Evaluation of the Registered and Enrolled Comprehensive Nurse Training Programs in Uganda

Transcription

1 Terms of Reference Evaluation of the Registered and Enrolled Comprehensive Nurse Training Programs in Uganda AUGUST of 5

2 1.0 Background The registered comprehensive nurse (RCN) and the enrolled comprehensive nurse (ECN) training programs started in Uganda in 1994 and 2003 respectively. Traditionally, training of midwives and nurses were done separately until in the early 1990s when changes were recommended with a view to achieving the Alma Ata declaration of Health for all by the year The purpose of the change from the traditional program was to create a multi-purpose nurse with competencies in general nursing, midwifery, public health, psychiatry pediatrics and management who will be deployed to primary health care posts and be able to provide basic health services to meet the majority of the health needs of rural communities. The comprehensive nurse was expected to provide: Preventive, promotive, curative and rehabilitative services to the community Extend primary health care to all sections of the community Train and supervise health workers and communities Manage the health facility where posted and work effectively with the district health teams Collaborate with other sectors concerned with socio economic development. Today the traditional enrolled nursing and enrolled midwifery training programs in Uganda have been replaced by the ECN program in all government owned Health Training Institutions. Many PNFP Health Training Institutions have also gradually phased out their enrolled midwifery training programs replacing it by the ECN program. The enrolled midwifery and enrolled nursing training programs are now only offered in a few faith-based Private-Not-For-Profit (PNFPs) institutions like Kamuli, Kalongo, Nyakibale and Nsambya. Even these are now offering the enrolled midwifery training program alongside the ECN. Problem Statement There is an ongoing debate amongst stakeholders in Uganda as to the adequacy of the ECN curriculum to provide sufficient exposure to particularly practical hands-on learning for them to develop the required competencies for midwifery as well as nursing practice. Some stakeholders are questioning whether ECN graduates should be considered skilled attendants, purporting that their practical exposure to midwifery practice does not meet the WHO standards to qualify as such. In the job market, the public service regulations are not clear about the status of the ECN in the staffing norms of health facilities and hence many districts have declined to recruit ECN and RCN graduates. Many health facility managers have expressed dissatisfaction with the level of competence and skills of the ECN graduate regarding, particularly, midwifery care. The first graduates of the RCN and ECN have now been in service for about 10 years and 5 years respectively. To date no formal evaluation of their performance in service has been done, amidst a growing perception and concern that the quality of their training or service delivery outputs may be below standard. During a stakeholders meeting in the Ministry of Health to discuss the comprehensive nurse program, all the stakeholders present (Ministry of Heath, Ministry of Education, UNFPA, WHO, Professional Associations, Nurses and midwives council Medical Bureaus, Health Training Institutions, the Capacity Project) agreed that evaluation of the program was overdue. A Midwifery Needs Assessment completed in 2009 recommended that partners should undertake an evaluation of the quality of care provided by the ECN graduates as a matter of urgency Purpose of the evaluation Against the foregoing background an evaluation of the ECN and RCN training programs in Uganda is proposed to: 2 of 5

3 1. Assess the extent to which the current comprehensive nursing programme is equipping trainees with knowledge, skills, and competencies required to provide quality health services to the Ugandan population. 2. Assess how and to what extent the ECN and RCN programs are filling in the existing gaps in the delivery of nursing and midwifery services in the country. It is envisaged that the findings of this report will be used by the Government of Uganda, training institutions, the civil society and development partners to inform policy and programmatic aspects of ensuring quality Nursing and midwifery services in the country. This will also help Uganda align with the 2006 international call for change in human resource policies to undertake a Decade of Action for Human Resources for Health made at the World Health Assembly to address MDGs 4 and The Specific objectives are to: 1. Assess whether the ECN and RCN curricula are being implemented as designed 2. Asses whether the tutors have the skills and knowledge to implement the program as designed 3. Asses the capacity of the training institutions to execute the program as designed 4. Assess if the comprehensive nurse programs achieved the expected outcomes to impart knowledge, skills, attitude and competencies as per the objectives of the programs. 5. Assess if the curricula are sufficient to provide all the competencies for the specialities designed therein (psychiatry, midwifery, paediatrics, general nursing, and community health) as per international competence levels recommended for those specialities 6. Assess the absorption rate and pattern into the public service and elsewhere, the career path, and appropriateness of schemes of service. 7. Assess the quality of services offered by comprehensive nurses (RCN and ECN) 8. Assess how and whether the ECN and RCN graduates are meeting the needs of the population in areas such as midwifery, Nursing and community health. 3.0 Scope of work The consultant will work with a WHO internationally recruited consultant to undertake the following tasks: Develop a detailed proposal to show the approach that will be utilized to conduct the study indicating the methodologies including the sampling strategy and data collection methods. Conduct review of documents and literature pertaining to comprehensive nurse training as well as traditional nurse and midwifery training in Uganda, the region and elsewhere to enrich understanding of the findings of data collected and enable comparison and contextualization. Develop data collection instruments for the evaluation and manage and undertake the data collection exercise. Undertake data analysis and report writing and submit the draft of the evaluation report to Ministry of Health. Organize and conduct a workshop for stakeholder consultation and validation of findings Incorporate stakeholder comments and submit final report to Ministry of Health 4.0 Outputs/ deliverables: Inception report with study design and tools, timelines and budget proposal A draft report for discussion and consultation A final report incorporation comments that may include the following contents: 3 of 5

4 - Executive summary - Introduction: An overview of the evaluation - Background - Methodology and process, including detailed description of sampling and study limitations. - Findings responding to each evaluation objective - Policy and programmatic recommendations - Conclusions - Annexes: Tools used, list of people interviewed, references etc. 5.0 Time frame: The consultancy is expected to take 30 days in total. The consultant with her/his team is expected to submit the final report no later than November 30 th Meetings and review of literature and preparation of inception report 5 days Preparation for field data collection 2 days Field work/data collection 12 days Report writing 7 days Finalization of comments from stakeholders 4 days Total 30 days 6.0 Management of the consultancy A working team comprising of Ministries of Health, Ministry of Education and Sports, WHO, UNFPA, MOES, SIDA, AMREF, Association of Heads of Health Training Institutions, Uganda Nurses and Midwives Union, Association of Obstetricians and Gynaecologists of Uganda, the Nursing Department of Makerere University and the Uganda Nurses and Midwives Council will provide technical guidance to the consultants. The team will be chaired by a representative of the MOH and Co-chaired by Ministry of Education & Sports. The Chair is responsible for circulating all communication and clarifications made to the consultants to all the members of the working team. The final approval of the report lies with the Ministry of Health. The lead consultant together with her/his team will be required to work together with the working team and the international consultant in seeking any clarifications and technical advice. 7.0 The qualifications of consultants Proven track record in research and evaluation of public health programs particularly training and human resource development Experience working with Government and development partners in the area of Public health and social services. Proven experience and knowledge about the situation of human resource for health especially with regard to nursing and midwifery services in sub Saharan Africa. A minimum of Master s Degree in a relevant field with background in health training and education Ability to produce high quality and concise written reports A record of published research articles is added advantage. 8.0 Submission of Proposals a) Interested individuals with the required qualifications and experience to undertake the consultancy work should submit their proposals and CVs by to [email protected] 4 of 5

5 Or Hand-delivered to The Representative, United Nations Population Fund, Plot 12A Baskerville Avenue, Kololo, P. O. Box 7184, Kampala - Uganda. b) The Technical proposal (of not more than six pages) together with the financial proposal should be submitted as separate documents. c) Proposals must reach UNFPA offices by 2.00 pm on Wednesday September 08, The criteria for assessing the proposals shall include: 1. Qualifications of consultant as given in section 7 above; 2. Understanding of the assignment; 3. Detailed methodology and study approach proposed; 4. Appropriateness of the proposed work plan for the entire assignment; 5. Concrete quality assurance measures; 6. Financial proposal. 5 of 5