Women for women's health: Uganda

The primary health care model targets social, political, and economic environments as key determinants of health for populations, as well as for individuals. If nursing in Uganda is to make a difference in health care outcomes and in the health of all Ugandans, nurses must look broadly at situations and be educated to practice primary health care nursing. After 14 years of civil war, Uganda is finally experiencing a period of reconstruction and rehabilitation: the whole infrastructure is undergoing a face-lift. Ugandan nurses recognize that their educational preparation has stagnated for many years and that it was not only the political unrest in their country that put them behind professionally. They realize that, given the new directions set by the government, they must become prepared to implement primary health care. They are demanding a university education so they may take their place alongside other health care providers prepared at the university level. Some of the most convincing arguments for a university program for nurses came from doctors at the university who spoke about the need to raise the standards of nursing practice, the quality of teachers, and the morale of practitioners. One nurse said: "If we lose hope for a BScN program, I think all the nurses will quit and we won't have any new students going into the profession." This program is designed to improve the health and well-being of all Ugandans, especially the most vulnerable groups of women and children in rural areas, through strengthening and expanding health services by targeting the educational preparation of nurses. Health planners in Uganda envision the professional nurse as key to the implementation of the national health policy of primary health care. University-educated nurses should be able to assess problems, make clinically sound decisions, and act appropriately within the scope of nursing practice. They should be able to interact and consult collegially with other health care professionals. Placed in rural community sites, nurses should function independently as community leaders, health education facilitators, primary health care practitioners, and educators for nursing students. Such intervention in community health care by BScN nurses should improve health care utilization and decrease mortality and morbidity from preventable causes. BScN nurses should make an impact on health care policy, nursing education, and primary health care. The evaluation of this project needs to be as comprehensive as its development and implementation. It will focus on health outcomes, particularly for women and children in rural areas of Uganda. Measurement of the effects of the process of nursing education (the BScN curriculum) in terms of output (nurses educated and placed in rural practice, nursing education, or government policy posts), outcomes (change in health status of rural communities), and broader impacts (changes in the status of women and in government policy toward women, nurses, or health at the local, regional, and national levels) is planned. An element of sustainability is present, as an operations research structure will be left in place at the community level. Timing, as the saying goes, is everything, and this project has had good timing. Our belief in the efforts and the goals of the project also gave us the strength to get support from various funding agencies for "small" things. For example, we got support from churches in the United States for building schools in Uganda; we persisted with the women's income-generating project when other support was pulled; we got books for the library in Uganda and got clothes, books, and furnishings for the students who came to this country. The motivation for project personnel has been altruism. The services that the two consultants provided to their Ugandan colleagues have extended far beyond the scope of the project.Ugandan health planners view the professional nurse as key to the implementation of the national primary health care strategy. In rural community sites, nurses should function independently as community leaders, health education facilitators, primary health care practitioners, and educators for nursing students. Reported in this paper is a collaboration of primary health care nurses, health planners and multiple communities in Uganda, and the Case Western Reserve University (US) School of Nursing. It was recognized that improvements in the formal education of nurses and increases in the number of primary health care nurses with midwifery training held potential for reducing infant and maternal morbidity and mortality in rural areas. Although there are several non-degree training programs, Uganda has no formal nursing education or standardized curriculum. This jeopardizes the status of nursing as a profession and results in uneven clinical capacities. A joint project, initiated in 1990, has the following five-year objectives: a bachelor of science nursing program reflecting a primary health care orientation, prepared nurse educators to implement the program, and establishment of primary health care nursing demonstration sites with a community-based teaching facility at each site.