The African Health Profession Regulatory Collaborative for Nurses and Midwives

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.

In contrast to top-down guidelines and policy recommendations, the ARC approach to addressing health worker regulation issues begins with supporting country-driven priorities and fostering collaboration among regulation stakeholders. ARC’s framework, based on a proven model for advancements through collaboration, provides a regional forum for countries to share approaches with each other and learn from similar experiences, challenges and successes. It is hoped that south-to-south collaboration of ARC will increase each year as countries funded in earlier cycles share lessons learned with countries experiencing similar workforce challenges. This peer-to-peer learning is designed to create long-term capacity among the regulatory leadership of the ECSA nations. The collaboration among the national regulation stakeholders will also help ensure that improvements to regulation are integrated into key institutions in the health and education sectors which are critical to sustaining health workforce improvements [10, 11]. The regional focus of ARC should allow for a rapid scale-up of successful regulatory reform. ARC’s partnership with ECSACON provides a regional platform from which to coordinate and harmonize nursing and midwifery regulation.

ARC not only advances regional priorities for nursing and midwifery regulation, but also supports global priorities as articulated by the World Health Organization’s 2011–2015 Strategic Directions for nursing and midwifery, such as collaboration among government, professional, and education stakeholders and reforming nursing and midwifery education and practice regulations [19, 20]. Further alignment with global standards and guidelines is ensured through attendance at and participation in ARC meetings by representatives from the International Council of Nurses, the International Confederation of Midwives, the World Health Organization’s Regional Office for Africa, and others. Furthermore, ARC will measure the progress and impact of country projects as well as conduct an annual evaluation of the ARC approach, thereby contributing to the global evidence base of HRH interventions.

Major donor and policy makers have clearly articulated global health workforce priorities requiring collaboration among stakeholders and institutional capacity within health professional regulatory bodies. ARC institutes a country-driven, south-to-south collaborative approach that empowers local and regional regulatory leadership to address issues affecting the largest component of the health workforce in this region. The ARC model for strengthening the nursing and midwifery workforce in East, Central and Southern Africa is adaptable to other health care cadres and other regions struggling with similar health workforce challenges.