The Lived Experience of Discontinuing Hormonal Contraception Among Women in Rural Uganda

The purpose of the study was to describe the experience of discontinuing hormonal contraceptive use among women in rural Uganda. A significant number of women in Uganda discontinue hormonal contraception even though such method has been effective. Consequently, these women have unprotected sex, although not wanting to conceive. Narrative descriptions of the experiences by eight women were analyzed using content analysis. The findings describe the experience as Frustration and Helplessness, Living in Fear of Uncertainty, Ingenuity of using other methods of contraception, thus fostering the Accomplishments of being a wife, mother, and woman. Implications for nursing practice, research, and education are described

Strengthening educational advancement for enrolled nurses: Developing a new program framework for Uganda

Uganda has three pre-service program levels for entering nursing practice, the first of which is, the Enrolled Nurse (EN) and constitutes majority of Uganda’s nursing workforce. While these enrolled nurses constitute a substantial proportion of the nursing workforce and are the lowest on the qualification’s framework, their educational advancement opportunities remain limited. A host of barriers are implicated including unsuitable program schedules among others. Due to work and family commitments ENs find themselves unmatched to available programs which are supposed to target them. Most of the literature on EN educational advancement originates from High income countries, such as Australia, Canada, USA, and European countries. Within Uganda, a low-income country, there is a lack of understanding of the needs of ENs who struggle to access educational advancement programs. Therefore, this thesis explores ENs experiences, aspirations and needs with respect to advancing their nursing careers, hence generating new evidence for designing responsive education programs. The research progressed in three phases guided by Cross’ Chain of Response Model. The study utilized a mixed methods multiphase design targeting four Focus Group Discussions (FGDs) with ENs (N=38) and exposed experiences aspirations and needs for their educational advancement within Uganda (phase 1). The knowledge generated from the FGDs was used to ground a cross-sectional survey of barriers and facilitators which was administered to a target random sample (n=423) of ENs (phase two). Interviews with key educators (n=9) examined the suitability of Ugandan EN-RN advancement programs in meeting EN education needs (phase three). Findings reveal a population of ENs who have strong aspirations for educational advancement yet remain unserved by the current advancement education. Consequently, ENs described their experience as worrying, frustrating and desperate. To advance, they need tuition support, flexible scheduling of advancement education, favourable policies, and support of their employers among others. A comprehensive and stratified table of model elements necessary for building responsive EN-RN programs is presented

Improving Response Rates to an Alumni Survey in East Africa

Feedback from students and graduates is essential to inform ongoing quality improvement in higher education. However, African universities often face implementation issues in alumni surveys, including technological barriers and difficulties in tracking graduates, particularly those from earlier cohorts and rural alumni. Innovative strategies are needed to locate alumni and obtain a good response rate across widely dispersed, rural and remote areas. This paper reports on strategies used to increase response rates in an East African online alumni survey in a context of limited computer/Internet access. The survey aimed to assess the impact of nursing graduates over a 15 year period (2001–2016). Strategies focused on locating and communicating with graduates and providing solutions to barriers associated with computer/Internet access. Better engagement with alumni was achieved using mobile technologies and social media networks. Facilitating access to online surveys by taking technology to alumni or providing hubs for online access encouraged survey participation. The strategies discussed in this study are particularly relevant for clustered or networked alumni populations (e.g. nurses) in low income and limited resource settings

Capacity building among nursing and midwifery professional associations in East Africa

Background: Despite improvements in educational opportunities, policy changes, and pay raises in the nursing and midwifery professions in East Africa, poor working conditions, few professional development opportunities, and a general lack of respect for these professions predominate. These issues contribute to a low quality of care among a population with a high burden of communicable diseases. Health professional associations may help to address these challenges by providing a voice for nurses and midwives. Objective: This study evaluated the impact of a 5-year programme focused on strengthening nurses’ and midwives’ professional associations in East Africa. Methods: This study used a mixed methods design. Quantitative, cross-sectional descriptive data were captured via surveys (n = 1,266) distributed to association members. In-depth interviews (n = 65) were used to obtain qualitative data and complement the survey responses. Quantitative and qualitative data collection occurred concurrently. The results were compared to assess the impact of the programme across Uganda, Kenya, and Tanzania. Results: The programme successfully built capacity in four of five organisational capacity areas: resource mobilisation, financial management, strategy, and monitoring and evaluation. Marketing and communications, the fifth targeted area, did not show improvement. Capacity in both research and service delivery was also improved, despite the programme not providing training in these areas. In addition, collaboration among associations and their members was improved. Conclusion: These results support existing evidence on the impact of capacity building among professional nursing associations and coincide with the World Health Organization’s objectives for nursing. Future capacity building programmes should consider replicating the successful activities from this programme and investigate ways to reach more rural branches and provide tailored content. This study contributes to a small but growing body of knowl- edge that supports capacity building among the African health workforce

Introducing a new cadre into Uganda’s health care system: lessons learnt from the implementation process

Uganda introduced Registered Comprehensive Nursing (RCN) and Enrolled Comprehensive Nursing (ECN) training programs in 1994 and 2003 respectively, to create certificate and diploma level cadre of nurses with competencies in general nursing, midwifery, public health, psychiatry, paediatrics and management. This paper is based on an evaluation study undertaken to assess how the programs were implemented including stakeholders’ perceptions about the graduates. Despite being relevant, the implementation process of both programs failed to meet acceptable standards. We conclude that introducing a new cadre of nurses without proper preparation hinders realization of their full potential including their contribution to the healthcare system

Supporting Healthy Futures for East Africa: Celebrating 15 years of partnership in nursing education. School of Nursing and Midwifery in East Africa, Aga Khan University, Nairobi, Kenya

This impact evaluation study was designed on the basis of quality and accountability. It focused on sourcing evidence regarding the impact and achievements of a 15-year investment in nursing education and workforce capacity building. The study was also designed to enhance alumni connection and establish sustainable models for monitoring and evaluation.https://ecommons.aku.edu/books/1062/thumbnail.jp

The World Health Organization should design serious strategies to oblige poor nations to comply and curb rising numbers of female tobacco users

I write to commend the decision taken by WHO as in your article to Halt rising numbers of female tobacco users in poor nations, urges WHO, by John Zarocostas. BMJ 2010;340:c2956. As a person who has lived and worked in a tobacco growing area of my country, Uganda, I have vividly seen many of the dangers of tobacco, from growing it, to using it by chewing and smoking it in even the unprocessed forms. I have seen women, girls, boys and men waste their livelihoods in what I could term the ‘tobacco mess’. It saddened me because as a health worker (Nurse) working in that region at that time, I knew what they were headed for – disaster. Most heart breaking was that the government was busy praising the tobacco industry for the ‘great revenue’. Many governments, through their ministries of health, are in the know of all these issues and have tried to regulate them by putting policies in place to curb the situation. But because they pick the revenue with one hand it becomes difficult to sanction ‘meaningful’ policies with the other hand. The end result usually is unenforced policies, and many poor nations have a lot of these. This is worsened by the aggressive marketing policies of the tobacco industry. It’s a commendable decision that the World Health Organization has called for concerted global action to curb the rising numbers of female tobacco users, especially in poor nations. My concern is that this good move may eventually be watered down by the fact that these poor nations are blinded by the revenue from the tobacco industry and may not dare develop meaningful policies to curb the rising numbers of female tobacco users. The tobacco industry may also be threatened because this call may result in an overall reduction of their clientele, both female and male. The tobacco industry may therefore design more complex ways to keep the female tobacco users and even recruit more, both female and male. I therefore encourage and call upon the World Health Organization to design serious strategies to governments of these poor nations to comply and curb rising numbers of female tobacco users

Stakeholders’ Expectations of Graduates of a Work-Study Nursing Upskilling Programme in East Africa

Sound alignment of stakeholders’ expectations and graduate ability forms the reputational hallmark of a university’s education programmes. However, little is currently known about stakeholders’ expectations of graduates of work-study nursing upskilling programmes in low- and middle-income settings. Information is needed to ensure the quality and adequacy of curricula in such settings. The main aim of the current study was to explore the nursing stakeholders’ expectations of graduates of work-study nursing upskilling programmes. An exploratory qualitative study was conducted between March and October 2016 in three low- and middle-income countries in East Africa. Forty-two representatives of nursing employers, regulators and professional associations (PAs) participated. The data was collected during 27 key informant interviews (KIIs) and three focus group discussions (FGDs) using a pretested interview guide. Content analysis of the data was completed. Consolidated criteria for reporting of qualitative research guidelines were used as the standard for collecting data and reporting results. Stakeholders reported their expectations of a clinically and professionally competent nurse (an “all-round” graduate) with nursing management and leadership skills that facilitated sound clinical judgement and decision making and a high level of professionalism. The study highlighted nursing stakeholders’ expectations of nursing graduates who had completed a work-study upskilling programme. These expectations should inform curriculum planning and development, and highlight the need for a strong focus on clinical competence, leadership, critical thinking and professionalism in nursing upskilling programmes