Developing a specialist children's nursing workforce in sub-Saharan Africa: a descriptive programme evaluation.

BACKGROUND Achieving Universal Health Coverage in low and lower-middle income countries requires an estimated additional five and a quarter million nurses. Despite an increasing focus on specialist nursing workforce development, the specialist children's workforce in most African countries falls well below recommended densities. The Child Nursing Practice Development Initiative was established with the aim of building the children's nursing workforce in Southern and Eastern Africa, and Ghana. The purpose of this evaluation was to enable scrutiny of programme activities conducted between 2008 and 2018 to inform programme review and where possible to identify wider lessons of potential interest in relation to specialist nursing workforce strengthening initiatives. METHODS The study took the form of a descriptive programme evaluation. Data analysed included quantitative programme data and contextual information from documentary sources. Anonymised programme data covering student enrolments between January 2008 and December 2018 were analysed. Findings were member-checked for accuracy. RESULTS The programme recorded 348 enrolments in 11 years, with 75% of students coming from South Africa and 25% from other sub-Saharan African countries. With a course completion rate of 94, 99% of known alumni were still working in Africa at the end of 2018. Most graduates were located at top-tier (specialist) public hospital facilities. Nine percent of known alumni were found to be working in education, with 54% of graduates at centres that offer or plan to offer children's nursing education. CONCLUSION The programme has made a quantifiable, positive and sustained contribution to the capacity of the specialist clinical and educational children's nursing workforce in nine African countries. Data suggest there may be promising approaches within programme design and delivery in relation to very high course completion rates and the retention of graduates in service which merit further consideration. Outputs from this single programme are however modest when compared to the scale of need. Greater clarity around the vision and role of specialist children's nurses and costed plans for workforce development are needed for investment in specialist children's nursing education to realise its potential in relation to achievement of Universal Health Coverage.