Moving the Agenda Forward for Nursing and Midwifery Clinical Research in Southern and Eastern African Countries

Most African people receive their health care from nurses or midwives, yet there is a large gap between the unmet health priorities in the region and the kind of clinical nursing and midwifery research required to improve health outcomes using evidence-based practices.  A milestone conference sponsored by Columbia University School of Nursing and the Columbia Global Centers | Africa (Nairobi), in collaboration with nursing and midwifery experts from Kenya, Malawi and South Africa, brought together for the first time nurse and midwifery leaders from 12 Sub-Saharan African nations with the goal of creating an action plan that identifies knowledge gaps in clinical care and greater use of scientifically-informed health care practices.

Executive Summary

Columbia Global Centers | Africa hosted “Moving the Agenda Forward for Nursing and Midwifery Clinical Research in Southern and Eastern Africa” on July 8th – 9th, 2015 in Nairobi Kenya. Partners included:

• Columbia University School of Nursing
• School of Nursing Sciences University of Nairobi
• Kamuzu College of Nursing of the University of Malawi
• Forum for University Nursing Deans in South Africa
• WHO Regional Office for Africa.

The aim of the research summit was to promote regional and international relationships for increasing clinical research capacity in nursing schools in Africa and to emphasize the importance of conducting research on priorities identified by regional nursing and midwifery research experts.

In attendance were more than 30 experts from 14 countries. The participants agreed to: 1) develop regional action plans (with themes and guiding principles) to address clinical research priorities and 2) establish a steering committee and theme-based technical committees to continue the momentum of the conference.

Background

Disease burden is the collective effect of health problems as measured by mortality, morbidity, financial cost, and other indicators. Under these criteria, Africa, which has one percent of the world’s health care workers, bears 25 percent of the global disease burden whereas North America, which bears three percent of the global disease burden, has 30 percent of the healthcare workforce.

To address this mismatch of needs and resources, Columbia Global Centers | Africa, the Forum of University Nursing Deans of South Africa, the University of Malawi | Kamuzu College of Nursing, the University of Nairobi School of Nursing Sciences, and Columbia University School of Nursing’s Office of Global Initiatives, with financial support from Columbia University’s Presidential Global Innovation fund, committed to establishing an international partnership.

Goals of the partnership include forming a network and data base of clinical nursing and midwifery researchers in Africa and convening a research summit to address gaps in knowledge and identify priorities for clinical nursing research and education in Africa. This work will serve as a template for similar efforts by Columbia Global Centers | Middle East and other Columbia Global Centers.

The Research Summit

1. Research on nursing and midwifery

Participants agreed that research on the nursing and midwifery fields in African countries was important as a prelude and correlate to research on prevention and treatment of illnesses, best care practices, and clinical outcomes. Since nurses and midwives provide the majority of health  care in Africa, best practices for the field should be identified to ensure maximum effectiveness of current nurse midwives and to plan for educating nurses and midwives in the future.

Research topics that the summit participants identified as important for local nurse scientists include:

• the nursing and midwifery shortage in parts of Africa
• nursing workload
• best deployment of nurses in relation to their skills
• task shifting to address the nursing shortage
• identifying resources for teaching nursing research
• strikes
• ability to manage highly infectious diseases
• education standards
• internships
• mentorship programs.

Participants also agreed that: 1) there should be a data base of those involved in research; 2) centers of research excellence should be established; and 3) professional nursing associations, international organizations, governments, and NGOs should play a major role in these efforts.

2. Clinical nursing and midwifery research priorities

The intellectual context for the summit was provided by several activities conducted by Columbia University School of Nursing faculty members. These included:

• a scoping review of peer-reviewed published literature, which identified 72 indexed publications from 20 African countries, most frequently focusing on midwifery/maternal child health and patient satisfaction studies
• a grey literature review of unindexed research, which identified 262 research projects from 25 countries, most frequently focusing on midwifery, maternal health mortality, and women’s health  
• a Delphi survey of 71 clinical nursing and midwifery research experts from 14 countries to identify clinical research priorities. Critical clinical research priorities identified were infectious diseases/infection control and midwifery/maternal health and mortality/women's health/neonatal care/infant mortality. Some of the important priorities were children’s health, health promotion, malaria, non-communicable diseases, and rural health. Moderately important research priorities were population health, palliative care, and infectious disease. Low priority topics included gerontology.

Building on presentations of these findings, participants identified common regional gaps in knowledge and projects for addressing them:

3. Barriers to and actions needed to address research priorities

Participants identified regional barriers and action plans to address these barriers:

Broad themes for addressing gaps and barriers emerged at the summit. These include:

• the need for increasing research capacity all levels in the profession
• the importance of developing a research culture, including mentoring
• the necessity of adopting and disseminating evidence-based practices in nursing and health care institutions throughout Africa
• the value of using existing evidence, including developing strategies to increase generalizability of research from other regions and countries
• recognition of the need to increase political will and advocacy in support of funding for nursing research.

4. Short- and medium-term actions

The participants agreed on the need to establish technical groups, each focusing on a key theme. A steering committee to guide overall action was established and members selected.

5. Measures of longer-term success

The participants established several measures of longer-term success (2015-2020). These include increases in:

• the number of Africa-based researchers
• the number and scope of funded research proposals and projects
• the quantity and quality of clinical research (i.e. research with patient outcomes) publications and citations
• the number of post-graduate students.

Conclusion

The participants agreed that the summit achieved its objectives of reaching consensus on identifying nursing research priorities, gaps, and barriers as well as creating an international infrastructure for addressing them.

There was also agreement that implementing critical research priorities will require the continued efforts of each of the participants and well as government and non-public sector collaborators.

Summit participants

I. Core collaborators

Grace Omoni, PhD, associate professor at the School of Nursing Sciences, University of Nairobi.

Address Malata, PhD, professor of nursing and midwifery at the University of Malawi, Kamuzu College of Nursing and adjunct professor of nursing and midwifery at Michigan State University.

Hester Klopper, PhD, chief executive officer of the Forum for University Nursing Deans of South Africa.

Jennifer Dohrn, DNP, assistant professor and director of the Office of Global Initiatives and the WHO Collaborating Center for Advanced Practice Nursing at Columbia University School of Nursing.

Elaine Larson, PhD, associate dean for research and the Anna C. Maxwell Professor of Nursing Research at Columbia University School of Nursing and professor of epidemiology, Columbia University Mailman School of Public Health.

Maureen Adudans, HIV/AIDS regional advisor for the MDG Centre, East and Southern Africa,   Columbia Global Centers | Africa.

Belay Ejigu Begashaw, PhD, director of Columbia Global Centers | Africa & the MDG Centre, Eastern and Southern Africa.

Mabel Adhiambo Wendo, regional community health worker technical advisor at Columbia Global Centers | Africa.

Magda Awases, adviser, Human Resources for Health, Health System and Services Cluster, Inter-Country Support Team for East and Southern Africa (IST/ESA), WHO Regional Office for Africa, president of Sigma Theta Tau International. Awases was unable to attend the summit, but provided guidance and advice on this initiative.

II. Participants by country

1. Botswana

Naomi Mmapelo Seboni, PhD, registered nurse-midwife and coordinator of the WHO Collaborating Centre for Nursing and Midwifery for sub-Saharan Africa.

2. Ethiopia

Gezashign Denekew, MPH, national nursing and midwifery service coordinator of the Ministry of Health of Ethiopia. Denekew was unable to attend the summit.

3. Jordan

Hania Dawani, DNSc,  mental health nurse consultant and associate professor of nursing at California State University Northridge-Los Angeles.

Shahla Matar, program officer for Columbia Global Centers | Middle East.

4. Kenya

Hannah Inyama, MSC, head of the midwifery/obstetric & gynecological nursing unit at the School of Nursing Sciences, University of Nairobi.

Samuel Kimani, PhD, senior lecturer in medical-surgical nursing at the School of Nursing Sciences, University of Nairobi.

Juliana Misore, MPH, director of the School of Nursing, Uzima University College in Kisumu, Kenya.

Charity Ndwiga, program officer, Reproductive Health Program with Population Council

Susan Agunda Otieno, MPH, director of nursing services in the Ministry of Health of Kenya and president of the East Central and Southern Africa College of Nursing.

Elizabeth Oywer, MA, deputy chief nursing officer of the Nursing Council of Kenya.

Rose Ruthuthi, Kenya, head of department of education, Nursing Council of Kenya

Edna Tallam-Kimaiyo, MPH, registrar and chief executive officer of the Nursing Council of Kenya.

Sabina Wakasiaka, senior lecturer and post graduate chairperson at the School of Nursing Sciences, University of Nairobi.

5. Lesotho

Nthabiseng Molise, MSC, coordinator of the Nursing Education Partnership Initiative at the Lesotho Ministry of Health.

6. Malawi

Angela Chimwaza, PhD, Kamuzu College of Nursing, University of Malawi.

Ellen Chirwa, PhD, professor of nursing at Kamuzu College of Nursing, University of Malawi.

Belinda Thandizo Chimphamba Gombachika, PhD, senior lecturer of nursing at Kamuzu College of Nursing, University of Malawi.

7. Mozambique

Lídia Justino Mondlane, PhD, practicing nurse and founding member of the Mozambican Association of Palliative Care.

8. Namibia

Käthe Hofnie-Hoëbes, PhD, senior lecturer and associate dean for the School of Nursing and Public Health at the University of Namibia.

9. South Africa

Judith Bruce, PhD, professor and head of the School of Therapeutic Sciences at the University of the Witwatersrand, Johannesburg.

Minette Coetzee, PhD, associate professor in the UCT School of Child and Adolescent Health at the Red Cross Children's Hospital in Cape Town.

Elizabeth Mokoka, PhD, program manager at the Forum of University Nursing Deans in South Africa (FUNDISA) in South Africa

10. Tanzania

Marycelina Msuya, MPH, dean of the faculty of nursing at Kilimanjaro Christian Medical College in Moshi, Tanzania.

11. Swaziland

Priscilla Sibongile Dlamini, PhD, director of the Institute of Research on Traditional Medicines and lecturer in the Department of General Nursing at the University of Swaziland.

12. USA

Kenrick Cato, PhD, informatics researcher at Columbia University School of Nursing.

Yu-Hui Ferng, MP, program manager for the Office of Global Initiatives at Columbia University School of Nursing.

Carolyn Sun, MS, ANP, PhD, research assistant at the Office of Global Initiatives at Columbia University School of Nursing.

13. Uganda

Elizabeth Namukombe Ekong, MSN, lecturer in the Department Of Nursing at Uganda Christian University.

14. Zambia

Margaret C. Maimbolwa, PhD, a nurse midwife and senior lecturer in the Department of Nursing Sciences at the School of Medicine, University of Zambia.

15. Zimbabwe

Rudo Nyamakura, MSCNS, MSC, lecturer in the Department of Nursing Science at the University of Zimbabwe.