The impact of care competency training for primary care nurses in South Africa

Includes bibliographical references (leaves 184-200).To effectively support the primary health care transformation of the South African health system, human resource development is needed. Nurses, at the forefront of primary care service delivery, urgently need support and advancement to fulfill their role. This study aimed to investigate the impact of core competency training on primary care nurse competence. To begin this investigation, a framework or core competencies was generated through two reference group meetings. This work was followed by a Delphi study to further define core competence in primary care nursing and how best to measure such competence. Nine core competencies were defined which led to the development and piloting of a core competency evaluation tool including a self-lest and observation tool. This early work was followed by the implementation and evaluation of a novel core-competency training program. This program was implemented within district health systems with working clinic nurses. It involved tour distinct sites in three different provinces. A total of 162 nurses took part in the study, including an intervention and reference group. The goal was to assess the impact of training in a real world setting. Using the self-lest and observation tools, this study showed that competence does improve with this type of training. Additionally, competence is most reliably assessed through observation since test familiarity and possible contamination decrease the usefulness of repeated self-test measures. Further assessment or this novel training program and ref1nement of the measurement tool are recommended. This study can serve to inform health policies, particularly regarding human resource development within emerging district health systems. It provides a practical and effective training approach for increasing nurse performance of primary care core competencies

The impact of care competency training for primary care nurses in South Africa

Includes bibliographical references (leaves 184-200).To effectively support the primary health care transformation of the South African health system, human resource development is needed. Nurses, at the forefront of primary care service delivery, urgently need support and advancement to fulfill their role. This study aimed to investigate the impact of core competency training on primary care nurse competence. To begin this investigation, a framework or core competencies was generated through two reference group meetings. This work was followed by a Delphi study to further define core competence in primary care nursing and how best to measure such competence. Nine core competencies were defined which led to the development and piloting of a core competency evaluation tool including a self-lest and observation tool. This early work was followed by the implementation and evaluation of a novel core-competency training program. This program was implemented within district health systems with working clinic nurses. It involved tour distinct sites in three different provinces. A total of 162 nurses took part in the study, including an intervention and reference group. The goal was to assess the impact of training in a real world setting. Using the self-lest and observation tools, this study showed that competence does improve with this type of training. Additionally, competence is most reliably assessed through observation since test familiarity and possible contamination decrease the usefulness of repeated self-test measures. Further assessment or this novel training program and ref1nement of the measurement tool are recommended. This study can serve to inform health policies, particularly regarding human resource development within emerging district health systems. It provides a practical and effective training approach for increasing nurse performance of primary care core competencies

Regulation of the Ysh1 endonuclease of the mRNA cleavage/polyadenylation complex by ubiquitinmediated degradation.

Mutation of the essential yeast protein Ipa1 has previously been demonstrated to cause defects in premRNA 3ʹ end processing and growth, but the mechanism underlying these defects was not clear. In this study, we show that the ipa1-1 mutation causes a striking depletion of Ysh1, the evolutionarily conserved endonuclease subunit of the 19-subunit mRNA Cleavage/Polyadenylation (C/P) complex, but does not decrease other C/P subunits. YSH1 overexpression rescues both the growth and 3ʹ end processing defects of the ipa1-1 mutant. YSH1 mRNA level is unchanged in ipa1-1 cells, and proteasome inactivation prevents Ysh1 loss and causes accumulation of ubiquitinated Ysh1. Ysh1 ubiquitination is mediated by the Ubc4 ubiquitin-conjugating enzyme and Mpe1, which in addition to its function in C/P, is also a RING ubiquitin ligase. In summary, Ipa1 affects mRNA processing by controlling the availability of the C/P endonuclease and may represent a regulatory mechanism that could be rapidly deployed to facilitate reprogramming of cellular responses.post-print4,60 M

Addressing human resources for health needs to support HIV epidemic control: prioritizing site-level interventions in Democratic Republic of the Congo, 2018-2020

Introduction: The United States President's Emergency Plan for AIDS Relief (PEPFAR) in Democratic Republic of the Congo (DRC) continues to fund programs aimed at achieving epidemic control in three provinces where 30 percent of people living with HIV/AIDS in the country reside. Challenges around human resources for health impede the delivery of quality HIV/AIDS services in DRC. Methods: In partnership with the United States Health Resources and Services Administration (HRSA), PEPFAR, and DRC Ministry of Health (MoH), Columbia University's International Center for AIDS Prevention (ICAP at Columbia University) worked with 16 PEPFAR-identified high-priority health facilities and developed specific interventions to address challenges in achieving PEPFAR 95-95-95 targets. Once interventions were selected and prioritized using a collaborative, criteria-driven approach, implementation of these human resources for health improvements began alongside care and treatment efforts already underway. This study began in October 2018, and high-priority interventions were launched in July 2019. Monthly reporting of key PEPFAR metrics continues for evaluation purposes. Results: All 16 high-priority health facilities participated fully. Of several hypothesized interventions, 12 were selected as highest priority, and budgets and task plans were developed for each. The interventions were launched for implementation and evaluation within six months of Ministry of Health approval. Conclusion: This assessment delineated necessary interventions to address site-specific human resources for health challenges/deficiencies. Downstream reporting of key PEPFAR 95-95-95 metrics, including Monitoring, Evaluation, and Reporting indicators, will allow intervention teams to conduct program evaluations and their impacts on targets

Strengthening the Quality and Quantity of the Nursing and Midwifery Workforce: Report on Eight Years of the NEPI Project

In response to the urgent need to scale up access to antiretroviral therapy, the Global Nursing Education Partnership Initiative (GNCBP), a PEPFAR program administered by the U.S. Department of Health Resources and Services Administration (HRSA), was implemented from 2011 to 2018 by ICAP at Columbia University. Working closely together, HRSA and ICAP partnered with local nursing leaders and ministries of health to strengthen the nursing and midwifery workforce across 11 countries. This multi-country project, developed to address critical gaps in nursing education and training worked across six building blocks of health workforce strengthening: infrastructure improvement, curricula revision, clinical skills development, in-service training, faculty development and building partnerships for policy and regulation to increase the quality and quantity of the nursing and midwifery workforce. As a result, 13,387 nursing and midwifery students graduated from schools supported under GNCBP. A total of 5,554 nurses received critical in-service training and 4,886 faculty, clinical mentors and preceptors received training in key clinical care areas and modern teaching methodologies. ICAP completed 43 infrastructure enhancements to ensure environments conducive to learning and strengthened nursing leaders as best evidenced by the election and formation of Mozambique’s first national nursing council and the NEPI Network. Going forward, efforts to strengthen nursing and midwifery can build on the results of the GNCBP project. Going forward, a new group of African nursing leaders are being supported to advocate for high quality patient-care led through inter-professional collaboration and participation in international efforts championing the critical role of nurses in achieving universal health coverage

Responding to the Challenge of the Dual COVID-19 and Ebola Epidemics in the Democratic Republic of Congo-Priorities for Achieving Control.

As of June 11, 2020, the Democratic Republic of the Congo (DRC) has reported 4,258 COVID-19 cases with 90 deaths. With other African countries, the DRC faces the challenge of striking a balance between easing public health lockdown measures to curtail the spread of SARS-CoV-2 and minimizing both economic hardships for large sectors of the population and negative impacts on health services for other infectious and noninfectious diseases. The DRC recently controlled its tenth Ebola virus disease (EVD) outbreak, but COVID-19 and a new EVD outbreak beginning on June 1, 2020 in the northwest Équateur Province have added an additional burden to health services. Although the epidemiology and transmission of EVD and COVID-19 differ, leveraging the public health infrastructures and experiences from coordinating the EVD response to guide the public health response to COVID-19 is critical. Building on the DRCs 40 years of experience with 10 previous EVD outbreaks, we highlight the DRCs multi-sectoral public health approach to COVID-19, which includes community-based screening, testing, contact-tracing, risk communication, community engagement, and case management. We also highlight remaining challenges and discuss the way forward for achieving control of both COVID-19 and EVD in the DRC

Increasing nursing student interest in rural healthcare: lessons from a rural rotation program in Democratic Republic of the Congo

Background Many challenges exist in providing equitable access to rural healthcare in the Democratic Republic of the Congo (DRC). WHO recommends student exposure to rural clinical rotations to promote interest in rural healthcare. Challenges to rural engagement include lack of adequate infrastructure and staff to lead rural education. This case report highlights key steps in developing a rural rotation program for DRC nursing students. Case presentation To implement a rural rotation (RR) program, ICAP at Columbia University (ICAP) consulted with students, the Ministries of Health (MoH) and Education (MoE), and nursing schools to pilot and expand a rural rotation program. Nursing schools agreed to place students in rural clinics and communities. Key stakeholders collaborated to assess and select rural sites based on availability of nursing mentors, educational resources, security, accessibility, and patient volume. To support this, 85 preceptors from 55 target schools and 30 rural health facilities were trained of which 30 were selected to be “master trainers”. These master trainers led the remaining 55 preceptors implementing the rural rotation program. We worked with rural facilities to engage community leaders and secure accommodation for students. A total of 583 students from five Lubumbashi schools and two rural schools outside Kinshasa participated across 16 rural sites (298 students in 2018–2019 school year and 285 in 2019–2020). Feedback from 274 students and 25 preceptors and nursing school leaders was positive with many students actively seeking rural assignments upon graduation. For example, 97% agreed or strongly agreed that their RR programs had strengthened their educational experience. Key challenges, however, were long-term financial support (35%) for rural rotations, adequate student housing (30%) and advocacy for expanding the rural workforce. Conclusions With nearly 600 participants, this project showed that a RR program is feasible and acceptable in resource-limited settings yet availability of ample student accommodation and increasing availability of rural jobs remain health system challenges. Using a multipronged approach to rural health investment as outlined by WHO over two decades ago remains essential. Attracting future nurses to rural health is necessary but not sufficient to achieve equitable health workforce distribution