Charged with the responsibility of regulating nursing and midwifery education and practice in Kenya, which entails: registration and licensing of nurses and midwives trained in Kenya and those trained outside Kenya (TOK) for their eligibility to practice as competent nurses and midwives; enhancing competencies of nurses and midwives through provision of CPD; coordination of internship for graduate nurses (BScN) and midwives (BScM); and development, review and dissemination of policy documents, among other activities, the Nursing Council of Kenya is a key pillar in the realisation of Universal Health Coverage.
In an exclusive interview with Corporate Watch Magazine, the Nursing Council of Kenya Registrar/CEO Mrs Edna Tallam – Kimaiyo noted that Universal Health Coverage will address National challenges and will go a long way in achieving the core principle of the Vision 2030 Agenda, that is, the realisation of a society where ‘no one is left behind’.
‘On our part as a regulator in nursing and midwifery education and practice, we are working towards achieving the Universal Health Coverage goals which are anchored in our Strategic Plan 2017-2022, and we are on track and the timelines are satisfactory. Universal Health Coverage, Vision 2030 and Sustainable Development Goals are achievable by the set timelines through the strategic partnerships the government has put in place,’ she said.
The Council which she is the Registrar/CEO, regulates nursing and midwifery education and practice to ensure compliance of standards through quality assurance by conducting inspections and support supervisory visits to training institutions and health facilities; development, review and implementation of procedures pertaining to investigations of professional misconduct.
In accordance with the Nurses Act Cap 257, the Council’s functions are to establish and improve standards of all branches of the nursing and midwifery profession in all their aspects and to safeguard the interests of all nurses and midwives; to establish and improve the standards of professional nursing and midwifery, and of health care within the community; with the approval of the Cabinet Secretary, to make provision for the training and instruction for persons seeking registration or enrolment; to prescribe and regulate syllabuses of instruction and courses of training for persons seeking registration or enrolment.
Banking on the institution’s vision and mission, which is to be a world-class regulatory body in education and practice and to develop standards; enforce regulations in nursing and midwifery education and practice, the Council prides itself in ensuring quality nursing and optimal health.
‘We ensure we effectively effect this through our core values. These are the DNA of the Council that everything we do comes from deeply-held commitments and shared understanding of our values, what we stand for, how we treat each other and those we serve; that inform every policy and steer every action summarized as; INSPIRE – Integrity, Nurture, Social Responsibility, Professionalism, Innovation, Responsiveness, and Excellence,’ noted Mrs Kimaiyo, who is currently pursuing a PhD in Nursing & Midwifery Education at Stellenbosch University in Cape Town, holds a Masters Degree in Public Health from Kenyatta University and is an Afya Bora Consortium Global Health Leadership Fellow.
Nursing and Midwifery Education and practice Regulation
Over the years, the Council has regulated the standards of nursing and midwifery care, qualified nursing and midwifery staff, nursing and midwifery training institutions, facilities, conditions and environment of health institutions, and taken such disciplinary or appropriate measures as may be necessary to maintain a proper standard of nursing and midwifery care in health institutions.
The Council regulates nursing and midwifery education and practice through the Education, Examination and Research, Registration and Licensing, and Discipline, Standards and Compliance Departments using various methods, including; development and validation of scope of practice, guidelines, policies and nursing and midwifery procedure manuals; development of a curriculum and curriculum evaluation checklists; development and review of old and new programs with new regulatory tools which aided the review of curriculums; develop measures to reduce and eliminate exam malpractice/irregularities; automation of departmental processes; approval and accreditation of institutions to offer different basic and post basic nursing and midwifery programmes; closure of training institutions and facilities regulated by the Council for non-compliance; and development of regulatory tools, to ensure safe and ethical nursing education and practice.
The Council provides a frame of reference of the nursing and midwifery education programs in the country in preparing safe and competent nurse practitioners who will function effectively not only as members but as leaders in health care delivery system; assessing the extent to which educational programs meet accreditation requirement as laid down by the regulatory authorities (Nursing Council of Kenya, Commission of Higher Education, senate of universities and Technical and Vocational Education and Training Authority (TVETA).
The Council ensures nursing and midwifery education programs are appropriate and adequate in preparing nurses to join the profession and foster continuing improvements in nursing and midwifery education and hence professional practice.
Cognizant of growing demand of well educated, certified and licensed nurses in Kenya, nurses and midwives now can access 1300+ free Online Continuous Professional Development courses through the Council’s Online Services Portal http://osp.nckenya.com. The Nursing Council of Kenya has developed standards of nursing and midwifery education that will ensure nurses and midwives’ response to advancement in health care delivery, practise, research outcome and new technology.
‘The Council has put measures in place to ensure we produce competent nursing and midwifery graduates through issuance of licensure examination and practising license,’ says Mrs Kimaiyo. ‘Nursing and midwifery is regulated because it is one of the health professions that pose a risk of harm to the public if practiced by someone who is unprepared and/or incompetent. The general public may not have sufficient information and experience to identify an unqualified health care provider, and is vulnerable to unsafe and incompetent practitioners. A license issued by the Council provides assurance to the public that the nurse has met predetermined standards,’ notes the institution’s CEO.
The Council, through its Standards and Compliance department, conducts supervision visits and inspection of training institutions and health facilities to ensure that they comply with the set standards of nursing and midwifery education and practise for the provision of high quality services in the nursing and midwifery sector.
Technological advancements and service delivery
Since its establishment, the Council has achieved a number of milestones such as the decentralization of select Council services to 7 zonal offices, namely: Mombasa, Kisumu, Uasin Gishu, Garissa, Marsabit, Meru and Turkana, acquiring and operationalizing license printing machines that have reduced the turnaround time for production of practice licenses for nurses and midwives.
The Council has also digitized its services through its Online Services Portal which offers online services like; online retention, online verification of nurse/midwife’s licensure status, online registration, online examination application, online internship application, private practice application and a list of approved and accredited nursing and midwifery training institutions.
‘The Council has developed and continues to maintain an elaborate database and information system for regulation of nursing and midwifery activities. Some of the online services that have been developed and deployed include indexing, exam and verification of retention status,’ added Mrs Kimaiyo.
The Nursing Council of Kenya has invested heavily to provide an enabling ICT infrastructure to support its mandate. The Regulatory Human Resource Information System (rHRIS) is the core enterprise wide system in use at the Council. It was developed as a solution to manage the training and practice pipeline for nurses and midwives though online indexing, online registration, online licensing, online retention, online Continuous Professional Development (CPD), online verification/registration and licensure status, and online application for internships. This information system manages the entire database for the nursing and midwifery professions in Kenya.
A client facing information system known as the Nursing Council of Kenya Online Services Portal (OSP) has been developed to support the e-government agenda. While the Council has decentralized selected services to the zonal levels, the use of the technology to increase the reach and accessibility of the Council services. The OSP is deployed in a cloud environment where the Council has acquired joint ICT infrastructure with other Health Regulatory Boards and Councils through the Joint Regulatory Collaborative (JRC).
In addition to the rHRIS and OSP, the Council has also invested in the development of an Enterprise Resource Planning (ERP) System. This has been progressively deployed at the Council to ensure that its resources are channelled towards its core mandate. This system has been integrated to mobile money and other banking systems to ensure that funds are received and managed effectively and efficiently.
‘The entire Nursing Council of Kenya ICT framework has been established based on the principles of interoperability, with data sharing under agreed standards so systems and solutions can be interoperable with the Ministry of Health and other players in the Health Sector,’ the CEO affirmed.
The Nursing Council of Kenya, through the able leadership of the parent ministry the Ministry of Health, has received tremendous support in its quest for a healthy nation and the realization of Universal Health Coverage (UHC). The Council remains committed to transformative devolved healthcare in line with the constitutional right of every Kenyan to access the highest standard of quality healthcare attainable and the Nursing Council of Kenya is dedicated to ensuring that it achieves Universal Health Coverage, Vision 2030 and Sustainable Development Goals through regulating nursing and midwifery education and practise.
The various institutions the Council has partnered with have different roles ranging from: regulating institutions of higher learning; provision of opportunities for internship training, clinical placement and mentorship for nursing and midwifery students; employment of nurses and midwives with valid practise licenses; resource mobilization; technical support; legal matters; and creating an enabling environment that supports affordable health care.
To sustain the gains achieved through these strategic partnerships, and improve the health status of Kenyans, evidence is available that most of the maternal, neonatal and child mortalities and morbidities are preventable with basic interventions. In this regard, the Nursing Council of Kenya commits to accelerate all the necessary efforts needed to ensure that the health workforce capacity matches the rising demands. This implies the need for ensuring adequate numbers of skilled nurses and midwives to offer the various need driven specialized services especially for mothers and their children among others.
The Council strives to ensure that its mandate is known, its roles are visible and communication and engagement with stakeholders is effective and comprehensive, to enables stakeholders to make informed assessments about the performance of the Council and its prospects in the long term and in the achievement of UHC.
The Council’s approach to stakeholder engagement is inclusive in nature, with various processes implemented to improve an understanding of the needs, expectations and interests of its stakeholders, while remaining cognizant of the Council’s best interests over time. Regular interaction with shareholders on key strategic themes and the performance of the Council, through various presentations and scheduled meetings continues to be a priority. This includes hosting exhibitions and participating in nursing and midwifery conferences.
The Nursing Council of Kenya was the 2nd runners up in the Statutorily Bodies category, 2018 at the Champions of Governance Awards that was held at Radisson Blu Hotel on 2nd November, 2018.
Protecting the public
The Nursing Council of Kenya has the unique role of assuring the public through approving the curriculum, approving and accrediting training institutions, issuing licensure examinations, and the issuance of practice licenses, that nurses and midwives are competent. The purpose of the Council, as defined by law, is to protect the public. The Council, when developing the curricula with various other stakeholders, ensures that health and social needs of the targeted communities guide nursing and midwifery education and research.
The Council maintains high quality assurance on standards of nursing and midwifery care through the development of regulatory tools: scope of practice; procedure manual; approval of nursing and midwifery training institutions and clinical placement areas; and setting guidelines that act as a baseline to guide the nursing and midwifery education and practise.
Enforcement of standards is also a key mandate of the Council in protecting the public and is done through accreditation of nursing and midwifery institutions to ensure that they meet the set standards, compliance audit of the health facilities to check if they are maintaining standards in regards to provision of nursing and midwifery care, joint inspections with other regulatory boards and councils in the Ministry of Health for compliance, assessment to ensure adherence to the set standards, carry out investigations where there are complains, and ensuring safe and ethical nursing and midwifery practice in line with the and code of ethics and conduct.
The Council also advices the Cabinet Secretary on all aspects pertaining nursing and midwifery education and practise, develop nursing and midwifery policies, recommend to the Cabinet Secretary on institutions to be approved for training of persons seeking registration or enrolment under the Nurses Act Cap 257.
Through Online Continuous Professional Development programs, the Council’s efforts have contributed to improved health indicators by trained nurses and midwives after improving and broadening their knowledge, expertise and competences and developing the personal and professional qualities required have helped in reduction in morbidity and mortality in the country.
Challenges still stand in the way of the Council. Even though the Council conducts inspections in hospitals and other health facilities to crack down on unlicensed practitioners, a number of unscrupulous operators are on the loose. The Council is also battling with unaccredited training institutions, and in this regard, the Council publishes an updated list of names of approved training institutions on its website to keep the public in the know.
The CEO says that pursuant to the instructive provisions of the Nurses Act Cap 257, such offenders if caught shall be guilty of an offence and shall be liable to a fine not exceeding five hundred thousand shillings or imprisonment for a term not exceeding two years or to both. However, slow judicial processes hinder the completions of matters.
Inadequate funds/ grants to support Council core mandate activities have been a major challenge which has resulted to constraint resource in terms of technical staff. Nonetheless, the Council identifies, develops and retains the requisite human resources to support its activities.
Rapid technological advancement has also been noted as a challenge with technological advances every new day. The Council therefore trains its staff regularly to keep them at par with the new advancements.
The Council recommends the government; to strengthen health systems, HRH issues on deployment, remuneration and retention strategies, security and better working environment.
The Registrar further notes that within their strategic plan, the Council has put in strategies and is working on partnerships to strengthen nursing and midwifery components that will impact the sector positively as envisioned in the Council’s mission and vision.
‘There is no optimal health without quality nursing and midwifery care, it is in this regard that the Council seeks to take a collaborative approach and working with the various health sector professionals to ensure we deliver Universal Health Care,’ Mrs Kimaiyo concluded.