Globally, the nursing profession is in a crisis as the shortage of nurses and midwives escalates each year. But this has even worsened with the outbreak of Covid-19.
However, the general public expects to be cared for by competent nurses and midwives through delivery of optimal care. Each country has professional regulatory bodies that set and regulate standards for training and practice.
In Uganda, the Uganda Nurses and Midwives Council (UNMC) is mandated with regulating and setting standards for the nursing and midwifery profession.
UNMC is also supposed to protect the public from any unsafe nursing and midwifery practices and ensure quality of the services provided while fostering the development of the profession.
One way to do this is to ensure a current scope of practice for the different categories of nurses and midwives in place commensurates with the current developments and trends in the profession.
This scope of practice is in tandem with the Uganda Nursing and Midwifery Act which unfortunately was last updated in 1996. This means that despite guidelines issued by the International Council for Nurses (ICN) and International Confederation of Midwives (ICM) to member countries, Uganda still lags behind. This deprives Ugandans the opportunity to tap into the unique skills and abilities of nurses and midwives who have been highly trained to meet the ever changing population needs.
Currently, Uganda has trained and licensed nurses and midwives at various levels ranging from certificate, diploma, bachelors, masters and even PhDs.
As of March 31, Uganda has 681,527 registered nurses and 39,071 midwives. A lack of an updated scope of practice means that these nurses and midwives trained at bachelor’s level and above cannot practice to their full potential.
With the current human resource challenges in the country and nurses and midwives forming the largest proportion of the healthcare workforce, nurses and midwives are the most represented cadre of health workers at all levels of health care. They are responsible for more than 80 per cent of health outcomes within the nation.
Lately, there has been a shift in tasks with nurses and midwives taking up roles that were initially for doctors.
In Uganda, lower health centres are purely managed by certificate and diploma nurses. They are the ones responsible for assessment of patients including history taking, physical examination, investigation and treatment.
But this is not indicated nywhere in their current scope of practice. There are also many instances where nurses and midwives are performing tasks beyond what is stipulated in the 1996 Nurses and Midwives Act. However, in such circumstances, they are not protected by the current law despite them serving the population.
In 2011, there was a consultancy advert funded by UNFPA and ICM to review the Nurses and Midwives Act of 1996, and 10 years down the road there is no circulation and implementation of this revised act. One would ask, why are the nurses and midwives in Uganda still governed by the 1996 Act?
In 2013, a technical team of nurses and midwives developed and submitted the first ever draft of the Uganda National Nursing and Midwifery policy to Ministry of Health (MoH). This policy was to act as the mother board that provides the strategic direction for the profession on most issues including the streamlining the scope of practice. Surprisingly, to date, this policy has never been approved and is not in use.
The Ministry of Health and the Uganda Nurses and Midwives Council should fast track the processes of finalising the Nursing and Midwifery scope of practice, Nurses and Midwives Act and Nursing and Midwifery policy.
Lilian Nuwabaine Luyima (BSc trained Nurse and Aisha Naava (Registered Nurse); Kawolo General Hospital Buikwe