Community Health Nursing

N/A

1. Community Health Nursing and
improving access and equity: A global
perspective
10th Conference of the Global Network of WHO
Collaborating Centres, 23-25 July, 2014
Coimbra, Portugal

Annette Mwansa Nkowane, RN, RM, Bsc, MA
Technical Officer, Health Workforce Department
Health Systems and Innovations, WHO, Geneva, Switzerland

2. 2 |
Presentation
Community Health Nursing
The context
WHO Multicounty Study
Opportunities
Conclusion

3. 3 |
Community health nursing

“A field of nursing that combines the skills of nursing,
public health and some phases of social assistance and
functions as part of the total public health programme
for the promotion of health, improvement of the
conditions in the social and environment, rehabilitation
of illness and disability"


World Health organization, Community Health nursing, 1974. Report of the WHO Expert Committee. WHO
Technical Report Series 558, Geneva Switzerland.

4. 4 |
The context (1)
Unmet human recources for health needs
A global chronic shortage of well-trained health workers
Countries with the greatest public health threats are more
affected.
57 countries facing crippling health workforce shortage,
mostly in sub-Saharan Africa but also including Bangladesh,
India and Indonesia.
Globally, nurses and midwives are recognized as the central
pillar of health care systems
Not sufficient numbers are trained or retained
Nursing and midwifery workforce aging with a decline in
younger women choosing nursing as a career

5. 5 |
The context (2)
Density of nursing and midwifery personnel, latest available year
Global Health Workforce Statistics database, 2013 update
(http://who.int/hrh/statistics/hwfstats/en/index.html)

6. 6 |
The context (3)
Global Health Workforce Statistics database, 2013
update
(http://who.int/hrh/statistics/hwfstats/en/index.html)

7. 7 |
The context (4)
Economic burden of NCDs and mental disorders
GLOBALLY
0
5
10
15
20
25
30
35
40
45
50
Low income Lower-middle
income
Upper-middle
income
High income World
Foregone economic output (US$ trillion, 2011-2030)
Mental, neurological and
substance use disorders
4 major NCDs (CVD, diabetes,
cancer, respiratory disorders)
(Source: WEF, 2011 – The Global Economic burden of NCDs)

8. 8 |
The context (5)
Years lived with disability

9. 9 |
The context (6)
Commuicable Diseases
AIDS, TB and Malaria are still global public health
threats
1. HIV global achievements notable but:
- Many children still affected with HIV
- Access to testing and treatment still a challenge
- Key population groups missing out on recent progress
2. Of the 9 million who develop TB each year, 1/3 not reached with diagnosis
and treatment
3. Malaria still endemic in 99 countries causing estimated 219 million cases
and 660,000 deaths
Other communicable diseases e.g. Ebola virus diseases (EVD)
devastating communities

10. 10 |
WHO Multi-Country Study
Period •Between 2010 and 2012
Purpose
•To determine the existing scope of practice of Community
Health Nursing in selected countries experiencing a critical
shortage of human resources for health
Countries
•18 from 4 WHO regions: AFRO (5), SEARO (6), WPRO
(4), & AMRO (3)
Participants
•Directorates of Nursing (13)
•Nursing Regulatory bodies (10)
•Nursing/midwifery Training
institutions (44)

•Nurses/Midwifery Associations (11)
•Practicing Community Health
Nurses (428)

11. 11 |
Health Systems and Services

All countries had Primary Health Care (PHC) as strategy
for health care service delivery
17 had a specific National strategy for Human
Resources for Health – 8 (47%) were developed after
2005
11 (64%) had a specific national strategy for
strengthening Nursing and Midwifery services
15 (83%) had Community Health Nursing as a
recognized profession

12. 12 |
Policy and Practice of Community Health
Nursing
All countries had institutions for responsible
for policy, training, regulation, accreditation
and monitoring and evaluation of nursing
services
The roles and functions of the institutions
differed between the countries
80% (12/15) of the Nursing Directorates
were responsible for Policy formulation and
review
86% (13/15) of the countries CHN was
recognized profession had a clear mechanism
for monitoring workforce performance
Only 9 (50%) of the countries had specific
retention packages (incentives) for nurses
working in hardship areas




Types of incentives:
Incentives considered effective
frequently named by policy makers
were:
personal/professional support (50%);
educational support (25%)
financial incentives (19%)
Educational/staff development
incentives commonly offered by the 8
countries included :
Continuing education (32%);
Training (21%),
Scholarships (5%)

13. 13 |
Education, Training and Career
Development (1)
Of the 15 professional regulatory bodies participating
12 (80%) were involved in formulation/review of
educational syllabus for nurses and midwives.
CHN offered as a post-basic qualification in 7 (38%)
countries f the, in 8(44%) an entry level exam is a
requirement for admission to the training programme.
Nine (60%) of the regulatory bodies regulated the
scope of CHN.
11 (73%) indicated there was a career structure for
the Community Health Nursing profession

14. 14 |
Education, Training and Career
Development (2)
33%
20%
27%
20%
Level of qualification for CHN
Diploma (5)
University Degree (3)
Diploma & University Degree (4)
Other (3)

15. 15 |
Education, Training and Career
Development (3)
28%
28%
17%
14%
13%
Roles the training of Community Health Nurses are
prepared for
Service & health care delivery
Counseling, consultation &
education
Leadership/administration/Manage
ment
Coordination/Supervision/advocacy
Others

16. 16 |
Community Health Nursing Practice
(1)
Background educational status
–76% received formal training
in Community Health Nursing
–In 51% of them, the training
was more than 24 months
–Only 15% indicated their
training involved training with
other health professionals
(primarily medical doctors and
other nurses)
–In 91%, the practicum period
was at least 12 months
duration
Deployment and Practice
after qualifying
– 56% were to health
centres or PHC clinics and
24% to hospitals
–68% currently work with
other health professionals
–Commonest tasks
performed by the CHNs
are
•Maternal and child
health (30%)
•General health care
provision (23%)
•Administration (16%)
•Health education (10%)

17. 17 |
Community Health Nursing Practice
(2)
Performance of tasks by CHNs
– 35% reported they performed tasks that they were not
trained for
–Areas of work most named where CHNs felt they could
contribute more were
•Community Health Nursing (24%)
•Expanding community level activities for health disease
prevention (20%)
•Quality care provision (10%)
•Research (9%)

18. 18 |
Community Health Nursing Practice
Incentives
Conditions of service of CHNs
– Incentives were received
by 21% of CHNs
–Commonest named were
allowances (7%) and
continuing education and
professional development
(6%)
–Almost 96% indicated
there were clear
mechanisms for evaluation
of their performance.
–90% had an assessment of
their performance in the
previous two years

0
5
10
15
20
25
30
35
40
45
Percentage of Responses

Incentives Considered to
be Effective

19. 19 |
Summary of interventions
Health Promotion
- education
-counseling
- support tools
Disease Prevention
- Risk Assessment
- Screening
- Treatment
Disease Management
- case management
- care coordination
- care provision, including patient
monitoring, treatment, counseling,
teaching, etc.
Key Roles at all times
- policy, planning, evaluation, advocacy
Key role in supporting development and
implementation of effective national
responses in accordance with the
national contexts, needs and priorities

20. 20 |
Opportunities (1)
In the 70's Global community made a commitment to Primary Health
Care
Commitment emphasized Equity, Community participation, Health
Promotion, Intersectoral approaches, appropriate technology,
effectiveness and accessibility
This commitment remains today as key in management of human
resources of public health nurses
Public health nurses can effectively contribute to universal health
coverage (UHC)

UHC is defined as ensuring that all people can use the promotive,
preventive, curative, rehabilitative and palliative health services they
need, of sufficient quality to be effective, while also ensuring that the
use of these services does not expose the user to financial hardship.

21. 21 |
Opportunities (2)
PHC renewal

A sense of
direction for
fragmented health
systems
Dealing with
current and future
challenges to
health

22. 22 |
Opportunities (3)
WHA Resolutions on HRH
•International migration of health personnel: a challenge for
health systems in developing countries (WHA57.19)
2004
•Rapid scaling-up of health workforce production (WHA59.23)
•Strengthening nursing and midwifery (WHA59.27)
2006
•Primary health care, including health system strengthening
(WHA62.12)
2009
•WHO Global Code of Practice on the International
Recruitment of Health Personnel (WHA63.16)
2010
•Strengthening the health workforce (WHA64.6)
•Strengthening nursing and midwifery (WHA 64.7)
2011
•Transforming health workforce education in support of
universal health coverage (WHA66.23)
2013

23. 23 |
Opportunities (4)
Strengthening nursing and midwifery (WHA
64.7)

"….implementing strategies for enhancement of
interprofessional education and collaborative practice
including community health nursing services as part of
people-centred care; including nurses and midwives in the
development and planning of human resource……."

24. 24 |
Opportunities (5)
Cross-cutting principles
1.Universal health coverage
2.Human rights
3.Evidence-based practice
4.Life course approach
5.Multisectoral approach
6.Empowerment of persons with mental disorders and
psychosocial disabilities

25. 25 |
Conclusion (1)
Community Health Nursing contributes to health services in the
community. There are gaps and shortcomings identified in the study
to be addressed and strengthened:
Their educational preparations, though varied between countries
surveyed, but need to be strengthened
Enhance Key roles including planning of health activities,
management of other health professionals and coordination and
planning with other partners
CHNs practice in a variety of settings, appropriate policies ,
based on professional needs assessments are critical
Health care training has traditionally tended to be largely
biomedical with emphasis on diagnosis and treatment of acute
problems
Refocus to embrace continuum of care –health promotion, disease
prevention, acute care, palliative and rehabilitative care

26. 26 |
Conclusion (2)
Nurses are the main professional component of the
"Frontline staff in most health systems and their
contribution is recognized as essential for universal
health coverage
Conditions of service must be conducive enough to
retain CHNs in the practice
Need for opportunities to develop professionally, gain
autonomy and participate in decision making, fair
rewards to attract and retain any category of nurses

27. 27 |

THANK YOU