After acknowledging and duly respect contrary viewpoints, the community Nursing and Midwifery program is to solve a particular lingering problem. That is, getting Nurses to stay in the PHCs and very hard to reach communities.
Knowing that over 65% of our population in Nigeria live in rural areas and have a greater burden of disease, the govt waited for us as nurses to solve this problem but we didn’t until it was pressed to launch the CHEW and JCHEW programs. Dr. Ransom Kuti’s fact. He came to us nurses first. But we sounded then like we are sounding now. If we were more foresighted, today we would have been solely in charge of PHCs and regulating all those practicing one form of care or the other as done in all other countries.
The community cadre professionals solved the govt’ problem at a lower cost. It witnessed less attrition because most of them have their families in those localities. These are real community/PHC issues we have grabbled with for years. That is why the CHEW prog is resonating very well with govt. Our drawback gave room to the CHEW who have become our nightmare. Sadly, they practice nursing yet they are not regulated by the nursing council. It is an error. I don’t know of another serious country where that is the case. If I am right, I think the Medical Laboratory and Pharmaceutical councils have been able to solve their own. I think they play a critical role in regulating lab technicians and pharmacy technicians. For me, the launch of the community nursing and midwifery program should have come years ago and there would never have been any other cadre like the CHEWs not regulated by NMCN. But our failure to see the big picture is now of greater threat to our profession than any other. Better late than never though.
In almost all the other countries including the USA, UK, Australia, and Canada, every and anybody carrying out any form of CARE is licensed/ certified and regulated by the nursing council. You have cadres like home care assistants, care aids, licensed Nurses practitioners etc….some as low as 2weeks training. They all have their specific jurisdictions and duties
For the govt, it is not the name or even the “quality of care” first. “Are they going to be available and possibly cheaper?” Is their question. If Yes! With the reality of scarce resources facing every nation, govt will always appreciate available and affordability in certain circumstances like staffing PHCs even if the quality of care is not up to standard. They believe, half quality is better than no service at all. And believe it or not, if you are familiar with PHCs and hard to reach areas, that statement is 100% true. There are many PHCs that lack certified care providers CHEWs & JCHEWs inclusive. The health attendants are the best they have. And while we encourage govt to do more to equip our health centers and make it conducive, the resource available will not deliver that anytime soon no matter how you push. However, as we expect govt to do the needful, we have rural dwellers who need our care in any way possible. We won’t abandon them until the government makes the environment conducive. Your guess is as good as mine.
There is absolutely no need for us to start putting up #tags or campaign against this!
Just last week we were talking about how nurses no longer conduct ANC palpitations, delivery and IVs in some hospitals but on the contrary, the CHEWS and JCHEWs are being trained to undertake greater roles including delivery. Funny enough, CHEWS hare not just taking charge of the PHCs, they are also employed by GHs, Tertiary hospitals and private as care assistance and nurses respectively. That gives them more employability scope than we nurses.
Please, we need to do more to regain our place in the PHCs management as seen in other countries. PHCs are managed purely by Nurses. As preventive care takes centre stage globally, the PHCs in the target of 80% attending to people at community level.
Hence a clarion call to Nurses to emulate global changes in health care delivery system most especially in Nigeria, so that we avoid our previous mistakes.