryteam
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QUALITATIVERESULTS
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TeamworkamongNationalNursingLeaders
• Teamwork:QuadmemberstendedtoworkinisolationfromeachotherpriortoARC– “priortoARCeachnursingpillaroperatedindividually.Therewasmiscommunication,alackofcoordinationandwastedresources…currentlythepillarsareworkingtogetherwithacommongoal”
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Relationship-buildingbetweenQUADorganizations
• RelationsbetweenQuadorganizationspriortoARCweredescribedasbeingpoortomoderate,with5countriesindicatingweakorveryweakties.
• AttheendofARCY4,allbut3Quadsdescribedinter-organizationalrelationshipsasstrongorverystrong.
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Relationshipbuildingwithotherorganizations
• PriortoARC,5Quadsreportedhavingmoderatetiestonon-ARCorganizations,and8reportedthattheserelationshipswereweakorveryweak
• After4yearsofARCengagement,Quadsreportedhavingmuchstrongerrelationshipswithotherorganizations,includinglocalCDCoffices,internationalNGO’sandUNgroups
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NetworkingwithQuadsfromotherARCcountries
• ARChasalsopromotedregionalnetworkingbetweenQuadteamsfromparticipatingcountries.– “wenowattendfrequentandinteractivemeetings.Topicsofcommoninterestarepresentedanddiscussed,andguidanceisprovidedtostrengthenregulatorycapacity.Thereisconsultationwithothernurseleadersfromvariouscountries”
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Summary
• ARCinitiativehasdemonstratedthatsustainedinvestmentinasouth-to-southregionalcollaborationcanyieldimportantandmeasurableimpactsonhealthworkforceregulation
• Thereweresignificantgainsinnursingleaders’teamwork,organizationalcollaborationandcross-countrynetworking