Quality nursing, midwifery critical to saving lives in West Africa
By Franca Ofili
Across West Africa, the survival of mothers and newborns, along with the overall quality of healthcare, heavily relies on how well nurses and midwives are trained.
As the primary healthcare providers in the ECOWAS region, they are often the first, and sometimes, only point of contact for patients, especially in rural areas where doctors and specialised medical care are scarce.
However, differences in training standards, inadequate educational facilities, shortages of qualified instructors and variations in professional regulations have continued to raise concerns about the quality and consistency of nursing and midwifery education.
These challenges have prompted the West African Health Organisation (WAHO) to intensify efforts to establish common regional accreditation criteria for institutions training nurses and midwives.
The initiative seeks to ensure that graduates possess the competencies required to deliver safe and effective healthcare, irrespective of the ECOWAS country where they received their education.
The Director-General of WAHO, Prof. Palokinam Pitche, spoke in Abuja at a 3-day workshop to finalise the Harmonised Regional Accreditation Criteria for Nursing and Midwifery Training in ECOWAS Region.
He said the initiative was particularly important given the persistent shortage of qualified health professionals across the region.
Pitche said regional assessments showed that ECOWAS countries faced critical shortages of health workers, with an average health professional density of 0.73 per 1,000 population, compared with the referenced minimum threshold of 2.28.
He said increasing the number of health professionals alone would not address the challenge unless their education and training were relevant, consistent and responsive to the healthcare needs of the population.
The director-general said the COVID-19 pandemic demonstrated that universal health coverage and health security depended on a competent, adequately trained and equitably distributed workforce.
“Accreditation must therefore be regarded not merely as an administrative or regulatory requirement, but as a strategic investment in health system resilience, patient safety and national development.
“The proposed accreditation framework will establish common requirements for curricula, institutional infrastructure, qualifications of teaching staff and clinical training environments.
“It will also provide transparent procedures for institutional assessment, compliance monitoring and periodic reviews to ensure that training institutions maintained acceptable standards.”
He noted that WAHO had already harmonised and validated 58 basic and specialist training curricula covering medical specialties, pharmaceutical sciences, allied health professions, nursing and midwifery.
“Other interventions included harmonised training manuals for community-based health workers, regional training plans, scholarships for health workers in shortage specialties and financial assistance to member states implementing harmonised curricula.
“WAHO’s efforts to address workforce shortages through its engaging medical experts in the diaspora programme, which seeks to mobilise experienced professionals for training, retraining and mentorship,” he said.
Pitche, however, said the success of the accreditation initiative would depend on effective implementation, stronger regulatory oversight and the commitment of member states.
He urged participants to produce competency-based criteria that would strengthen nursing and midwifery education, facilitate professional mobility and improve the quality of healthcare across West Africa.
The concerns surrounding training standards were further highlighted by Prof. Koffi Balogou, President of the Regional Council for Health Professionals Education.
Balogou warned that some institutions continued to offer nursing and midwifery training without qualified teaching personnel, appropriate infrastructure and the academic resources required to produce competent professionals.
He said some admitted students did not meet the necessary academic requirements, while certain institutions relied on instructors lacking adequate professional and pedagogical competencies.
“These practices undermine professional standards, exploit families who invest their resources in education and, most importantly, place the lives and safety of our populations at risk.
“Graduates from poorly regulated institutions could undermine public confidence in the healthcare system and expose patients to avoidable risks.
“Harmonised accreditation will ensure that only institutions meeting established standards were authorised to train nurses and midwives and award recognised qualifications,” he said.
According to Balogou, the framework will protect families from institutions collecting training fees without providing adequate education or legitimate qualifications.
He also emphasised that accreditation would promote mutual recognition of qualifications and facilitate the movement of competent health professionals across ECOWAS countries.
The representative of the West African Professional Colleges, Prof. Yao Tettey, also called for stronger collaboration among professional bodies, training institutions and regulatory authorities.
Tettey said the professional colleges should build on WAHO’s existing work on harmonised accreditation, curricula, professional practice and ethics instead of duplicating efforts.
He recalled that discussions during the 50th anniversary celebrations of the West African College of Physicians had revealed that some professional institutions were not sufficiently aware of WAHO’s extensive work in harmonising health professional education.
He said the current workshop provided an opportunity to develop a comprehensive accreditation framework that could serve as a reference for institutions across the region.
Tettey urged stakeholders to ensure that the final document was effectively disseminated to professional colleges, training institutions and regulatory authorities for adoption and implementation.
Similarly, Prof. Boni Avoaka, a Dental Surgeon, and Health Administrator said harmonised accreditation would strengthen academic standards and build confidence among universities and professional training institutions.
She said academic institutions had a responsibility to ensure that their programmes met international standards while supporting the free movement of qualified health professionals within ECOWAS.
Avoaka maintained that mutually recognised qualifications backed by credible accreditation mechanisms would strengthen regional cooperation and improve the quality of healthcare education.
The Nigerian Government also reaffirmed its commitment to the initiative.
The Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, said accreditation was essential to ensuring that nursing and midwifery graduates acquired the knowledge, skills and competencies required to provide safe, effective and compassionate care.
Pate said harmonised standards would promote professional mobility, strengthen regional cooperation and improve public confidence in healthcare systems.
“Accreditation should therefore not be viewed merely as a regulatory requirement.
“It is a vital investment in patient safety, quality healthcare and the future of our health systems,” he said.
Also, Dr Bosede Arogundade, WAHO Professional Officer for Nursing and Midwifery, traced the process to regional and international commitments to strengthen health workforce development.
She said the process gained momentum in 2006 following a resolution by ECOWAS health ministers calling for the harmonisation of health professional curricula across member states.
According to her, WAHO began implementing the initiative in 2007 with a consensus workshop on the equivalence of diplomas and certificates.
“This was followed by manpower analysis and assessment in 2008 and the first multidisciplinary curriculum harmonisation exercise in 2009.’’
Arogundade explained that nursing and midwifery education initially faced considerable disparities, including differences in programme duration, diploma nomenclature and admission requirements.
She said WAHO subsequently worked towards establishing equivalencies between Francophone and Anglophone training programmes, including the six-year training structure in Francophone countries and the five-year programme in Anglophone countries.
Beyond programme duration, she said the harmonisation process identified the competencies expected of nursing and midwifery graduates across the region.
“These included clinical management, community healthcare, research, preventive and rehabilitative care, maternal and child health, and the management of medical and surgical conditions.
“Particular attention was given to emergency obstetric and neonatal care, given the continuing burden of maternal and newborn deaths in the region,” she said.
According to her, properly trained nurses and midwives should be capable of providing culturally acceptable care during pregnancy, labour and childbirth, identifying complications and responding appropriately to emergencies.
She explained that improving their competencies, particularly in managing obstetric emergencies, could contribute to preventing avoidable deaths among mothers and newborns.
Arogundade also disclosed that WAHO had supported basic and post-basic nursing and midwifery training, continuing professional development through e-learning, training of trainers and initiatives targeting professionals serving rural and difficult-to-reach communities.
In spite of the progress, Arogundade identified inadequate funding, workforce attrition, limited training and retraining opportunities, and insufficient development partners as major challenges.
Observers say the proposed framework is expected to strengthen institutional inspections, improve regulatory compliance, promote safe clinical training environments and establish clearer standards for professional education.
For stakeholders, harmonising nursing and midwifery curricula across ECOWAS member states is essential for regional health integration; this process transforms credentials into competent clinical practice and improved population health outcomes.(https://newsatlarge.ng)