Training a new generation of Nurses and Midwives
August 27, 2012
Bilha Achieng and Jonathan White
Photo selection throughout from freelance photographer Eliza Deacon taken of our students (above) at the Juba College of Nursing & Midwifery and at the Juba Teaching Hospital.
South Sudan’s maternal mortality remains the highest in the world, at 2,054 deaths per 100,000 live births; 200,000 women die in childbirth every year according to the 2006 South Sudan Health Survey. High levels of maternal mortality are linked to: poor access to quality reproductive health services, including family planning, access to skilled birth attendants and access to emergency obstetric and neonatal care. Fewer than 20 certified nurses and even fewer registered midwives, 4 in total, exist in all of South Sudan, a population of 9.6 million.
Photo: Nurse at Juba Teaching Hospital consulting with patient
Real Medicine Foundation, in collaboration with the Government of South Sudan, UNFPA, UNICEF, UNDP, WHO, St. Mary’s Hospital Juba Link, Isle of Wight, and the Japanese International Cooperation Agency (JICA), and in partnership with and with financial support from World Children’s Fund, has established South Sudan’s first ever accredited College of Nursing and Midwifery (JCONAM). The consortium aims to provide a scalable working model for this college that offers a 3 year diploma for Registered Nursing and Midwifery and is envisioned to be extended to other strategic locations within the newly independent country of South Sudan. This graduated level of nurses and midwives aims at filling the gap of professional skilled care services, destroyed as a result of the more than two decades of civil strife and war.
To improve the quality of and access to professional health care services by imparting the necessary skills through a three-year diploma program in either nursing or midwifery at the first College of Nursing and Midwifery in South Sudan accredited by the Ministry of Higher Education and Juba University that offers a diploma of Registered Nursing and Midwifery Status.
Photo: Mother and child at Juba Teaching Hospital, and Doctor checking on newborn
Provide model courses in Registered Nursing and Registered Midwifery in the first National Health Training Diploma Institute in South Sudan
Provide a curriculum recognized by all ministries associated with education in the ROSS (new designation for the new Republic of South Sudan, replacing GOSS)
Photo: Doctor checking on newborn at Juba Teaching Hospital
Provide leading edge skills laboratory and library for the students
Provide improved clinical setting for student training
Provide highly qualified instructors and tutors for the duration of the three year program
Provide an unprecedented model of health care sector capacity building for South Sudan
Provide a sustainable solution to South Sudan’s Maternal and Infant Mortality Rate, the former, which is the highest in the world at 2,054/100,000 as per the 2006 South Sudan Household Survey. Approximately 200,000 women die each year giving birth
Photo: Midwives and Nurses in action at Juba Teaching Hosptial
Summary of RMF/WCF-sponsored activities carried out during the reporting period undereach project objective:
Implemented activities in-line with RMF sponsored activities and project objectives include:
Support to the Ministry of Health, Republic of South Sudan and project partners in the coordination and implementation of project activities over the reporting period. Also in line with the approved college annual work plan.
Continued facilitation of inter-linkages with UNFPA, MOH and other stakeholders in ensuring quality assurance in the implementation of both nursing and midwifery curricula in the diploma programme.
Continued sponsorship of first and second year nursing and midwifery students
Photo: Midwives assist patient in labor into the delivery room, and Nursing student taking a test.
Contribution of essential content by college tutors in the review of the draft diploma midwifery curriculum which will be later finalized and endorsed by the Ministry of Health for use by all Diploma National Health Institutes.
Facilitation of IRIN-funded (http://www.irinnews.org/) filmmaker/freelance journalist and professional photographer on a documentary covering JCONAM, Hospital Facilities and Ministry of Health representatives in South Sudan.
Visit by RMF CEO to South Sudan
Procurement of high speed wireless internet equipment and services for JCONAM students and staff on campus.
Results and/or accomplishments achieved during this reporting period:
First year JCONAM students completed their foundation courses and were posted into the wards to conduct clinical rounds in Medical, Surgical and Pediatric Wards. Both nursing and midwifery students will be in the wards until July when the college breaks for two weeks. Second year midwifery students were posted into the wards while nursing students continued theoretical courses in the classrooms. During ward rotations, the students also began conducting supervised deliveries in the maternity ward. This was the first time the students were allowed to conduct deliveries; they were supervised by the maternity ward in charge, the college clinical instructor and the head of midwifery faculty at the college. After the first week into deliveries, the hospital midwives and doctors supervised the students.
From the 10th-17th of May 2012 RMF South Sudan hosted: Nicky Lankester-freelance filmmaker funded by IRIN (UNOCHA office in Nairobi) and Elizabeth Deacon-freelance photographer. The team of two worked in partnership with RMF South Sudan in highlighting the challenges faced by the health sector in maternal and child health including: the health services for mothers and children, human resources for health care accessible to mothers and children at the facility and community level and the current state of hospitals and county health care facilities as frontline and referral centres. Activities conducted culminated in a documentary titled “The Birth of South Sudan’” that covers the story of the world’s youngest nation in curbing the highest maternal mortality rates and among the highest infant mortality rates in the word. This documentary will be a critical advocacy tool for support from the international community for South Sudan. Documentary is in the final stages of editing by IRIN and shall be available for distribution shortly.
Photo: Mother and child at Juba Teaching Hospital
In June 2012, the Minister of Health Dr. Michael Hissen Milli officially opened the college dormitories constructed by UNDP. The dormitories had been completed in the first quarter but were undergoing some minor repairs and additional fittings. Both first and second year students moved into the accommodation facility upon their return from their break in mid-July.
During the second quarter, RMF initiated the procurement process for Wireless Internet facilities at the college. This initiative by RMF will see the installation of a VSat internet equipment and payment of monthly subscription for internet services for the next one year, starting July 2012 to June 2013. In an ever-changing global environment, it is essential for training institutes especially in the health sector to be updated on current information and research via the internet. RMF therefore envisions ‘bringing the world closer’ to JCONAM through internet facilities.
After its registration and formalization as a partner in the health sector through the signing of the MOU with the MOH, RMF sets up its offices in Juba-South Sudan. This move allows RMF to increase its efficiency and effectiveness as a partner to the central MOH in strengthening its health systems.
The college received 4 more additional tutors from UNDP for both the nursing and midwifery programs.
Photo: Midwife at Juba Teaching Hospital
Impact this project has on the community within the second quarter (who is benefiting and how):
The MOH is currently working with its stakeholders in identifying best practices for other public institutes based on lessons learnt from JCONAM. These include;
Prerequisites required for the establishment of training institutes
Working with developmental partners in setting up two other similar institutes in Wau one for the training of Diploma Midwives and the other for Diploma Nurses.
Photo: Students during a lecture at the Juba College of Nursing & Midwifery
The Ministry of Health through the support of RMF and other stakeholders is working on replicating the College in other states. This will translate to the continued growth in the number of nursing and midwifery diploma institutes in South Sudan and potentially new Nursing College partnerships for RMF.
Stakeholders in nursing and midwifery education and service delivery led by the Ministry of Health are undertaking the development of a bridging course for Community/Enrolled Midwives to be able to be admitted for diploma training and complete the course in less than 3 years.
It is currently estimated that it will take close to 66 years for South Sudan to establish a professional and sustained capacity to address maternal mortality issues in a region with the highest ratios of 2,054 for every 100,000 live births, as per the MOH. In addition to establishing other diploma institutes in South Sudan, the MOH is working on bilateral agreements with neighboring countries to send out qualified South Sudanese to train as nurses and midwives in order to establish a critical mass in the next 10 years.
Photo: Weighing a newborn at Juba Teaching Hospital
The college expects an even greater number of applications for the 2012 intake during the 4th quarter due to increased awareness creation and advocacy for the need to increase the human resource capacity in South Sudan.
Several years of experience derived from working with JCONAM and other partners has enabled RMF to develop a vision of increasing its level of support in South Sudan. By virtue of its registration and autonomy, RMF will seek to partner with organizations/agencies and most importantly government elements in the areas of health system strengthening and sustainable economic empowerment as witnessed in its other country projects.
Number served/number of direct project beneficiaries:
With the latest 2012 admissions into JCONAM, the current population stands at a combined number of 95 nursing and midwifery students. The continued support of the MOH and its developmental partners has thus facilitated the sponsorship of all students in their respective diploma courses.
Upon graduation after the three-year course, the registered nurses and registered midwives will provide a much-needed service within the states and counties at facilities level. The services offered by this cadre of graduates are also expected to extend into the community through health education, community mobilization and home care among others.
Photos: Expectant mothers outside the Maternity Ward at Juba Teaching Hospital
The review of the registered midwifery curriculum has also necessitated the review of the registered nursing curriculum. The JCONAM and MOH are currently soliciting the support of its funding partners to support the review process in 2012.
With the inclusion of the second year midwifery students into the maternity ward delivery roster, the 16 students are able to conduct/participate in 10-20 supervised delivers per day. These numbers are however meant to increase as the college looks into expanding the number of practicum sites in the near future.
Photo: Sisters waiting outside the Juba Hosptial