Rwanda’s The Department of Education has reintroduced nursing at the upper secondary or A-Level level and a few days ago invited applications for those who wish to study nursing at this level in a few selected schools. The move is a noble idea, especially given the national and even regional and global demand for community health workers and nurses in light of the number of doctors available and the growing population.

A strong, properly trained and skilled workforce of health workers, including nurses and midwives, is the backbone of a well-functioning health system in any country. But their education and training, recruitment, deployment and retention remain major challenges for many countries, including Rwanda. And therefore any measure to meet these challenges is welcome.

However, the introduction of nursing as a subject in a combination of sciences in general education must have been an educational oversight. Nursing is a professional course with many subjects and should be a stand-alone training course like any other medical-related course or vocational or vocational course. There is no real need to lump it together with other subjects and require trainees to excel in those subjects as well. It only overloads them with content for which the foundations of their level of training have been laid at the level of basic secondary education.

The new practical nurses course comprises 17 subjects, ten of which are general education subjects with an instruction time of 39 periods out of a total of 60 periods per week. This leaves only 21 periods for basic nursing subjects. Clearly not enough time to acquire relevant knowledge and develop professional skills

An analysis of the time allocation for general subjects only shows how biased this is. For example, Chemistry has 7 periods, Biology 7, Physics 6, Maths 3, English 4, and Entrepreneurship 2. This allowance and content is similar to the combination of Physics, Chemistry, Biology (PCB) in most of the Commonwealth of Nations, including Rwanda.

This is a rather heavy load, oriented towards the purely academic field, especially since the vocational and vocational education of this century is supposed to be focused on the development of practical skills accompanied by relevant and related subjects. Either way, the new course is aimed at training nursing assistants and therefore a disproportionate amount of academic content is unlikely to be of much use.

According to the recommendations of the World Health Organization (WHO) adopted at the 62nd session of the regional committee of African ministers of health in 2012, nursing as a course is supposed to cover the following topics: foundation of practice nurse, pathology, pharmacology, observation and evaluation of health. , anatomy and physiology, clinical and laboratory skills, parasitology, biochemistry, microbiology, human development, medical ethics, drug classification, and health care use and care, including adult and child care

The coverage of these topics is in line with the “Roadmap for strengthening human resources for better delivery of health services in the Africa region 2012-2025”

The nursing profession and the training required in Rwanda have evolved over the past twenty-five years, the starting point being the creation of the Kigali Health Institute (KHI) to train senior nurses. This was followed by the establishment of five regional nursing schools in 2007 which trained nurses at the IA (Assistant First Class) level. The aim was to strengthen KHI and train more mid-to-tertiary level nursing professionals to work in hospitals, clinics and health centers, and eventually to serve the community and fill gaps in the health care market. local work and even beyond our borders.

Previously, few nursing schools offered traditional vocational subjects mixed with a good number of general subjects without the appropriate links. The training focused on teaching general subjects and did not equip our basic technicians and health workers with the skills necessary for a modern health system and for the domestic and external labor market.

The establishment of the colleges was followed by the abolition of the A3 (Third Class Assistant) and A2 (Second Class Assistant) programs which were offered in nursing schools where training was treated as a course and not as a subject.

This phasing out of lower-level nursing courses was in line with the recommendations of a study commissioned by the East African Community in 2013, made several important recommendations.

It recommended the phasing out of certificate programs (such as A2 and A3) by 2020 and the intensification of nursing education where direct admission into the diploma program should be the completion of secondary education. . This is already the case in most EAC countries where nursing education begins at post-secondary level.

At the time, Rwanda pledged to have all nursing and midwifery cadres in the country at all levels in order to be harmonized with the rest of the EAC countries.

It may appear that we are reversing the progress that had been made. For some as yet unexplained reason, these five nursing colleges are not functioning, whether suspended or closed. We seem to be reneging on our commitment to harmonize training in ABC.

The country has also made progress. There are advances in all areas, including health. The expectations are higher. We should not go back to the past but rather seek to put in place systems for the future.

And so today, the training of health workers in Rwanda must be seen from the point of view of where the country has come from since 1994, where it is today and where it intends to be in at least 50 years. Those responsible for education policy, curriculum development and implementation should never lose sight of this. They must keep abreast of developments in the sector, particularly in terms of vocational and vocational training.

Trends and training practice in other parts of the world should also provide guidance. In many countries today the trend is towards training nurses at university level. It is increasingly common for university graduates to enroll in a one-year nursing education course. A-Level leavers take a one-year Licensed Practical Nursing Diploma course, while those who have only completed O-Level take a Health Assistants Certificate course.

In most Third World countries, students enroll in nursing education after completing A level or upper secondary education without any other conditions, provided they hold an O or L level certificate. ‘equivalent showing that they studied biology and chemistry.

It is of course important to design a training program adapted to the circumstances of Rwanda. This can still be done without incurring additional costs in terms of new infrastructure, training resources and creating unnecessary load on the entire system.

For example, nursing colleges can enroll A-level science graduates who already have the basic academic training required by the new training regime. Or they can enroll those who have not entered university or who wish to take short professional courses but who meet the minimum requirements for the training of auxiliaries or health assistants. They could then get an A2 diploma or whatever name we choose to give it.

There are many school leavers who might jump at the opportunity for such training. But even if this was not the case, they can be mobilized to attend the courses. By training them, this country could reduce the number of nurses and midwives per 1,000 inhabitants. In Rwanda the number is one nurse per 1,000 people, while in more advanced countries like Switzerland it is 18 per 1,000.

Education programs should aim to reduce this gap as well as to raise the level of education of health workers. For this, they must be taught by qualified doctors or registered nurses and have access to clinical and laboratory facilities and to patients.

The opinions expressed in this article are from the writer.

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