Beginning with the World Health Report 2000, landmark publications have firmly established the importance of the health workforce in advancing population health [1–6]. The shortage of human resources for health (HRH) in sub-Saharan African countries severely limits the ability of countries to meet national health targets and global health goals [7–9]. Compounding the insufficient number of health workers (defined by the World Health Organization as less than 2.5 health workers per 1000 persons), is the lack of appropriate skills, competencies, and education necessary for this workforce to deliver adequate care to the populations they serve [3, 10–12]. In response to these shortcomings, global health policy makers identified regulatory actions, such as professional licensure, continuing professional development (CPD) of health workers, and accreditation of educational institutions as key interventions for strengthening the health workforce in low resource countries [3, 10, 11, 13–15]. Implementing these key regulatory interventions requires collaboration among national stakeholders, including the health worker regulatory bodies, professional associations, and health educators [10, 11, 13].
Guidelines on task-shifting and suggestions for regulatory reform have been provided by the donor community and external policy-making bodies. The collaboration needed to implement this reform is often inadequate [10, 11, 16]. Furthermore, local health worker regulatory bodies most impacted by these recommendations, such as nursing and medical councils, often lack the capacity, resources, or expertise to enact the suggested reforms [16, 17].
In 2011 the United States Centers for Disease Control and Prevention (CDC) began an innovative four-year initiative to increase the collaboration among national stakeholders and help strengthen the capacity of health professional regulatory bodies to reform national regulatory frameworks. The African Health Profession Regulatory Collaborative for Nurses and Midwives (ARC) convenes leaders responsible for regulation from 14 countries in East, Central and Southern Africa (Figure 1) for a high profile, local country collaboration to assist countries in implementing joint problem-solving approaches that target national issues affecting the health workforce. The following discussion describes ARC and discusses its importance in implementing and sustaining national, regional, and global workforce initiatives.
The African Health Profession Regulatory Collaborative for Nurses and Midwives (ARC)
ARC is a partnership between the CDC, Emory University, The Commonwealth Secretariat, and the East, Central and Southern African Health Community through the East, Central and Southern African College of Nursing (ECSACON) designed to increase the regulatory capacity of health professional organizations and ultimately improve regulation and professional standards in the east, central and southern Africa (ECSA) region. The objectives of this four-year initiative are to 1) ensure nursing and midwifery practice standards are harmonized in the ECSA Region and aligned with global standards, 2) ensure national nursing and midwifery regulatory frameworks are updated and reflect nationally approved practice and educational reforms, 3) strengthen the capacity of the health professional councils within the ECSA Region to conduct key regulatory functions and, 4) establish a sustained consortia of African nursing and midwifery leaders in practice and regulation.
The framework of ARC is adapted from the Institute for Healthcare Improvement’s (IHI) Breakthrough Series© ‘clinical collaborative’ model [18]. Under the IHI model, clinical teams from healthcare institutions are convened, along with topical experts, to address a pressing quality improvement issue. Teams plan their improvement approach, design measurement strategies, and meet regularly to report on progress, discuss challenges, and receive feedback from peers and experts. In a similar fashion, ARC convenes regional and international regulation experts and national nursing and midwifery regulation leaders from ECSA countries to address important regulatory issues impacting professional practice.
In February 2011, ARC launched this regional initiative in Nairobi, Kenya, during an invitational meeting of the 14 national regulatory teams. These leadership teams consisted of the chief nursing officer, the registrar of the nursing and/or midwifery council, the president of the professional nursing and/or midwifery association, and a representative of nursing and/or midwifery academia. Each country team developed a plan to address a locally identified regulation issue. Issues identified included developing a CPD system, revising the nursing scope of practice, or revising midwifery education standards. Ten country teams submitted project proposals for national regulation improvement projects; ARC selected five proposals for funding (up to US$10 000 each) through the end of 2011. The selected proposal topics for 2011 included CPD (Lesotho, Malawi, Swaziland), and revising nursing and midwifery legislation (Mauritius and Seychelles). Throughout 2011, ARC convened the selected country teams twice to present progress on their regulation improvement projects and share challenges and lessons learned with their peers and experts. Each ARC-funded country team is responsible for accomplishing an established set of deliverables, representing measurable improvements to national nursing and midwifery regulation. In June 2012 a new ARC annual cycle will begin with a meeting of fourteen country leadership teams and the opportunity to again develop and submit national regulation improvement projects.
