Lusaka Nursing Institute trains medical brains

All health issues in Zambia, but there is a strong focus on the main ?killer diseases?, being malaria, HIV/AIDS and TB. The country suffers from a severe shortage of medical staff. There are 600 medical doctors registered for a population of 11 million people. The Ministry of Health (MoH) indicated that Zambia needs 43,500 nurses while only 22,300 are registered. Moreover, every year a large number of doctors and nurses goes to work overseas (the brain drain). Working conditions elsewhere are attractive and there are opportunities galore in Anglophone countries. More than 50% of rural health centres have only one qualified staff member! MoH has made reducing the current shortage of medical staff it?s primary objective; state nursing schools should provide 10,000 more nurses in the next seven years. The state system will never be able to cater for these needs. Additional support needs to be mobilized. When the LNI reaches its full training capacity, 100 nurses will join the medical workforce in Zambia annually . Direct beneficiaries: Our clients are young Zambians, keen to fight poverty and disease in their communities, and to get the best education because they pay for it. Candidates qualify by having successfully completed twelve years of schooling and have credits in at least five O-level subjects, including Mathematics, English and Biology. Indirect beneficiaries: All Zambians needing medical care now or at a later time. Eventually a growing number of all Zambians in need of care will benefit from the improved levels of service. Since April 1st of this year, healthcare in Zambia has been free to the in the poorer rural areas, but the key providers, people with the capability and experience to put prevention and cure into practice are not there? Zambia faces a medical human resource crisis. The LNI trains nurses; for many Africans the highest level of medical personnel they are ever likely to meet. Where there is no doctor? the nurse will take charge!

About You

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Your idea

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Focus of activity

Healthcare Delivery

Start Year

2005

Positioning in the mosaic of solutions

Main barrier addressed

Limited reach of healthcare infrastructure

Main principle addressed

Adopt market-based models as a scaling-up strategy

You may have the drugs, or even the infrastructure, but do you have the people? In most cases, nurses are the most expert level of medical help that Zambians will encounter during their lifetime. But health services are deteriorating. HIV/AIDS undermines the whole of society, including the medical profession. Every year, 3.5% of nurses in Zambia die from AIDS-related illnesses. To compensate, many more nurses need to be trained annually. 20% of the population is HIV positive. There are 690 doctors registered in a population of 11 million inhabitants. With only 22,000 nurses, where 44,000 are needed, the country faces an acute shortage of medical staff. The LNI will contribute to one of the key factors in the fight against any disease and for proper patient care in Zambia: human capital.

Name Your Project

Lusaka Nursing Institute trains medical brains

Describe Your Idea

All health issues in Zambia, but there is a strong focus on the main ?killer diseases?, being malaria, HIV/AIDS and TB. The country suffers from a severe shortage of medical staff. There are 600 medical doctors registered for a population of 11 million people. The Ministry of Health (MoH) indicated that Zambia needs 43,500 nurses while only 22,300 are registered. Moreover, every year a large number of doctors and nurses goes to work overseas (the brain drain). Working conditions elsewhere are attractive and there are opportunities galore in Anglophone countries. More than 50% of rural health centres have only one qualified staff member! MoH has made reducing the current shortage of medical staff it?s primary objective; state nursing schools should provide 10,000 more nurses in the next seven years. The state system will never be able to cater for these needs. Additional support needs to be mobilized. When the LNI reaches its full training capacity, 100 nurses will join the medical workforce in Zambia annually . Direct beneficiaries: Our clients are young Zambians, keen to fight poverty and disease in their communities, and to get the best education because they pay for it. Candidates qualify by having successfully completed twelve years of schooling and have credits in at least five O-level subjects, including Mathematics, English and Biology. Indirect beneficiaries: All Zambians needing medical care now or at a later time. Eventually a growing number of all Zambians in need of care will benefit from the improved levels of service. Since April 1st of this year, healthcare in Zambia has been free to the in the poorer rural areas, but the key providers, people with the capability and experience to put prevention and cure into practice are not there? Zambia faces a medical human resource crisis. The LNI trains nurses; for many Africans the highest level of medical personnel they are ever likely to meet. Where there is no doctor? the nurse will take charge!

Innovation

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Description of health product/service offering:

All health issues in Zambia, but there is a strong focus on the main ?killer diseases?, being malaria, HIV/AIDS and TB. The country suffers from a severe shortage of medical staff. There are 600 medical doctors registered for a population of 11 million people. The Ministry of Health (MoH) indicated that Zambia needs 43,500 nurses while only 22,300 are registered. Moreover, every year a large number of doctors and nurses goes to work overseas (the brain drain). Working conditions elsewhere are attractive and there are opportunities galore in Anglophone countries. More than 50% of rural health centres have only one qualified staff member! MoH has made reducing the current shortage of medical staff it?s primary objective; state nursing schools should provide 10,000 more nurses in the next seven years. The state system will never be able to cater for these needs. Additional support needs to be mobilized. When the LNI reaches its full training capacity, 100 nurses will join the medical workforce in Zambia annually . Direct beneficiaries: Our clients are young Zambians, keen to fight poverty and disease in their communities, and to get the best education because they pay for it. Candidates qualify by having successfully completed twelve years of schooling and have credits in at least five O-level subjects, including Mathematics, English and Biology. Indirect beneficiaries: All Zambians needing medical care now or at a later time. Eventually a growing number of all Zambians in need of care will benefit from the improved levels of service. Since April 1st of this year, healthcare in Zambia has been free to the in the poorer rural areas, but the key providers, people with the capability and experience to put prevention and cure into practice are not there? Zambia faces a medical human resource crisis. The LNI trains nurses; for many Africans the highest level of medical personnel they are ever likely to meet. Where there is no doctor? the nurse will take charge!

Description of innovation:

The LNI is the first private nursing school in Zambia. There are many private schools providing all kinds of vocational training. But until last year, education for nurses was only available in schools managed by the state or foreign missionaries. The LNI provides affordable, high quality nursing education. The institute will have to provide conclusive proof that the private education approach not only works, but also works better. The LNI sees this as a responsibility to the country as a whole, and in particular to the students. We feel that resources from the private sector can be more easily mobilized towards an education that can demonstrate return on investments. We offer Value for money: Tuition fees are kept low, whilst quality of education is monitored continuously. Paying students will expect nothing less. The school embraces interactive forms of education. Many schools and vocational training institutes are limited to the classic teacher lecturing, class listening/writing model, mainly because of the extra cost of teaching materials, which they cannot afford. At the LNI we are implementing a teaching method that requires students to prepare for their classes in advance. Students get accustomed to reading the material and reflecting upon it, which enables them to find out for themselves what they do or do not understand prior to lessons in class. This enhances quality and effectiveness of understanding the lessons to be learned, and also guides students in the practical elements of their education. Another form of interactivity is that students are encouraged to speak out on all matters that influence the quality of their education. In 2007 the school plans to introduce ?problem based learning?. Students will learn how to make choices in order to select the best or the most practical solution in various situations. Working circumstances differ widely between urban, well-equipped private hospitals and distant rural clinics.

Operational model:

The Lusaka Nursing Institute trains nurses. It provides high-quality education to train motivated and competent nurses, with a long-term goal of training a sufficient number of people to strengthen the Zambian healthcare and reduce the impact of the brain drain and AIDS. The LNI will contribute to one of the key factors in the fight against any disease and for proper patient care in Zambia: human capital. Without enough properly trained nurses, neither care nor medicine will reach the present and future patients. In 2008 the first nurses will graduate. The LNI will train up to 100 nurses a year. In return for grants, students agree to work at least three years in Zambia. Thus the LNI provides local jobs, educates nurses, strengthens Zambian health care, and fights the Brain Drain. We found that many candidates are willing and qualified, but are unable to pay our tuition fees. The current amount of 6 million Kwacha (1,900 $) is too high. As of July 2006, the LNI will start offering student grants, which, based on transparent conditions, will sponsor students by contributing to their tuition fees. Students who pay for themselves can apply for partial sponsorship ranging from 25 ? 75 per cent of the fees. Partial sponsorship was chosen for two reasons: 1. More students can be sponsored, and 2. Making a contribution of their own will be a positive way of self-investment for the students, which will add to their motivation and attitude to work. After all, this is all about their studies and their future. The first substantial pledges to the Student Support Fund have been made. In the process of raising funds, we also encountered various foundations abroad, which specifically focus on the training of nurses in developing countries. So far these institutions have pledged to cover the expenses of training an additional six young Zambians to become registered nurses. These pledges are reserved for the exceptionally bright, who otherwise would not be able to study.

Human resources:

Marijn Wiersma (chair of the board of Governors) represents PharmAccess (PAI) in Zambia. She studied medical anthropology in the Netherlands. Her international network and fundraising capacities will ensure further growth and ultimately a stable basis for the school. Brighton Chellah, the present director, is a bio-medical scientist who teaches microbiology at Chainama College of Health Sciences and at the School of Medicine. He has a Masters degree in education and primary health care. Antoś Szkudlarek (finance and public relations) is a teacher and has in the past ten years worked as logistics manager for M?decins Sans Fronti?res and the World Food Programme. Mrs. Muyunda ( Nursing Education Manager) and Mrs. Mukuboto (Senior Lecturer) have previously managed nursing schools in Zambia and Botswana. The LNI offers direct employment for 16 people, ranging from management to cleaners and guards. Currently there are 4 part time lecturers. Employment will increase up to 18 permanent and 8 part time staff in 2007. Backgrounds vary widely; management consists of specifically experienced people, support staff is employed based on motivation to support the schools' key tasks.

Key operational partnerships:

The LNI has received considerable support from the General Nursing Council (GNC), which indicates that the need for more nurses is being recognised and that government is prepared to support initiatives that will reduce these shortages. The Ministry of Health has indicated that this is their main challenge for the coming years. No business in the medical sector in Zambia can ever be sustainable without consent of the government. The GNC wants our school to succeed, but in order to do so we have to follow every rule in the book. The GNC has licensed the school. This strategic relationship will help us to achieve our goals. We receive considerable financial support from the ?Getu foundation? (GF) in the Netherlands. The GF raises funds for the LNI by means of its website, as well as by newsletters and other related activities. The foundation aims at reaching out towards people interested in solutions for the bigger problems relating to health care and education in Africa. Money received from the Getu Foundation, has kept the LNI in business when cash flow problems arose. For schools in particular, cash flow is a difficult issue to manage, since 90% of the cash comes from tuition fees and 70% is paid out for salaries. Until the moment that the institute reaches its break-even point, financial injections from the GF remain necessary.

Impact

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Financial Sustainability:

Current and Future Impact:

Scaling up strategy:

Stage of the initiative:

Scaling Up stage.

Expansion plan:

To assure stability of the school, it should not grow beyond 300 nursing students. Expansion is possible but only if the institute diversifies. Training for midwives, nursing tutors, physiotherapists, HIV scouts and clinical officers is being considered. Expansion of the training package will make the growth of the institute possible but will also be a managerial challenge. The school can become a regional centre of excellence and we feel it would help if management can be internationalised. Expansion will require a clear vision of decision makers along with funds for further investments. The current space the school is renting can accommodate a maximum of 200 students. Depending on the availability of properties for sale, the building of a new school should be considered. At the same time we are considering accommodating a clinic on the school premises where our students can do their internships. External investments will be required to finance such an undertaking. Further development in African countries requires education, vision and capable human beings, as well as international knowledge and financial backup. Income from tuition fees will be around $ 540,000 in 2009.

Origin of the initiative:

Our first experience with a private nursing college in Zambia was a disappointing one: the director-owner of the ?college? turned out to be fraudulent. Besides not being registered by the General Nursing Council, this particular nursing course went 'bankrupt' after three months. All students? fees for a year?s tuition, disappeared into the pocket of the 'director': 14 of its students were left out on the street without money or education. Marijn Wiersma decided that an initiative was needed to help out these and other future students. With Mr. Brighton Chellah, one of the principal teachers, they established a new nursing school. Marijn Wiersma, one of the founders, is a medical anthropologist and worked in various African and Latin American countries for the UN and NGOs. She represents the Dutch PharmAccess Foundation. Currently she chairs the Board of Governors of the LNI.

This Entry is about (Issues)

Sustainability

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Policy change:

The top policy change to fundamentally improve the healthcare system in Zambia would be a commitment from government and assisting (foreign) partners to truly invest in the sector by raising the salaries of medical staff significantly. A direct change that would follow is that the Brain Drain out of Zambia would diminish. At the same time training facilities for medical staff have to be upgraded, salaries for teaching staff reviewed and the number of institutes has to be doubled. Only then will the people of Zambia have a chance to receive their rightful and highly desired basic medical care. As a direct result from these improvements, the rampant ?killer diseases? (malaria, HIV/AIDS, TB, etc.) will affect fewer people and fewer will die from them.