The challenges addressed are not exclusive to the nursing area. A study developed in 20 countries, including Angola, emphasizes the lack of health professionals to respond to the population needs , which demonstrates the importance of education and the continuous development of these resources. In another recent study, involving medical students enrolled in public schools in Angola, Guinea-Bissau and Mozambique, which was aimed at describing and analyzing expectations about the profession and the difficulties related to education and the professional future, it was identified that investments in the infrastructure and preparation of higher education institutions are fundamental to achieve institutional success.
Particular attention needs to be devoted to students’ socialization and teachers’ roles and status. In countries with a lack of resources, a focus on the hospital area is noticeable, instead of being associated to skills development for work in primary care areas. The development of local graduate programs can serve as an interesting strategy to support the retention of professionals in their country of origin .
As regards the valuation of nurses, an incipient political movement seems to be on course to acknowledge nursing as an important part of health services. In a speech on the occasion of the Day of the Nurse, celebrated in May 2012, the Minister of Health of Angola, Mr José Van-Dúnem, recalled that nurses are responsible for controlling and guaranteeing therapy and for transmitting moral and psychological support to patients and their families. He added that nursing can get closer to the community and enhance the effective execution of municipal health programs, so as to reduce the demand referral hospitals are confronted with and return the population’s confidence in health professionals. According to an article published in Jornal de Angola, another aspect the minister highlighted was the improved efficiency and quality of health services and the valuing of human beings .
In 2012, the Angolan Nursing Council chose the theme "Fighting inequality: from evidence to action”. According to the Minister of Health, the theme follows the executive power’s concern with making efforts to improve work conditions and serve as motivation for nursing professionals to continue working with their characteristic zeal and dedication .
The proposal disseminated by the Angolan Nursing Council, as presented in the Activity Plan and Budget for 2011, underlines concerns with nursing education, in accordance with the participants’ reports. In the document, the need to strengthen the qualified interventions of educational policiesis highlighted, including proactive participation in the redesign of organized responses to the learning needs. As fundamental pillars for the autonomic and developmental process of the profession, education and research continue to be in need of further professional and political deepening .
In other African countries, difficulties for nursing education are similar. In Kenya, the problematic situation of higher education, mainly related to the characteristics of the education system in force and the lack of public support, does not favour educational opportunities after gaining a basic degree. The country’s experience has shown that distance education is effective and can support professional nursing training at different levels, including leadership in clinical practice, teaching, administration and research .
South Africa’s experience shows a legacy of inequalities in health care access, growing morbidity and mortality rates and an insufficient number of qualified nurses to achieve the MDGs the government defined in 2010. According to researchers, nurse managers need to influence political decisions that involve nursing services and the education needed to prepare the next generation of professionals to execute these new services .
In Ghana, to solve problems related to health service delivery and the lack of nursing professionals, the participation of all stakeholders was required, moving beyond traditional stereotypes, showing flexibility and orientation towards the future. Political options included the expansion of nursing education, broadening of teaching locations, offering of professional training, and collaborative education opportunities, which improved personal satisfaction rates and professionals’ continuation in their country. The international exchange of nurses and resources was shown to be mutually beneficial for the countries of origin and the collaborators .
The convergence between nursing education difficulties in Angola and other African countries, as well as the solutions proposed to minimize the problems raised, show the urgent need to elaborate and put in practice strategies to improve the quality of education and professional teaching and practice conditions in nursing, leading to the acknowledgement of the role of nursingin the context of the health-disease and teaching-learning process, among others. The Brazilian researchers discussed the fact that all issues addressed demand paradigm changes in professional education, with a view to the collective construction of a more active and committed nursing workforce, which participates in decision-making on public, social and institutional policies. The same discussion and approach can be directed at African countries such as Angola .
The Ouagadougou Declaration on primary health care and health systems in Africa,Achieving Better Health for Africa in the New Millennium, provides a framework for implementing necessary activities in each of the WHO priority programme areas. The Declaration proposes recommendations for consideration by Member States in the development of their own country frameworks. All 46 Member States have national health sector development policies and plans, which provide a platform for the national health agenda. A number of countries have developed HRH policies and plans .
The predominance of male participants stands out in the sample. Angola has a 27-year history of civil war, which started in 1975, caused by a global identity crisis that was associated with exogenous factors. The conflict originated countless internal and external migration movements. A mass migration movement was observedin search of new existential possibilities, particularly among the male population in response to fears of combat and the consequences of civil war . The literature about the theme is scarce, but the participants’ reports revealed that most men who emigrated looked for educational opportunities in other countries, assuming the commitment to return home with better social, cultural and financial development conditions for their families and compatriots. This can justify the predominance of male participants in the population of nurse leaders.
To date, many African health professionals have migrated to developed nations to promote their education and career, leading to a lack of health professionals in their countries of origin. The Organization of Economic Cooperation and Development (OECD) estimates that 18% of all physicians and 11% of all nurses who work in their countries are foreigners. This migration aggravates the lack of health professionals and contributes towards the weakening of poor nations’ health systems, which have failed in their attempts to manage the severe health problems that affect the population .
According to Mateus Foster, the director of international issues of the Royal College of Physicians in London, the reasons for this migration go beyond the very small remuneration and involve the work and living conditions, education and, at the bottom, continuous professional development .
Nursing in Angola has reached a moment to conquer its professional space. Therefore, it is fundamental to establish regulatory policies, defining the rights and duties of all categories involved, to determine and legitimize nurses’ function in the health team, including respect for and acknowledgement of their role in the community .
The African Region continues to focus on standardizing guidelines and curricula and is actively implementing competence-based training for nurses and midwives, from pre-service through to faculty education levels. Despite challenges, progress is being made. Some countries are actively implementing the strategies to enhance institutional capacity and the education of suitably skilled practitioners. Scaling up the strengthening of nursing and midwifery education is accelerating in all six WHO. Curriculum evaluations for pre-service nursing and midwifery education programmes have been conducted in West and East African countries. Challenges identified include: curricula that are not competence-based; unclear distinctions between nursing and midwifery especially in francophone countries; shortage of teachers; and inadequate training and teaching materials and infrastructure .
In addition to the fact that not all leaders contacted were able to attend, another study limitation is that it cannot be guaranteed that the participants demonstrated their complete potential to contribute to the discussion fulltime. Also, as the data collection was formally organized and involved acquaintances, there may have been concerns about what should or should not be said. When analyzing the results, it would be interesting to combine the data with other information obtained through different data collection techniques, which goes beyond the present research objectives .
Also, the statistical database available about Angola is relatively outdated and very fragile. Despite the pertinence of the sources used, it is important to indicate some limitations in the data, due to the lack of studies and published material about the theme.