Nurses Leading Health Systems Change in Sub-Saharan Africa and the Caribbean

Edwards, Nancy C.

The global HIV and AIDS pandemic continues to devastate the health systems of Sub-Saharan Africa and the Caribbean, deepening the health human resources crisis and challenging delivery of essential health services. Nurses and midwives form the majority of the healthcare workforce in much of the world. An innovative five year program of research and capacity-building with a participatory action research approach involved Canada, Kenya, Jamaica, Uganda, and South Africa. Partner countries each established leadership hubs in three districts to address issues of equity and effectiveness of HIV/AIDS health services and policies. A quasi-experimental design with mixed methods data collection was used to compare changes in HIV/AIDS clinical practice, stigma, and health human resource policies between intervention and control districts. This presentation will describe this leadership hub intervention and highlight successes and challenges.

Hubs were comprised of community representatives and stakeholders including nurses, midwives, researchers and decision makers. Training focused on essential skills for active participation in policy and decision-making, with capacity needs assessed through the ARAR (ability, resources, authority, and responsibility) lens. Hubs implemented evaluation projects examining institutional policy gaps. Sharing the program’s research findings with hubs was a basis for preparing policy briefs for local health officials, and action plans to improve HIV/AIDs-related care. Successes include nurses and midwives beginning to self-identify change agents with confidence, skills, and a sense of responsibility to influence health systems change, and hub sustainability plans for the post-project period. Challenges included heavy workloads, an initial lack of institutional support for hub research-related activities, and socio-political influences.

The leadership hub intervention is a promising approach that engages nurses, midwives and local decision-makers in developing and implementing action plans adapted to local constraints. Post-intervention data collection, planned for 2012, will be used to assess the impact of hubs on HIV/AIDS care.

Learning Objectives: 1. Identify innovative approaches that enabled nurses and midwives across participating lower and middle-income countries to take leadership roles in implementation of research and improving clinical practices and policies for HIV and AIDS; 2. Describe successes and challenges with translating research knowledge for “leadership hubs” of nurses, researchers, decision makers, and community members, and engaging them in research and policy cycles; 3. Articulate opportunities for linking hubs with decision makers at district, provincial, and national levels, and internationally with other hubs. 4. Discuss strategies used to develop sustainable hub networks at local, national and international levels.

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