Strengthening the African Health Workforce

To help achieve the vision of an AIDS-free generation, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) is working to strengthen the African health workforce--an essential element of expanding HIV care and treatment services.

The African Health Profession Regulatory Collaborative for Nurses and Midwives (ARC) helps national nursing and midwifery leadership teams from 17 African countries to identify and address regulatory bottlenecks to expanding and sustaining nurse and midwife-led models of HIV care and treatment services.

Special Journal Supplement on ARC: Strengthening Task-Shifting and Quality Assurance for Nurses and Midwives Providing HIV Services: Click here to view articles

ARC is funded by CDC through PEPFAR, and is implemented in partnership with the Lillian Carter Center for Global Health & Social Responsibility at Emory University, the Commonwealth Nurses Federation, and the East, Central and Southern Africa Health Community—an intergovernmental regional coordinating body on health issues. ARC uses a unique, collaborative approach that entails convening regional meetings or “Learning Sessions,” providing targeted technical assistance, and awarding short-term grants (see box).

ARC - Where we work: Download a PDF with ARC Map details as shown on the above interactive map. Click on country names above to see ARC activities.

A Quality Assurance Approach

The ARC approach is adapted from the Institute for Healthcare Improvement (IHI) “Breakthrough Series” model for quality improvement collaboratives. (The Breakthrough Series: IHI’s Collaborative Model for Achieving Breakthrough Improvement. Boston: Institute for Healthcare Improvement; 2003.)

The structure of IHI’s quality improvement model is a series of alternating Learning Sessions and Action Periods. During the Learning Sessions, teams from participating organizations come together to learn about and discuss the chosen topic and plan changes to implement in their home institutions. During the Action Periods, the teams return to their home institutions and work together on the planned actions for change.

At the conclusion of the collaborative cycle, participating organizations engage in a Summative Congress to share lessons learned and produce publications to disseminate their breakthrough improvements.

ARC Year 3 activities

ARC kicked-off its third year of Learning Sessions, targeted technical assistance, and regulation strengthening grants with the annual Summative Congress, held July 30-August 2nd, 2013 in Nairobi, Kenya. Nursing and midwifery leadership teams from 18 countries attended to discuss how regulations, such as continuing professional development, scopes of practice, and licensure exams, can be developed or updated to enhance HIV service delivery by nurses and midwives. Strengthened health professional regulation can serve both as a quality assurance mechanism and as a way to reduce bottlenecks to expanding HIV care and treatment services, such as through “task shifting” HIV services to nurses and midwives.

After each Summative Congress, country teams submit a one-year grant proposal on a ‘winnable battle’ in nursing and midwifery regulation. The proposals must describe how strengthening the regulation will result in expanded HIV services, such as such as voluntary medical male circumcision, the prevention of mother-to-child transmission and nurse initiated and managed treatment of HIV. Fifteen country teams submitted proposals; an objective interdisciplinary review panel scored and ranked the proposals according to a set of criteria (e.g. feasibility, collaboration, impact on HIV service delivery). Ten proposals were selected for funding and are currently underway (see Table).

Country	ARC Year 3 Project
Botwana	Conduct a gap analysis of HIV and AIDS content in pre-service and in-service training to inform national CPD framework.
Lesotho	Scale-up access to HIV-related CPD by formalizing CPD requirements for licensure renewal.
Mozambique	Development of an entry to practice examination with HIV competencies
Namibia	Conduct a survey on CPD compliance among nurses delivering prevention of mother-to-child transmission of HIV services.
Rwanda	Expand the scope of practice for nurses and midwives to ensure the inclusion of HIV services.
Seychelles	Review and revise the scope of practice for nurses and midwives to include HIV services.
South Africa	Develop an accreditation system for CPD on HIV and AIDS content for nurses and midwives.
South Sudan	Develop a scope of practice for nurses and midwives to include PMTCT and ART services.
Swaziland	Establish a national entry to practice licensing examination to include content on HIV and AIDS.
Uganda	Finalize the development of scopes of practice for nurses and midwives which include advanced HIV service delivery tasks.
Zambia	Introduce CPD as a requirement for license renewal and initiate HIV related CPD for nurses and midwives.

Building a “south-to-south” collaboration

ARC is unique in that it supports regulation improvement projects which are developed, proposed, and implemented by the national nursing and midwifery leadership teams. The Learning Sessions and Summative Congresses provide a platform for country teams to share progress updates, tools, experiences, and challenges with their peers in the region. By emphasizing south-to-south collaboration and sharing of resources, ARC not only advances regulatory reform and HIV treatment expansion, but also builds long-term capacity among African professional institutions, resulting in stronger health systems for years to come.

Measuring the Impact of ARC

To understand the effectiveness and impact of this unique regulatory improvement collaborative, CDC developed a regionally relevant, stakeholder-vetted evaluation tool to standardize measurement of advances in nursing and midwifery regulation and regulatory capacity in Africa. The Regulatory Function Framework (RFF) documents current levels of national capacity in key regulatory functions and measures meaningful advancements in each function. The RFF also helps identify national and regional priorities for future regulation strengthening efforts to support HIV care and treatment scale up. Please click here to access a recent article on the impact of ARC grants from Years 1 and 2.

For more information, please visit the ARC Initiative web site.