Nurses and midwives: Leaders in health care in East Africa

KENYA: With an estimated population of 49.7 million and an annual growth rate of 1.68% per year, Kenya is the second most populous country in East Africa. The country has a median age of 19 years and a robust (although declining) fertility rate of 3.9 births per woman. According to the latest World Health Organization (WHO) Kenya’s life expectancy is 63.4 years. Kenya currently has a ratio of 8.3 practicing nurses to 10,000 people, significantly below WHO’s recommendation of 25 nurses per 10,000. Many nurses often attend to more than 100 patients per day, and in many health centres nurses are the only professional care available to rural populations.

AKDN / Christopher Wilton-Steer
Agnes Ojok has been working at the Aga Khan Hospital in Kisumu ever since she graduated with a diploma in nursing from the Kenya Medical Training College in 2009. She manages the maternity ward. “I have a vision of becoming a teacher or a lecturer," she says. "I want to see the number of people taking on midwifery increase. We need qualified staff who can deal with complications during birth.”

AKDN / Christopher Wilton-Steer
In 2012, the Aga Khan University School of Nursing and Midwifery (AKU-SONAM) awarded Hassan Kassim a scholarship that helped cover half his tuition fees. “Without such help," he says, "I wouldn’t have been able afford it, especially as I had children in high school.”

AKDN / Christopher Wilton-Steer
Beth Waweru, Clinical Instructor of the Medical Ward at the Aga Khan University Hospital Nairobi, joined AKU-SONAM in 2007 with support from both the hospital and the University. She was able to study in comfort and graduated four years later. "We learnt with textbooks," she remarks, "but we were also encouraged to think critically about various situations -- to add our own understanding beyond what the textbooks said. Immediately after I graduated from AKU, I applied for and was promoted to the role of Clinical Instructor of the Medical Ward".

AKDN / Christopher Wilton-Steer
While Zablon Lipule (pictured at left), the Clinical Practice Educator at the Aga Khan University in Nairobi, pursues his master’s degree in health management, he feels AKU-SONAM has played an important part in his professional career. He says he has gained relevant critical thinking skills and a confidence boost that has allowed him to sufficiently train nurses on current trends.

AKDN / Christopher Wilton-Steer
Peace Ambetsa Chitechy, Assistant Nurse In-charge at the Matuga Dispensary in Kenya, says her "dream is to make Matuga Dispensary’s comprehensive care clinic patient-friendly. I want to encourage more women and their partners to come here for their maternal/reproductive health needs.”

AKDN / Christopher Wilton-Steer
“After graduation I was appointed as a Shift Leader, having to make sure the other nurses on duty do the right thing and that the patients get the right care," says Florence Thaine, Clinical Practice Educator at the Aga Khan University Hospital, Nairobi. "I would chip in so much they noticed and would tell me how different I was after my degree.”

AKDN / Christopher Wilton-Steer
Mary Wambui Mwaniki (pictured at centre), a Public Health Nurse at Kangema Sub-District Hospital, says, “I want to be remembered as someone who had a positive impact, especially by the nurses I’ve supervised. I want them to say ‘I’m who I am today because Mary took time to mentor me’.”

AKDN / Christopher Wilton-Steer
“Nursing is not just a career, it is a calling," says Eunice Makena, an Intensive Care Nurse at the Aga Khan Hospital in Mombasa. "This isn’t the kind of work you do for money.”

AKDN / Christopher Wilton-Steer
Margaret Kanzu Kiti, Team Leader of Outpatient Care at the Pandya Memorial Hospital, remarks that "I’m proud of the clinic my daughter, Zawadi, and I are setting up. It’s a culmination of my career as a nurse and through it I can continue to serve my community, which has poor access to health facilities.”

AKDN / Christopher Wilton-Steer
David Odada, Clinical Nurse at the Aga Khan University Hospital, Nairobi, remarks that when he represented the hospital as an official at branch and national levels, "it really opened my eyes to opportunities for me and my colleagues.”

AKDN / Christopher Wilton-Steer
With nurses remaining the largest cadre of health professionals in Uganda, accounting for more than 80% of the healthcare workforce (with the vast majority being certificate or enrolled nurses), it is clear why improving the quality of nursing is critical to improving the overall delivery of health care services. This is especially true in a country that is home to the world's youngest population and where the leading cause of death remains HIV/AIDS.

AKDN / Christopher Wilton-Steer
Mary Musoke, Founder of Mama Maria Clinic Kagoma, Uganda, was an established midwife when she enrolled in the Bachelor of Science in Nursing programme at AKU-SONAM in Uganda. After her graduation in 2005, she was elected President of the Private Midwives Association for two terms.

AKDN / Christopher Wilton-Steer
When Rosemary Okello, Principal of The Good Samaritan School of Nursing and Midwifery, enrolled for a BScN at AKU Kampala, both the direct and indirect skills she learned had the greatest impact. “We had to work hard to hand in our assignments on time," she says. "My time management skills improved tremendously given that I also had a school to run.”

AKDN / Christopher Wilton-Steer
Sister Petua Kiboko, the Senior Principal Nursing Officer at Lira Regional Referral Hospital in northern Uganda, was identified as a change agent while at AKU-SONAM. Her final research project on infection control (with a focus on waste management) impressed the faculty so much that they invited her to present the paper at a nurses’ conference. From that conference, the Makerere School of Public Health selected her to participate in a Leadership, Management and Governance course. This time, she narrowed her focus to neonatal sepsis. “I wrote a paper on neonatal sepsis," she says, "and because of what I had already learned at AKU, it was easy for me to present with confidence and inspire others.”

AKDN / Christopher Wilton-Steer
In 2013, Deborah Gitta poured her entire life savings into starting Divine Day Care, a school that provides quality learning services for all children, irrespective of their health or income status.

AKDN / Christopher Wilton-Steer
When Justine Nalwadda, Area Manager for the Mengo District Hospital, graduated with a BScN at AKU-SONAM, she was immediately promoted to Head of Nursing, supervising about 40 nurses. “I don’t want to know everything alone," she says, "so I share my knowledge and mentor too.”

AKDN / Christopher Wilton-Steer
Juliet Kigonya, Founder of Nurses' Concern for Adolescents, is also a graduate of AKU-SONAM in Uganda. Since its inception in 2012, Nurses’ Concern for Adolescents has been going to schools in Wakiso and Kampala to engage the youth in sexual and reproductive health education and sensitizing them to the dangers of drug abuse.

AKDN / Christopher Wilton-Steer
Leah Kamau (pictured at centre), the Head Nurse at Kampala Hospital, trained at AKU-SONAM in Uganda. Currently studying for her Master’s, Leah wants Kampala Hospital to be recognised as the best maternity centre in and around Kampala.

AKU / Samuel Mwangi
Tanzania’s major challenge is the predominance of communicable diseases, which is exacerbated by a shortage of skilled health workers. Both the skills gap and affordability of services is therefore key to improving the quality of health care. The challenge is especially severe in rural areas, where most of Tanzania’s people live. The country relies on just 5.2 clinical health workers per 10,000 people. At the same time, the government is striving to expand health insurance coverage to at least 50% by 2020.

AKDN / Christopher Wilton-Steer
To advance her career, Robby Moses Marwa enrolled in a BScN at AKU-SONAM in 2010 and graduated in 2014. Since then, her nursing career has grown. She is now the Assistant Head of Nursing and Midwifery Services at Tumbi Referral Regional Hospital. “One of the most fulfilling moments in nursing," she says, "is when a patient leaves healthy.”

AKDN / Christopher Wilton-Steer
“I was an Assistant Matron during my BScN training at the Aga Khan University," says Yasintha Kamaleki, Head of Nursing and Midwifery Services at TMJ Hospital, "but after I graduated in 2015 I was promoted to Head of Nursing and Midwifery Services." Before joining the Aga Khan University, she did not even have competent computer skills, but now she operate any computer with ease. “The leadership and management skills I learnt also help me a lot in my position," she says. "I gained confidence in myself and my skills, and unlike before, I can stand in front of any number of people for a presentation."

AKDN / Christopher Wilton-Steer
Mariam Karatta, Principal Nursing Officer, Comprehensive Community-Based Rehabilitation in Tanzania (CCBRT), says that "I have worked hard to build junior nurses’ capacity and change their perspectives on patient care. We tend to receive nurses fresh from school, so they’re not adequately prepared for the field. I’m glad to be in a position to help train them."

AKDN / Christopher Wilton-Steer
As a mother-and-child health coordinator in Ubungo Municipal Council, Rehema Panga supervises all family health services, including antenatal and postnatal care, family planning, cervical cancer screening, gender violence cases, child abuse cases, reducing mother-child infections and youth health services.

AKDN / Christopher Wilton-Steer
Another AKU-SONAM alumna, Emelda Kuvumbi, is now Head of Nursing Services at the Comprehensive Community Based Rehabilitation in Tanzania. The organisation works to prevent disability (by strengthening maternal and newborn health), provides affordable medical and rehabilitative services and aids empowerment of people with disabilities and their families.

AKDN / Christopher Wilton-Steer
AKU-SONAM alumna Pendo Bukori (right) is a Cervical Cancer Screening Field Officer at Tanzania Health Promotion Support (THPS) – a nonprofit organisation that works in collaboration with the Ministry of Health. Her work ensures that Tanzanian women are screened for cervical cancer and treated as early as possible.

AKU / Hendri Lombard
Reflecting on her training from AKU-SONAM, Ethel Malla, Principal Nursing Officer In-charge of Referral Systems at the Comprehensive Community-Based Rehabilitation in Tanzania, says that it has had a big impact in her career. “When I went into nursing education," she says, "I was able to train my students just like I had been trained."

AKDN / Christopher Wilton-Steer
Gustav Moyo, Director of Nursing and Midwifery Services, Ministry of Health, Community Development, Gender, Elderly and Children, joined AKU-SONAM for a BScN in 2008. He notes that the Ministry of Health has not responded to the needs of the majority of Tanzanians, especially in rural areas -- something he hopes to change.

AKDN / Christopher Wilton-Steer

Nurses and midwives: Leaders in health care in East Africa

In 2001, upon receiving the prestigious Archon Award from the international nursing honour society, Sigma Theta Tau International, His Highness said in a speech that “I have long felt the enhancement of the nursing profession to be absolutely critical to the improvement of health care in the developing world, and the Islamic world. The way forward was to professionalise, to institutionalise, and to dignify this great profession.” The Archon Awards granted biennially to individuals who, regardless of their profession, have made health advocacy a major aspect of their lives and whose efforts have created significant change that is far-reaching in scope.

In that same year, His Highness the Aga Khan began opening nursing schools under the Aga Khan University (AKU) banner in East Africa. Designed to “professionalise, to institutionalise, and to dignify this great profession”, they would eventually create the critical nurses and midwives needed in Kenya, Tanzania and Uganda.

Founded in 1983 in Pakistan by His Highness the Aga Khan, AKU now has campuses in Kenya, Tanzania and Uganda, and has awarded more than 3,000 diplomas and degrees across the region. The University provides scholarships to nine out of 10 of its students in East Africa. Its academic units in East Africa include the Medical College, School of Nursing and Midwifery, Graduate School of Media and Communications, East Africa Institute and Institute for Human Development. The 300-bed Aga Khan University Hospital in Nairobi is East Africa’s leading private teaching hospital.

AKDN / Christopher Wilton-Steer

AKDN / Christopher Wilton-Steer

In 2012, the Aga Khan University School of Nursing and Midwifery (AKU-SONAM) awarded Hassan Kassim a scholarship that helped cover half his tuition fees. “Without such help," he says, "I wouldn’t have been able afford it, especially as I had children in high school.”

AKDN / Christopher Wilton-Steer

AKDN / Christopher Wilton-Steer

AKDN / Christopher Wilton-Steer

Peace Ambetsa Chitechy, Assistant Nurse In-charge at the Matuga Dispensary in Kenya, says her "dream is to make Matuga Dispensary’s comprehensive care clinic patient-friendly. I want to encourage more women and their partners to come here for their maternal/reproductive health needs.”

AKDN / Christopher Wilton-Steer

AKDN / Christopher Wilton-Steer

Mary Wambui Mwaniki (pictured at centre), a Public Health Nurse at Kangema Sub-District Hospital, says, “I want to be remembered as someone who had a positive impact, especially by the nurses I’ve supervised. I want them to say ‘I’m who I am today because Mary took time to mentor me’.”

AKDN / Christopher Wilton-Steer

“Nursing is not just a career, it is a calling," says Eunice Makena, an Intensive Care Nurse at the Aga Khan Hospital in Mombasa. "This isn’t the kind of work you do for money.”

AKDN / Christopher Wilton-Steer

AKDN / Christopher Wilton-Steer

David Odada, Clinical Nurse at the Aga Khan University Hospital, Nairobi, remarks that when he represented the hospital as an official at branch and national levels, "it really opened my eyes to opportunities for me and my colleagues.”

AKDN / Christopher Wilton-Steer

AKDN / Christopher Wilton-Steer

Mary Musoke, Founder of Mama Maria Clinic Kagoma, Uganda, was an established midwife when she enrolled in the Bachelor of Science in Nursing programme at AKU-SONAM in Uganda. After her graduation in 2005, she was elected President of the Private Midwives Association for two terms.

AKDN / Christopher Wilton-Steer

AKDN / Christopher Wilton-Steer

AKDN / Christopher Wilton-Steer

In 2013, Deborah Gitta poured her entire life savings into starting Divine Day Care, a school that provides quality learning services for all children, irrespective of their health or income status.

AKDN / Christopher Wilton-Steer

When Justine Nalwadda, Area Manager for the Mengo District Hospital, graduated with a BScN at AKU-SONAM, she was immediately promoted to Head of Nursing, supervising about 40 nurses. “I don’t want to know everything alone," she says, "so I share my knowledge and mentor too.”

AKDN / Christopher Wilton-Steer

AKDN / Christopher Wilton-Steer

Leah Kamau (pictured at centre), the Head Nurse at Kampala Hospital, trained at AKU-SONAM in Uganda. Currently studying for her Master’s, Leah wants Kampala Hospital to be recognised as the best maternity centre in and around Kampala.

AKU / Samuel Mwangi

AKDN / Christopher Wilton-Steer

AKDN / Christopher Wilton-Steer

AKDN / Christopher Wilton-Steer

AKDN / Christopher Wilton-Steer

AKDN / Christopher Wilton-Steer

AKDN / Christopher Wilton-Steer

AKU / Hendri Lombard

AKDN / Christopher Wilton-Steer

AKDN / Christopher Wilton-Steer

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