The African Health Profession Regulatory Collaborative

ABSTRACT: BACKGROUND: More than thirty-five sub-Saharan African countries have severe health workforce shortages. Many also struggle with a mismatch between the knowledge and competencies of health professionals and the needs of the populations they serve. Addressing these workforce challenges requires collaboration among health and education stakeholders and reform of health worker regulations. Health professional regulatory bodies, such as nursing and midwifery councils, have the mandate to reform regulations yet often do not have the resources or expertise to do so. In 2011, the United States of America Centers for Disease Control and Prevention began a four-year initiative to increase the collaboration among national stakeholders and help strengthen the capacity of health professional regulatory bodies to reform national regulatory frameworks. The initiative is called the African Health Regulatory Collaborative for Nurses and Midwives. This article describes the African Health Regulatory Collaborative for Nurses and Midwives and discusses its importance in implementing and sustaining national, regional, and global workforce initiatives. DISCUSSION: The African Health Profession Regulatory Collaborative for Nurses and Midwives convenes leaders responsible for regulation from 14 countries in East, Central and Southern Africa. It provides a high profile, south-to-south collaboration to assist countries in implementing joint approaches to problems affecting the health workforce. Implemented in partnership with Emory University, the Commonwealth Secretariat, and the East, Central and Southern African College of Nursing, this initiative also supports four to five countries per year in implementing locally-designed regulation improvement projects. Over time, the African Health Regulatory Collaborative for Nurses and Midwives will help to increase the regulatory capacity of health professional organizations and ultimately improve regulation and professional standards in this region of Africa. The African Health Regulatory Collaborative for Nurses and Midwives will measure the progress of country projects and conduct an annual evaluation of the initiative's regional impact, thereby contributing to the global evidence base of health workforce interventions. CONCLUSION: The African Health Regulatory Collaborative for Nurses and Midwives is designed to address priority needs in health workforce development and improve regulation of the health workforce. This model may assist others countries and regions facing similar workforce challenges.     

The African Health Profession Regulatory Collaborative for Nurses and Midwives

Background

More than thirty-five sub-Saharan African countries have severe health workforce shortages. Many also struggle with a mismatch between the knowledge and competencies of health professionals and the needs of the populations they serve. Addressing these workforce challenges requires collaboration among health and education stakeholders and reform of health worker regulations. Health professional regulatory bodies, such as nursing and midwifery councils, have the mandate to reform regulations yet often do not have the resources or expertise to do so. In 2011, the United States of America Centers for Disease Control and Prevention began a four-year initiative to increase the collaboration among national stakeholders and help strengthen the capacity of health professional regulatory bodies to reform national regulatory frameworks. The initiative is called the African Health Regulatory Collaborative for Nurses and Midwives. This article describes the African Health Regulatory Collaborative for Nurses and Midwives and discusses its importance in implementing and sustaining national, regional, and global workforce initiatives.

Discussion

The African Health Profession Regulatory Collaborative for Nurses and Midwives convenes leaders responsible for regulation from 14 countries in East, Central and Southern Africa. It provides a high profile, south-to-south collaboration to assist countries in implementing joint approaches to problems affecting the health workforce. Implemented in partnership with Emory University, the Commonwealth Secretariat, and the East, Central and Southern African College of Nursing, this initiative also supports four to five countries per year in implementing locally-designed regulation improvement projects. Over time, the African Health Regulatory Collaborative for Nurses and Midwives will help to increase the regulatory capacity of health professional organizations and ultimately improve regulation and professional standards in this region of Africa. The African Health Regulatory Collaborative for Nurses and Midwives will measure the progress of country projects and conduct an annual evaluation of the initiative??s regional impact, thereby contributing to the global evidence base of health workforce interventions.

Conclusion

The African Health Regulatory Collaborative for Nurses and Midwives is designed to address priority needs in health workforce development and improve regulation of the health workforce. This model may assist others countries and regions facing similar workforce challenges.     

Burning bridges: policy,practice, and the destruction of midwifery in rural Costa Rica

The trend toward hospitalization of birth has a long history in Costa Rica and currently approximately 98% of births take place in the clinical setting. Impoverished rural areas, like the town of Buenos Aires, lag behind national trends and only recently has birth moved from the home to the hospital. Costa Rica's midwife certification program co-opted rural midwives as bridges to biomedicalization, responsible for both pushing women into the biomedical setting and filling the gaps left by a limited national health care system. Despite the eventual illegalization of key practices and of home birth itself, local use of midwives' services continues, albeit with local demands that have transformed midwives into bridges to biomedical care in ways unanticipated by and invisible to national programmers. Midwives provide key services like prenatal massage, treatment of pregnancy crises, and attending unforeseen home births and women unable to afford the modest costs of hospitalization. Yet, midwives report increasing dissatisfaction and the desire to stop providing services in their communities. Practices like prenatal massage are in demand, but are no longer embedded in a system of local exchange that is socially and economically meaningful. Midwives blame their clientele for their dissatisfaction, but directly link these changes to the notions of professionalism, compensation, and changing community values. Thus, the social relationship between midwives and their clients must also be understood as a destructive force burning midwifery as a bridge to safe birth. In this essay, I argue that the process of both remodeling and subsequently destroying midwifery practices begun in the formal health care sector at the national level continues at the local level through changing values and meanings associated with midwives' practices.     

Midwives’ knowledge,attitudes and confidence in discussing maternal and childhood immunisation with parents: A national study

IntroductionDespite the enormous benefits of childhood and maternal immunisation to individual and population health, the uptake of maternal vaccines during pregnancy remains suboptimal. Midwives are a trusted information source for parents and play an important role in the provision of immunisation information. Understanding midwives’ attitudes and vaccine knowledge, along with their confidence to discuss maternal and childhood immunisation with parents, is key to reducing parental decisional conflict and achieving immunisation goals.MethodsAn online study was conducted to investigate midwives’ knowledge and attitudes towards maternal and childhood vaccination along with their confidence to answer parents' vaccine-related questions. Midwives were recruited by email via the midwifery peek body, the Australian College of Midwives.ResultsA total of 359 midwives completed the online survey. The majority of midwives supported maternal (influenza 83%, pertussis 90.5%) and childhood immunisation (85.8%); however, 69.4% of respondents wanted further training about immunisation. Midwives who felt their midwifery education adequately covered immunisation were more confident advising parents about maternal (p = 0.007) and childhood immunisation (p < 0.001). Similarly, Midwives were significantly more likely to confidently advise parents about maternal (p < 0.001) and childhood immunisations (p < 0.001) if they had completed a specific immunisation training course outside of their midwifery course.ConclusionMost midwives working in Australia support vaccination. However, access to contemporary, culturally appropriate education that enables midwives to engage confidently with parents about immunisation is lacking. Education based on a women-centred approach within the pre-registration curriculum along with continuing professional development programs could enable midwives to reduce the evidence to practice gap by increasing vaccine uptake.     

Nordic cooperation--expanding to the Baltic countries

The paper describes the establishment in 1995 of the Nordic Association for Medical and Health Information, bringing together the five national associations from Denmark, Norway, Sweden, Iceland and Finland. Many forms of good and informal cooperation between these countries have always existed, but an association is needed to be able to officially act as a unified medical library community. Since the opening up of Eastern Europe to the West in the early 1990s, their need for professional updating and literature was paramount, and one of the current concerns of the Nordic Association is cooperation with the Baltic countries.     

Unpacking capacity to utilize research: A tale of the Burkina Faso public health association

One of the most important challenges in addressing global health is for institutions to monitor and use research in policy-making. In low- and middle-income countries (LMICs), civil society organizations such as health professional associations can be key contributors to effective national health systems. However, there is little empirical data on their capacity to use research. This case study was used to gain insight into the factors that affect the knowledge translation performance of health professional associations in LMICs by describing the organizational elements and processes constituting capacity to use research, and examining the potential determinants of this capacity. Case study methodology was chosen for its flexibility to capture the multiple and often tacit processes within organizational routines. The Burkina Faso Public Health Association (ABSP) was studied, using in-depth, semi-structured interviews and key documents review. Five key dimensions that affect the association's capacity to use research to influence health policy emerged: organizational motivation; catalysts; organizational capacity to acquire and organizational capacity to transform research findings; moderating organizational factors. Also examined were the dissemination strategies used by ABSP and its abilities to enhance its capacity through networking, to advocate for more relevant research and to develop its potential role as knowledge broker, as well as limitations due to scarce resources. We conclude that a better understanding of the organizational capacity to use research of health professional associations in LMICs is needed to assess, improve and reinforce such capacity. Increased knowledge translation potential may leverage research resources and promote knowledge-sharing.     

The importance of effective communication in interprofessional practice: perspectives of maternity clinicians

Midwives and doctors require effective information-sharing strategies to provide safe and evidence-based care for women and infants, but this can be difficult to achieve. This article describes maternity care professionals’ perceptions of communication in their current workplace in Australia. We invoke social identity theory (SIT) to explore how these perceptions affect interprofessional practice. A survey was conducted with 337 participants (281 midwives and 56 doctors). Using exploratory factor analysis we developed three scales that measured interprofessional workplace practice collaboration. Results indicated an intergroup environment in maternity care in which the professionals found exchange of ideas difficult, and where differences with respect to decision making and professional skills were apparent. Although scores on some measures of collaboration were high, the two professions differed on their ratings of the importance of team behaviors, information sharing, and interprofessional socialization as indicators of collaborative practice. These results highlight the complexities among maternity care providers with different professional identities, and demonstrate the impact of professional identity on interprofessional communication.     

Legalized, regulated, but unfunded: midwifery's laborious professionalization in Alberta, Canada, 1975-99.

In 1992, Alberta became the second Canadian province to legalize midwifery. This happened even though there were only approximately 20 midwives in practice at the time, and despite strong opposition from the medical and nursing professions. Between 1992 and 1999. Alberta established a regulatory framework for midwifery as a profession but. unlike Ontario and British Columbia, failed to pay midwives out of the provincial health care budget. This sent midwifery in Alberta into a crisis as many midwives closed their practices. This article first considers why midwifery was legalized and then professionalized in Alberta. Our answer emphasizes the leading role of state health bureaucrats in promoting midwifery as part of the state's challenge to medical dominance. Second. the article addresses why midwifery received so little governmental support at the same time that it attained professional status. This analysis includes a comparison with how midwifery developed in Ontario and British Columbia. Our conclusion is that midwifery in Alberta became a victim in the post-1993 period when a new Right government set aside bureaucratic initiatives in health care and committed itself to major cuts in government spending.     

25 years of public health leadership in Africa: the Ethiopian Public Health Association

This commentary discusses the historical development, organization and activities of the Ethiopian Public Health Association (EPHA), a professional civil society organization that operates on the principles of protection of public interest and professional standards in health in areas of health development in Ethiopia. The important roles played by the EPHA in health training, research and policy advocacy have been highlighted. Some of the important health system interventions that have been effected in the country through the influence and active participation of the Association have also been pointed out. As an active member of the Executive Board of the World Federation of Public Health Associations, EPHA serves as a role model for public health professional associations in the African Region with regard to increasing their influence in health policy and interventions within their respective countries.     

The racial integration of medical and nursing associations in the United States

Nursing associations and hospital nursing staffs integrated well before most racial integration took place in American society. In contrast, hospital medical staff integration lagged behind, and separate medical associations representing the distinctive concerns of two groups of practitioners have continued to exist. This article describes the divergent histories of these two fields and explores some reasons for these differences from a population ecology perspective. Nursing associations, unlike their medical counterparts, faced environmental constraints that made them ineffective as advocates for the economic interests of nurses. Yet, the American Nurses' Association served a more constructive role in the efforts to achieve racial integration than did the American Medical Association. More recent increases in market competition are now moving the more broadly based hospital and medical associations into a niche similar to the American Nurses' Association and giving rise to new organizations that are addressing more narrowly defined interests.     

Association of the Scientific Societies of Hungarian Medical Doctors (MORTESZ) was founded 80 years ago

After the First World War the professional medical societies in Hungary, which have already organized themselves nationwide, started to operate independently from each other. In that time came the idea to create another association above the others to gather them together while retaining their independent functioning. The Association of the Scientific Societies of Hungarian Medical Doctors (MORTESZ), established in 1931, became the nationwide forum for many medical associations. It also organized the first Hungarian Medical Grand-Week which became the annual meeting of the medical society. In the first year the cooperation only consisted of a common topic of two or three associations presented in the "Grand-Week". From year 1935, reports were appointed annually that each professional association could comment on. The proceedings of the "Grand-Week" were published yearly as appendices of the Hungarian Medical Journal. After the Second World War the activities of the independent associations were shut down by the authorities. The scientific and professional associations could continue their work as sections inside of the Doctors and Health Workers' Union. In 1966 the situation was solved thanks to the initiative of the Trade Union, the Department of Medicine and the Medical Section of the Hungarian Academy of Sciences which resulted in the foundation of the Association of the Hungarian Medical Societies (MOTESZ) which continues to gather together the collective work of many scientific associations and carries out tasks of general interest since then, similarly to the now 80-years-old MORTESZ.     

Midwives: professionals in their own right.

A survey of the history of midwifery in Argentina reveals the underprivileged position of women and the attempt of doctors to dominate other health professionals. In 1852 in Buenos Aires, the faculty of medicine established a curriculum for professional midwives who first graduated in 1855. In 1882, a children's hospital was built. Between the turn of the 20th century and World War II, more than 6,500,000 immigrants arrived in the country necessitating the expansion of health care. Health posts set up in the suburbs of Buenos Aires served as bases for midwives to attend home deliveries together with infant dispensaries, pediatric institutes, maternity clinics, and a system for the inspection of wet nurses. In 1901, the National Association of Professional Midwives was founded. This group denounced the practice of doctors attending normal births for pecuniary reasons, thus displacing midwives. Between 1917 and 1921,, institutions were established by doctors which assured their dominant place in health care, and midwives were gradually forced out of the care of normal pregnancies, attendance at normal deliveries, and infant care. After the 1970s institutionalized childbirth replaced home deliveries, and initially midwives had to act as anesthetists, surgeons assistants, and neonatologists. In Argentina, 70% of neonatal and postnatal deaths have avoidable causes, and over 90% of deaths occur in health establishments. In 1965, the duration of study at the School of Midwifery in Buenos Aires was extended, and full training in midwifery is now 8 years. The functions of midwives should include the education of families in birth spacing and family planning to reduce abortions, which causes half of maternal deaths; early diagnosis of disease; inpatient are and outpatient consultations at health establishments; and work in health centers, practical teaching, and research.     

The agreement and internal consistency of national hospital EMR measures

There has been national focus on increasing the use of electronic medical records (EMR) in hospitals because of their potential to improve care. Previous research has examined EMR use and reported an inconsistent relationship between EMR use and performance. This study examines the agreement between and the internal consistency of two national datasets that measure hospital EMR use. Data include the Health Information Management Systems Society (HIMSS) and the American Hospital Association (AHA). This analysis is essential to determine the strength and challenges of the nationally available EMR measures that are used in research, which informs national policy and practice. The results show very poor agreement between the two national datasets on hospital EMR use. The datasets demonstrate some internal consistency. In the absence of a gold standard measure of EMR use, researchers must be aware of the limitations of national EMR measures, and future research may validate the datasets.     

Australian maternity reform through clinical redesign

The current Australian national maternity reform agenda focuses on improving access to maternity care for women and their families while preserving safety and quality. The caseload midwifery model of care offers the level of access to continuity of care proposed in the reforms however the introduction of these models in Australia continues to meet with strong resistance. In many places access to caseload midwifery care is offered as a token, usually restricted to well women, within limited metropolitan and regional facilities and where available, places for women are very small as a proportion of the total service provided. This case study outlines a major clinical redesign of midwifery care at a metropolitan tertiary referral maternity hospital in Sydney. Caseload midwifery care was introduced under randomised trial conditions to provide midwifery care to 1500 women of all risk resulting in half of the publicly insured women receiving midwifery group practice care. The paper describes the organisational quality and safety tools that were utilised to facilitate the process while discussing the factors that facilitated the process and the barriers that were encountered within the workforce, operational and political context.     

某省助产专职人员现况调查

为每位分娩者提供专业助产服务是持续有效降低孕产妇和新生儿死亡的关键。为全面了解陕西省县级以上医疗机构助产技术的现状,对调查的68份问卷进行整理分析。数据显示：助产专职人员在职教育的缺失。阻碍了其专业水平的提高;产房内医生、助产专职人员职责划分不清,存在安全隐患;助产专职人员工作量大、职业风险高,得到与付出不相匹配。建议卫生行政部门尽快制定助产专职人员管理法律法规,用法律保证“母婴安全”目标的实现。     

Structural constraints and opportunities for CAM use and referral by physicians, nurses, and midwives

This article examines the attitudes and reported behaviors of physicians, nurses, and midwives regarding complementary and alternative medicine (CAM), with respect to one key theme that emerged from a broader qualitative study. Of central interest are the structural influences identified by study participants that either act as constraints or opportunities for their professional use of or referral for CAM. In an effort to interpret these results, the analysis is situated within the sociology literature that documents the influences of professional socialization, practice philosophy, regulation, and organizations on professional behavior. These influences are classified as either professional-level structures or work/organizational structures. The main conclusion is that future research should pay more attention to such structural dimensions that may be exerting influence on the decisions of providers about whether or not to professionally use or refer for CAM. This article is offered as a conceptual starting point for doing so.     

English midwives and the Association of Radical Midwives

Concern about the apparently shrinking role of the British midwife led in 1976 to the formation of the Association of Radical Midwives (ARM). This paper describes the emergence and ideas of ARM. Comparison of ARM philosophy with the beliefs of a sample of English midwives reveals considerable support for ARM's non-medicalized philosophy of childbirth and its specific proposals for systemic change. Few English midwives, however, consider themselves "radical midwives" or agree with ARM that their role has shrunk and training suffered. The conclusions suggest several reasons why English midwives' support for ARM and its beliefs is limited.     

The swan effect in midwifery talk and practice: a tension between normality and the language of risk

Midwifery activity in the labour room coalesces around routine surveillance practices. When engaging in such practice, midwives have to cope with attempting to instil a sense of confidence in the mother's embodied ability to give birth to her baby spontaneously while concurrently attending to an array of risk-focused tests and measurements. Midwives are vigilant about the potential harm that may come to mother and baby while at the same time they are responsible for facilitating a normal birth. This article sets out to explore the tension between these two tasks and shows how routine midwifery practice during labour can communicate certain understandings about birth. Using empirical evidence taken from an ethnographic study of midwifery talk and practice, attention is given to how midwives' activity during labour and birth implicitly introduces a sense of danger, an imagined risk that confines practice and operates to unsettle normality.     

Renegotiating inter‐professional boundaries in maternity care: implementing a clinical pathway for normal labour

This article presents findings from a study of a clinical pathway for normal labour (Normal Labour Pathway) implemented in Wales, UK. The study was conducted between 2004 and 2006. The pathway aimed to support normal childbirth and reduce unnecessary childbirth interventions by promoting midwife‐led care. This article focuses on how the pathway influenced the inter‐professional relationships and boundaries between midwives and doctors. Data are drawn from semi‐participant observation, focus groups and semi‐structured interviews with 41 midwives, and semi‐structured interviews with five midwifery managers and six doctors, working in two research sites. Whereas some studies have shown how clinical pathways may act as ‘boundary objects’, dissolving professional boundaries, promoting interdisciplinary care and de‐differentiating professional identities, the ‘normal labour pathway’ was employed by midwives as an object of demarcation, which legitimised a midwifery model of care, clarified professional boundaries and accentuated differences in professional identities and approaches to childbirth. The pathway represented key characteristics of a professional project: achieving occupational autonomy and closure. Stricter delineation of the boundary between midwifery and obstetric work increased the confidence and professional visibility of midwives but left doctors feeling excluded and undervalued, and paradoxically reduced the scope of midwifery practice through redefining what counted as normal.