Nurses are the lifeblood of a thriving health system. In fact, the World Health Organization estimates that nearly half of the world’s entire health workforce are nurses and midwives. And in Eswatini (formerly Swaziland), nurses play a particularly important role in this nurse-driven national health system. To help meet this essential need, Seed Global Health has partnered with University of Eswatini (UNESWA) to strengthen nursing by building a versatile and relevant advancing nursing discipline in the country: the family nurse practitioner.
The nurse practitioner role began in the United States in 1965 for registered nurses who obtained masters level education and clinical experience to prepare them to assess, diagnose, manage, and educate patients across the health spectrum. Family nurse practitioners (FNPs) not only deliver this breadth of primary, acute and specialty healthcare to patients of all ages and walks of life, but also bring a unique skill set in family-focused care. Able to function independent of a physician, the FNP is deeply skilled in providing care across a range of ages, health needs, and resource states. Particularly given the high maternal morbidity and mortality rate in Eswatini, FNPs can play an important role supporting family health needs across the lifespan.
Through a series of stakeholder meetings in 2007 and 2009, University of Swaziland (UNESWA), this model was found to align with the healthcare needs of Eswatini’s population. And given the successful implementation of the FNP role in the U.S. and other countries, UNESWA decided that an investment in an FNP program would be worthwhile. By 2016, UNESWA, with Dr. Colile Dlamini as the champion for the FNP project, had approval for the curriculum and was awarded approval from the Eswatini Nursing Council and the first students enrolled in August 2017 with support from visiting nursing faculty, Dr. Louise Kaplan and Dr. Elizabeth Macera.
Seed’s partnership with UNESWA embodies the three pillars of Seed’s strategic framework: education, practice, and policy. With support from Seed and Seed’s current and returned faculty, UNESWA conducted a “Landscape Assessment of Readiness to Introduce the Family Nurse Practitioner Role in Eswatini.” Stakeholders across education, practice and policy were included. Results will chart the course for future success. And by partnering with local leadership, we were able to identify an educational opportunity to not only rebuild a shelved Family Nurse Practice certificate curriculum – paused at the diploma level due to funding constraints – but to further grow it into a Master’s-level program.
Growing a new practice area never succeeds without challenges along the way. While visiting faculty have helped connect education and practice for both the clinical and classroom aspects of this program, there are no FNPs are in Eswatini’s health system to mentor new colleagues being trained. However, this barrier to practice is being overcome today through collaboration with Baylor University, making mentorship possible in the short-term while simultaneously developing future local FNP educators who will go on to mentor the next generation.
And we’ve proudly worked alongside local leaders in advancing policy objectives that have made the FNP program viable in Eswatini. Seed has supported the dissemination of the landscape assessment globally, including at the AFREHealth conference in Durban, South Africa and at the International Council of Nursing’s NP/APN Conference in Rotterdam, Netherlands. And we plan to continue to collaborate with local policymakers for the expansion of FNP training and hiring across the health system.
The FNP program in Eswatini brings to life all three essential elements of our approach, but much more importantly, it creates life-changing and life-sustaining access to health for the communities that these FNPs will serve. With Eswatini’s double burden of infectious and noncommunicable disease, rural areas that are particularly vulnerable will benefit tremendously from increased access to advanced nursing care. And as we look to the future, continued faculty development will ensure there’s a continuous pipeline of experts and educators who are in this program for the long-term, skilled and confident, moving forward an ongoing cycle of FNP development.