School of Nursing and Midwifery & Pre-Service Training on Nutrition, Hawassa University, Ethiopia

By Aweke Yilma Dubi, Head, School of Nursing & Midwifery

Ethiopia is one of the least developed countries in the world. According to the Government's Interim Poverty Reduction Strategy Paper (2000-2003), over 45% of the population lives below the poverty line. A consequence of this widespread poverty is low levels of human capital accumulation. Whereas countries at the forefront of development often invest in education and aggressively engage in human capacity development and knowledge transfer, those who do not or cannot often fail to bring about significant development. Poverty reduction is a major issue for Ethiopia and capacity building in the public and private sectors is a key building block to accelerate much needed socioeconomic development.

The Higher Education Training Capacity Building Programme is part of the development effort of the Federal Government, regional states and the private sector. This aims to create countrywide sustainable human resource capacity that is responsive to changing circumstances. The development of higher education is among the highest national priorities. It is viewed as the major instrument towards achieving food security and alleviating poverty and other social and technological problems the country is facing. Hence, capacity building is the cornerstone of sustainable development in Ethiopia. In addition, there is a need to build the research capacity and address the critical issues of the country, particularly in relation to malnutrition and diseases such as HIV.

Hawassa University

Hawassa University, previously known as Debub University, was established in April 2000 by merging three colleges, namely Hawassa College of Agriculture, Wondo Genet College of Forestry and Natural Resources, and Dilla College of Teachers Education and Health Sciences. Located at the centre of the Great Rift Valley in Hawassa city, the University is the largest and most comprehensive University in the Southern Nations Nationalities and People's Regional state (SNNPRs) and in the southern part of the country. It has 24 academic departments, four institutes, three colleges and 58 academic programmes, with more than 20,000 students involved in 41 undergraduate, 22 Masters and 2 PhD programmes. There is 960 academic and 1,100 administrative staff.

In the School of Nursing and Midwifery, there are 800 nurse and midwifery students and 30 academic and administrative staff at different academic levels, ranging from assistant professors, and lecturers to graduate assistants. Staff have a diverse range of professional qualifications in the areas of curriculum development, public health, international health, maternal and child health, midwifery, adult health nursing. Unfortunately, the School of Nursing and Midwifery has no staff trained in nutrition or with a nutritional background.

The education of nurses and midwives

In order to meet the national aim of creating sustainable human resource capacity for health and nutrition services, the School of Nursing and Midwifery offers undergraduate training to prepare the nurses and midwifes for the demanding environment of Ethiopia. This environment is characterised by high prevalence of HIV/AIDS, high maternal and infant mortality rates, malnutrition and frequent emergencies, as well as high levels of staff attrition. The role of nurses and midwives in Ethiopia has had to diversify and broaden, so that in addition to hospital based clinical work, they need to be able to work in community-based programmes in areas, such as therapeutic and supplementary feeding and HIV.

To help prepare the graduates for these roles, the School has designed a Community-Based Training Programme (CBTP) and Team Training Programme (TTP). This involves students being deployed to remote and hard to reach communities affected by drought, high levels of malnutrition and communicable diseases. During this period, the students work with community members to assess their health and nutrition related practices, such as food intake and food taboos, infant and young child feeding practices, feeding of infants and children during periods of sickness, nutrition during pregnancy, food hygiene, storage and preservation. The students plan, implement and evaluate activities aimed at addressing the identified problems in collaboration with community members.

In addition to the CBTP and TTP programmes that are well integrated into the formal undergraduate curriculum, the School conducts pre-service trainings (PST) on new competencies and concepts that, although not formally integrated in the existing curriculum, are seen as very important for the students professional development. In collaboration with governmental and non-governmental organisations such as Save the Children, World Health Organization (WHO), World Vision, Plan Ethiopia and professional associations, the school offers PST on Nutrition in HIV, Integrated Management of Neonatal and Childhood Illnesses, Prevention of Mother to Child Transmission of HIV, Comprehensive HIV/AIDS care, Palliative Care, Infection Prevention and Injection safety. These PSTs are usually conducted when students prepare to enter their clinical years, a few months before they graduate and go into the community. This facilitates the immediate application of their newly acquired knowledge and skills.

Stakeholders, such as the WHO, Ministry of Health and Ministry of Education as well as employers, have clearly stated the importance of equipping the graduates with the necessary knowledge, skills and attitude (competency) to tackle new health and nutrition problems and emerging technologies. PST is viewed as a particularly cost effective approach in terms of money and time expended. Pre-service training has many advantages when compared to in-service training (IST) in that it creates the opportunity for building the capacity of large numbers of potential health professionals within a short period of time. The existing infrastructure and system of a university/institution helps keep costs low. Furthermore, PST provides a golden opportunity to equip graduates with the requirements of the work environment and enable them to integrate themselves into the community norms and cultures. In contrast, IST, though very useful, can be very costly in monetary terms and can take staff away from their place of work for considerable periods of time in an already under-staffed environment.

Cognizant of the role the School plays in producing a critical mass of nurses and midwives for nation building and the benefits of working in collaboration with new partners and stakeholders, Hawassa University is re-designing the overall university curriculum into a modular system. This presents another opportunity to integrate areas of concern into the nursing and midwifery training programme.

In line with this development, the School is actively seeking collaboration with partners to build the capacity of faculty members in the area of nutrition in emergencies and in HIV/AIDS and nutrition. This is needed to equip the teaching staff with additional skills and knowledge to pass onto the nurse and midwifery students though the new modular approach. Existing faculty staff do not currently have all the knowledge and skills to design and teach a new module on nutrition in emergencies or on HIV/AIDS and nutrition. Specific technical areas in need of capacity development for faculty staff are in infant feeding in emergencies and community-based management of acute malnutrition; all pressing problems in Ethiopia. Recently, the School has started a discussion with World Vision Ethiopia and Tufts University in USA on capacity building of faculty staff in the areas of infant and young child feeding and HIV/AIDS and nutrition. This offers a positive step forward towards strengthening the quality and content of teaching in the future.

For further information, contact: Aweke Yilma Dubi, Head, School of Nursing & Midwifery, University of Hawassa, Hawassa, Ethiopia. P.O. Box 1504
tel: +251 462 211 003 (Office)
e-mail: awekeyilma@gmail.com