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INTRODUCTION
Nursing and midwifery services are vital for
attaining health and development. They form
the backbone of health care, representing over
50 % of the health profession.
As early as 1948, World Health Assembly (WHA)
identified the need to strengthen the roles
of nurses and midwives.
In 2001 the member states in the WHA stated
that nurses and midwives play a crucial and
cost effective role in reducing excess mortality,
morbidity and disability and in promoting healthy
life styles. Due to inadequate care and declining
of the numbers of nurses and midwives, WHO launched
the "Strategic Direction for Strengthening
Nursing and Midwifery Services 2002-2008"
(Resolution 54.12) targeting 5 main areas to
scale up and enhance the development of nursing
and midwifery services to respond to health
needs on the basis of sound scientific and clinical
evidence. (more reading at www.who.int/org.nursing)
and (www.who.int/health.services-delivery/nursing/gagnm/index.htm)
COUNTRY SITUATION
The Directorate of Nursing Services under the
Ministry of Health and Family Welfare is responsible
for the delivery of nursing services and education.
There are approximately 22000 registered nurses
out of which 14689 are working in the public
sector, approximately 3000 are working in the
private sector and 3000 are working abroad.
The nurses are working in different capacities
in the public sector and in different health
care settings down to Upazila Health Complex.
There are 38 nursing institutes in the government
sector and 5 private offering three years Diploma
in General Nursing and one year Diploma in Midwifery/Orthopedic.
The total intake of students is 1135 each year
based on a central admission system.
There is one College of Nursing affiliated to
the University of Dhaka offering two years Bachelor
of Science Degree (BSc) in Nursing and Public
Health Nursing with a total of 125 seats each
year to prepare professional nurses with leadership,
management and teaching abilities. Eight more
nursing institutes and one college of nursing
will be constructed. Approximately 90 nurses
were awarded Master Degree in different fields
from in country, offshore course and abroad.
Additional information
Bangladesh Nursing Council was established
on ad hoc basis in 1971 and was formalised in
1983 as a regulatory body for nursing education
and services.
The Directorate of Nursing Services was established
in 1977 under MOH+FW. A Research Cell was established
in the College of Nursing In 1998.
CURRENT WHO SUPPORT
WHO has been supporting Bangladesh in improving
and strengthening the nursing and midwifery
services since 1971.
The main areas given attention to are:
- Facilitate capacity building and collaborative
partnerships
- Enhance and strengthen the managerial and
technical care skills of nurses and midwives
practice in order to meet the changes in population
and practice needs, and
- To foster an environment which enables the
nurses and midwives to be more pro-active
in decision-making regarding their own profession
and health care development and thus take
more active part in the national health system
performance and policy matters.
WHO supports Directorate of Nursing Services
by:
A. Strengthening and
enhancing the capability for effective management
To equip nurses and midwives with advanced knowledge
and skills in Leadership and Management are
vital for the nurses in every capacity and level.
Hence the Directorate of Nursing Services in
collaboration with International Council of
Nurses and WHO decided to run a 2 years course
(consisting of intensive workshops, individual
development project and group projects with
the aim to improve the quality of nursing care)
under motto "Leadership for Change"(LFC)
to encourage the nurses to develop their negotiation
and communication skills together with management
skills to enable them to be active contributors
to the country's health development and effectively
manage the patient care.
Training courses in Leadership and Management
for Dy. Nursing Superintendent, Nursing Supervisors
and District Public Health Nurses to update
and enhance their managerial knowledge and skill.
B. Increased competency
and capability of Nursing and Midwifery personnel
- Directorate of Nursing Services in collaboration
with Adelaide University and WHO agreed to
conduct a one year off-shore course in Clinical
Nursing for 3 years to enable more nurses
to be awarded a Master Degree.
- Infection control is one of the critical
components to ensure quality in hospital services.
Hence, in-service training workshops on infection
control/prevention are being conducted to
help the nurses to acquire better knowledge
and skills to safe guard, prevent and reduce
unnecessary sufferings for themselves and
the patients. They will then also act as health
promoters/educators.
This activity has been introduced in:
National Institute of Traumatology, Orthopedic
and Rehabilitation (NITOR),
Institute of Diseases of Chest and Hospital
(IDCH), Dhaka
Dinajpur Medical College Hospital
Patuakhali General Hospital
Noakhali General Hospital
Narayangonj 200 bedded Hospital.
Munshigonj General Hospital
Pabna Sadar Hospital
- Behavior change communication (BCC) workshops
are conducted with the aim to improve the
inter-personal relationship towards the patients,
their relatives and to establish more effective
and better communication towards multidisciplinary
health categories.
C. Improved quality of
Nursing and Midwifery
As Bangladesh still suffers from a relative high
maternal mortality and morbidity rate, Directorate
of Nursing Services agreed to adopt and introduce
Midwifery Standards of Practice for Safe Motherhood
developed by SEARO.
Health personnel
at 6 hospitals sites have already gone through
the training. In order to improve quality
and ensure more effective nursing care,
selected Nursing Standards was developed
and introduced in some hospital sites.
Midwifery- and Nursing Standards will be
further implemented in Medical College Hospitals
and District Hospitals.
Guidelines for management of hospital nursing
services at the ward and hospital levels
will be developed to support guidelines
for quality improvement in nursing and midwifery
care.
Midwifery Standards have been introduced
in:
Dhaka Medical College Hospital
Comilla Medical College Hospital
Barisal Medical College Hospital
Mymensingh Medical College Hospital
Cox's Bazar Sadar, Hospital |
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General Hospital,
Barisal
Kushtia General Hospital
Nursing Standards have been introduced
in:
National Institute of Traumatology, Orthopaedic
and Rehabilitation, Dhaka
Sir Salimullah Medical College Hospital,
Mitford, Dhaka
Comilla General Hospital
Bogra Medical College Hospital
Faridpur Medical College Hospital
Jessore General Hospital
D. Develop Evidence
bases in Nursing and Midwifery
A Research Cell was established as a functional
unit of the College of Nursing in 1999
with technical support from WHO. Training
courses are conducted to equip the nurses
with professional knowledge on research
methodology and undertake small-scale
studies focusing on the need to ensure
qualitative nursing care through evidence-based
practices.
E. Strengthening
of Nursing and Midwifery management and
regulation
Priority issues related to workforce management
will be strengthened based on the developed
national guidelines. Bangladesh Council
of Nurses will be further strengthened
with special attention for establishing
a operational system for accreditation
of nursing and midwifery educational programmes
and institutes.
KEY DOCUMENTS
- The Nursing Contribution to Future
Health Care Delivery.
A Policy paper (2002)
- National Plan of Action for Development
in Bangladesh (1994)
- Report of the Director of Nursing
Services (November 2002-August 2003)
- Code of Conduct for Nurses in Bangladesh
(2003)
- Study Report on In-Depth Assessment
of Nursing/Midwifery Workforce Management
in Bangladesh (2002)
- Resolution of the WHO Regional Committee
for South-East Asia (September 2003)
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