NML-ISSUE 5 VOL 2

NMLTT NEWSLETTER Issue 5 | Volume 2 APRIL 1ST, 2024

THE GROWING NUMBER OF NURSES AND MIDWIVES WITH PhDs, WHAT DOES IT MEAN FOR THE PROFESSION AND UGANDA

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CONTENTS

● PAGE 1-2: EDITORS NOTE: EMPOWERING WOMEN IN HEALTHCARE Ms. Irene Atuhairwe Duhaga, Country Director Seed Global Health ● PAGE. 3-8: THE GROWING NUMBER OF NURSES AND MIDWIVES WITH PhDs, WHAT DOES IT MEAN FOR THE PROFESSION AND UGANDA IN GENERAL? Assoc Prof Rose C Nanyonga and Elizabeth Pearson ● PAGE. 9-11: RECENT PhD GRADUATES ● PAGE. 12-16: SPOTLIGHT ON RETIRED NURSE-MIDWIFE MARGARET B. MUYINDA Interview by Elizabeth Pearson ● PAGE. 17-19: SPOTLIGHT ON FRONTLINE HEALTH WORKER—MIDWIFE NALUJJA JOSELYN Interview by Judith Hope Kiconco ● PAGE. 20-23: REFLECTIONS: BEAUTY OF MIDWIFERY AT QUEENS HOSPITAL, ROMFORD, LONDON

By Lilian Nuwabaine •

PAGE. 24: DIASPORA-UK NEWS

1 EDITOR’S NOTE: EMPOWERING WOMEN IN HEALTHCARE: RECOGNIZING NURSES AND MIDWIVES ON INTERNATIONAL WOMEN’S DAY AND BEYOND

As March draws to a close, recognized as Women’s Month, it's a moment for us to reflect on and honor the pivotal role women have historically played and continue to play in the economic, social, and cultural progress of society. This year's International Women’s Day centered around the theme "Inspire Inclusion," highlighting the importance of diversity and empowerment for all members of society, regardless of differences. It serves as a reminder to acknowledge and celebrate the unique and significant contributions made by women across all societies.

Contemplating this theme prompts us to spotlight the crucial role of nurses and midwives, who predominantly constitute women and represent 70% of the healthcare workforce. These professionals deliver nearly 90% of patient care and invest considerable time in direct patient interaction. Therefore, as we celebrate women and International Women’s Day, it’s imperative to recognize the inclusion and participation of nurses and midwives within the healthcare sector and broader society.

Leadership stands out as a critical element in fostering inclusion, particularly by ensuring the representation of underrepresented groups in leadership positions. Uganda has made notable strides in empowering women and promoting their involvement in leadership roles, with nearly half of the country’s leadership and cabinet comprising women. Notably, women hold prominent positions within the healthcare sector, including the Ministry of Health's top leadership but hardly any nurses and midwives. However, we must ask why nurses and midwives are not assuming significant leadership roles at both national and subnational levels. Are we not doing enough or are our contributions not visible enough?

Beyond leadership, it’s essential to consider other facets of empowerment for nurses and midwives, such as access to education, jobs offering equitable compensation, and fostering supportive work environments. Are these environments conducive to nurses and midwives realizing their full potential, free from harassment, and ensuring they receive due recognition for their contributions?

2 As the Nurses and Midwives Leadership Think Tank, we have dedicated this month’s issue to all women, particularly those in the healthcare sector, with special recognition for nurses and midwives who commit their lives to saving others daily. We bring you conversations with women to understand what makes them tick and what inspires them to do what they do. We also highlight many nurses and midwives who have attained their PhDs, and the highest academic qualifications.

We therefore urge decision-makers to champion inclusion by empowering and acknowledging women's invaluable contributions to the healthcare sector. Without the full inclusion of nurses and midwives, true gender equality remains unattainable.

Happy International Women’s Day and Women’s Month. We hope you all felt appreciated and included in the things that matter most to you.

Irene Atuhairwe Duhaga, Country Director Seed Global Health Uganda; Member of the Executive Committee, NMLTT. Newsletter Editor

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THE GROWING NUMBER OF NURSES AND MIDWIVES WITH PhDs, WHAT DOES IT MEAN FOR THE PROFESSION AND UGANDA IN GENERAL?

By Assoc Prof Rose Clarke Nanyonga (Vice Chancellor, CIU) and Elizabeth Pearson (Lecturer and Director NHCC Uganda)

In recent years, Sub-Saharan Africa (SSA), including Uganda, has witnessed a remarkable surge in the number of nurses and midwives achieving the pinnacle of academic achievement – a Doctor of Philosophy (PhD). This transformative shift carries profound implications for the future of healthcare professions, the robustness of health systems, advancements in nursing scholarship and science, as well as the overall well-being of nations like Uganda. In our previous editorial published in Issue 2, Vol 2, April 2023, we spotlighted the achievement of two colleagues and reported 18 nurses and midwives who had earned PhDs. We also shed light on the challenges they encounter related to finding good mentors and adequate funding for program completion. In this current issue, we delve into the potential future paths and advantages of fully integrating these highly qualified professionals into the healthcare system. Between 2000 to-date, there are over 38 nurses and midwives in Uganda who hold PhDs from various Universities across the globe with doctoral

4 studies in advanced nursing and midwifery science, research, leadership & policy, and clinical practice. This is an updated list following the previously reported 18 (Think tank will continue to update the database).

Elevating the Nursing and Midwifery Professions: The future trajectory of the nursing and midwifery professions will rely significantly on the pivotal role played by PhD-prepared nurses and midwives. A Doctor of Philosophy (PhD) signifies a dedication to philosophical inquiry and scholarly rigor, representing the highest academic achievement across all fields of study.

These professionals serve as the driving force behind the integration of cutting-edge research findings into clinical practice, policy formulation, and implementation. In the face of evolving healthcare landscapes characterized by aging populations, a surge in chronic conditions, (as is the case in Uganda), and persistent staff shortages, the expertise of PhD-prepared nurses and midwives becomes indispensable. Their research endeavors will not only enhance the quality of patient care but also contribute extensively to the development of evidencebased workforce and clinical practice policies that will shape the direction of healthcare delivery systems. (AACN, 2016) As the healthcare sector continues to navigate complexities and challenges, the knowledge, skills, and leadership of PhD-prepared professionals will remain instrumental in driving innovation, improving patient outcomes, strengthening the education of nurse and midwife scientists, and advancing the overall effectiveness and sustainability of nursing and midwifery. Cashion et al., 2019)

According to van McNelis et al., (2019), the infusion of advanced education brings with it a new era of leadership and influence within the nursing and midwifery professions, while their scarcity poses a significant hurdle in the progression of the professions, impacting both the education and the delivery of care. There is a pressing need for an increased number of PhDprepared nurses and midwives to lay the scientific groundwork for the disciplines and to facilitate the expansion of nursing and midwifery education programs to accommodate new cultures of learning and practice, innovations, and the changing demographics of new students. (Cashion et al., 2019) This shortage not only affects the depth of research and knowledge generation within the fields but also limits the capacity to train the next generation of nursing and midwifery professionals adequately. Addressing this scarcity is crucial for the sustainable growth and advancement of nursing and midwifery as robust and impactful disciplines.

Strengthening Health Systems: Nurses, constituting about half of the global health workforce, serve as the primary access point for nearly 90% of healthcare consumers worldwide. Bvumbwe and Mtshali (2018) In every health system, they are widely acknowledged as the backbone. Attaining ambitious health objectives such as Universal Health Coverage (UHC), the Sustainable

5 Development Goals (SDGs), and the emerging One Health (OH) concept necessitates maximizing their involvement at all levels of the healthcare system. (WHO, 2021; Mendes et al., 2020; iAHO-HWF, 2023; MoH, 2020) Despite their essential roles, nurses and midwives continue to encounter challenges, including inadequate representation in high-level policy decision-making positions, leadership, and governance (Bvumbwe and Mtshali, 2018). More acutely, barriers related to regulation, leadership, education, and practice for nursing and midwifery professionals have led to a devaluation of their worth, relegating them to a frequently low social status. The Plan of Action for Scaling up Quality Nursing and Midwifery Education and Practice for the African Region 2012 - 2022 provided a framework for the transformative and scale-up of health professions education for Sub-Saharan Africa. In their integrative review examining “Nursing education challenges and solutions in SubSaharan Africa” Bvumbwe and Mtshali (2018) report six critical themes that emerged: curriculum reforms, profession regulation, transformative teaching strategies, collaboration and partnership, capacity building, and infrastructure and resources. This underscores the critical role of PhD-prepared nurses and midwives. Their integration into the healthcare workforce strategies for the Sub-Saharan African countries would benefit not just the professions but also the healthcare systems immensely as they will strengthen the capacity to address ongoing challenges. Their advanced knowledge and skills, obtained in most cases from other continents, can not only create pathways for their inclusion in critical policy decisions but also

contribute to more effective patient care interventions, thereby improving health outcomes for all. PhD-prepared nurses and midwives have a proven ability to implement evidence-based practices based on the clinical needs of the nation. (Dagne and Beshah, 2021) The result is a practice that is not only evidencebased but forward-thinking and responsive to evolving healthcare needs. The diversification of expertise within this healthcare workforce augurs well for health systems' overall resilience and adaptability.

Fostering Nursing Scholarship and Science: A core impact area for these cadres is the acceleration of nursing scholarship and scientific inquiry. (Dagne and Beshah, 2021) With the capacity to conduct rigorous research, these professionals can delve into healthcare challenges unique to their contexts and regions.

This has the potential to give rise to a body of knowledge that is not only relevant, informs practice but also contributes to the global advancement of nursing and midwifery care.

Additionally, nurses and midwives with PhDs play a crucial role in building research capacity through mentoring and supervising others, fostering a culture of inquiry and evidencebased practice. This type of research can lead to innovative solutions, improved patient outcomes, and a better understanding of health disparities.

Policy Development and Advocacy: Nurses and midwives with PhDs are often at the forefront of leadership positions within healthcare institutions, academic settings, and

6 policymaking bodies. Their input and influence can shape policies, guidelines, and strategies to improve healthcare delivery, especially in areas such as maternal and child health, infectious diseases, and non-communicable diseases. In addition, with their advanced knowledge and research findings, they can actively participate in the development of healthcare policies and guidelines. (Costa Mendes et al., 2020) They advocate for policies that prioritize public health, equity, and access to essential services.

Their input helps shape policies that are evidence-based and responsive to the needs of underserved populations. (Cashion et al., 2019)

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Enhancing Absorption and Relevance It's crucial to recognize that PhD-prepared nurses and midwives encounter notable challenges concerning their practice, role acceptance, research funding, administrative support, reimbursements, and career advancement (Negarandeh and Khoshkesht (2022). To recognize and optimize the contributions of these professionals in countries like Uganda, it is imperative to establish an environment that fully utilizes and values their expertise. This involves creating supportive cultures and robust structures that elevate the roles of nursing and midwifery professionals: (van Dongen et al., 2022; WHO, 2020).

1. Policy Frameworks: Implementing policies recognizing the value of advanced nursing and midwifery roles is essential. Governments should develop clear guidelines for the integration of PhD-prepared nurses and midwives into healthcare systems, outlining their

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responsibilities, scope of practice, and career pathways.

Professional Recognition: Establishing professional recognition programs and incentives can motivate nurses and midwives to pursue PhD education.

Recognition through awards, promotions, and leadership opportunities can encourage others to advance their education and contribute to the field.

Research Funding: Governments and institutions should allocate funding specifically for nursing and midwifery research. This includes grants, scholarships, and fellowships to support PhD candidates in conducting research that addresses local health challenges and informs evidence-based practice.

Career Development: Creating clear career progression pathways for PhDprepared nurses and midwives is crucial.

This includes opportunities for academic positions, research leadership roles, policy advisory positions, and clinical specialization.

Collaborative Partnerships: Encouraging collaborations between nursing and midwifery professionals, healthcare institutions, universities, and research organizations can enhance knowledge exchange and research dissemination.

Collaborations also facilitate interdisciplinary approaches to healthcare challenges.

Continuing Education: Providing continuous learning opportunities, such as workshops, seminars, and

7 conferences, ensures that PhD-prepared nurses and midwives stay updated with the latest advancements in their fields.

This also fosters a culture of lifelong learning and professional development.

7. Leadership Training: Offering leadership development programs equips PhDprepared nurses and midwives with the skills to lead teams, manage projects, and advocate for policy changes.

Leadership training empowers them to drive innovation and influence healthcare decisions.

8. Public Awareness Campaigns: Educating the public about the roles and contributions of nurses and midwives with PhDs can change perceptions and promote respect for their expertise. This includes media campaigns, community engagements, and public lectures.

9. Mentorship Programs: Establishing mentorship programs pairs experienced PhD-prepared nurses and midwives with early-career professionals. Mentorship fosters career guidance, skill development, and knowledge sharing, creating a supportive network within the profession.

10. Quality Improvement Initiatives: Encouraging PhD-prepared nurses and

midwives to lead quality improvement projects enhances patient care outcomes. These initiatives focus on evidence-based practices, patient safety, and healthcare efficiency.

By implementing these strategies, Uganda and other countries can harness the full potential of nurses and midwives with PhDs. This not only improves healthcare delivery but also elevates the status of the nursing and midwifery professions, ultimately benefiting the health and well-being of their populations.

In conclusion, the growing number of nurses and midwives attaining PhDs in Uganda and other Sub-Saharan African countries is a harbinger of positive change. It represents a shift towards a more dynamic, knowledgeable, and influential nursing and midwifery workforce. As these professionals continue to make their mark, the ripple effects will be felt across health systems, scholarly endeavors, scientific advancements, and, most importantly, in the quality of care provided to communities throughout the region.

However, this requires the intentional integration of their roles, skills, and expertise within healthcare systems.

References AACN (2016). Advancing Healthcare Transformation: A New Era for Academic Nursing. Retrieved March 30th from https://www.aacnnursing.org/Portals/42/Publications/AACN-New-Era-Report.pdf

8 Cashion, A. K. , Dickson, V. V. , & Gough, L. L. (2019). The value and importance of PhD Nurse Scientists. Journal of Nursing Scholarship, 51(6), 611–613. https://doi.org/10.1111/jnu.12525 McNelis, A. M. , Dreifuerst, K. T. , & Schwindt, R. (2019). Doctoral education and preparation for nursing faculty roles. Nurse Education, 44(4), 202–206. 10.1097/NNE.0000000000000597 Global Strategic Directions for Nursing and Midwifery. WHO. 2021.

Retrieved March 30th 2024, from: https://www.who.int/publications/i/item/9789240033863 Bvumbwe, T., and Mtshali, N. (2018) Nursing education challenges and solutions in Sub-Saharan Africa: an integrative review. BMC Nurs 17, 3. https://doi.org/10.1186/s12912-018-0272-4 WHO (2021). One Health. Retrieved March 29th, 2024, from https://www.who.int/healthtopics/one-health#tab=tab_1 iAHO-HWF (2023). Nursing and midwifery workforce: a key component in achieving UHC. Retrieved 13th March 2024 from: iAHO_HWF_regional_Factsheet.pdf (who.int) Ministry of Health, Uganda Health Sector Development plan 2015/16 - 2019/20 Assessed via Https://Www.Health.Go.Ug/Cause/MinistryOf-Health-Strategic-Plan-2020-21-2024-25/ Dagne, A. H., & Beshah, M. H. (2021). Implementation of evidence-based practice: The experience of nurses and midwives. Plos one, 16(8). https://doi.org/10.1371/journal.pone.0256600 Mendes, I.A.C., Ventura, C.A.A., Silva, Í.R. et al. Alignment and contribution of nursing doctoral programs to achieve sustainable development goals. Hum Resour Health 18, 86 (2020). https://doi.org/10.1186/s12960-020-00530-7 Van Dongen LJC, Hafsteinsdóttir TB. (2022) Leadership of PhD-prepared nurses working in hospitals and its influence on career development: A qualitative study. J Clin Nurs. 2022 Dec;31(23-24):34143427. doi: 10.1111/jocn.16168.

Negarandeh, R., & Khoshkesht, S. (2022). Expected roles of PhD graduated nurses: a scoping review. Florence Nightingale journal of nursing, 30(2), 202. https://doi.org/10.54614%2FFNJN.2022.21233 WHO (2020). State of the World’s Nursing Report. WHO. 2020. https://www.who.int/publications/i/item/9789240003279

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RECENT Ph.D. GRADUATES LATE 2022-2024

Dr. Evelyn Wanyenze Makerere College of Health Sciences, 2024.

Continuous labor support in Uganda: practices, Role Orientation, Experiences and Effect on Birth Outcomes

Kiconco Dr. Frank Kiwanuka DrDr. Namagga DrFrank Namagga Kiwanuka JaneJane Kasozi Kasozi Dr. Dr.Slyvia Dr Frank Namagga Kiwanuka Jane Kasozi Dr. DrFrank NamaK Monash University, 2023 Dr. University Frank Kiwanuka of Eastern MUST, University MUST, 20232023 of Eastern Finland, University MUST, Dr Slyvia 2023 of Eastern Kiconco Finland,University MUST, Dr Sly2 Normative Cut-Offs for 20232023 University Finland, 2023 of Eastern HIV-Associated 2023 HIV-Associated 2023 HIV-Associated Monash University, HIV-Asso Mona Ovary Finland, Compliance 2023 with Family Neurocognitive Compliance Neurocognitive with Burden: Family Burden: Polycystic Compliance Neurocognitive Normative withCut-Offs Family Burden: for Complianc Neuroco Norm Diagnostic Nursing an Compliance Nursing and with theFamily Impact of Feasibility Nursing Feasibility and of Integrating the of Integrating Impact of Syndrome Nursing Feasibility Polycystic and the ofOvary Impact Integrating Syndrome of the Feasibilit Polycy inInterventions Adolescents Nursing Nurse-led andInterventions the Impact of the Nurse-led International the International Interventions HIV-HIV- Features Nurse-led International diagnostic features HIV-Dementia in Nurse-led Internati diagno Cluster During Acu Nurse-led During Acute Interventions Care: Family Dementia During Dementia Acute ScaleScale Care: intointo the Family the Using During Scale Adolescents Acute intoAnalysis Care: the HIV Using Family Care Cluster Scale Adole int During Members’ Acuteand Care: Nurses Family HIV Members’ HIV CareCare Model and Model at Nurses TASO at TASO Members’ Model Analysis. at and TASO Nurses Centers in Members’ Model Analys a Members’ Perspectives and Nurses Centers Perspectives Centers in Central in Central and and Perspectives Central and SouthwesternPerspectiv Central a Perspectives.

Southwestern Southwestern Uganda.

Uganda.

Uganda.

Uganda.

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Dr. Catherine Atuhairwe MUST, 2023 Postpartum depression in Southwestern Uganda: prevalence, associated factors, lived experiences of mothers who recovered from a clinical diagnosis and validation of screening tools.

Dr. Ronald Arinaitwe Kiboneire University of South Africa (UNISA), 2023 Strategies to enhance indigenous men’s support for the utilization of longacting reversible contraceptives among rural women in Uganda.

Dr. Namukwaya Caroline University of Salford, UK, 2023 A Feasibility Study to Explore the Possibility of Implementing a Child Development Counseling Programme for Caregivers of Children Aged 0-3 Years in Uganda

Dr. John Baptist Asiimwe MUST, 2024 Traditional medicine practitioners’ concept of cancer, model of care, herbal medicine use, and patient perceived benefits (Clinical outcomes) in Uganda

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Dr. Elizabeth Namukombe Ekong. University of Central Have you recently completed your doctoral studies?

Nicaragua, 2022. Work-based Learning for Please send us your short bio. We would like to Baccalaureate Nurses in Uganda: Perception and celebrate you here.

Current Practice.

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Excellence in Nursing and Celebrating International Women's Day: Spotlight on Retired Nurse/Midwife Mrs. Margaret B. Muyinda.

Interview by Elizabeth Pearson (Diaspora Nurse, Lecturer, and Director NHCC Uganda) International Women’s Day (IWD), celebrated on March 8 annually, is a global day celebrating the social, economic, cultural, and political achievements of women. The day also marks a call to action for accelerating women's equality. IWD has a rich history spanning over a century, beginning with its inaugural gathering in 1911, which garnered support from over a million individuals. Presently, IWD transcends boundaries, encompassing all communities globally. It is a universal observance not limited to any particular country, group, or organization. The theme for IWD 2024 advocates for inclusivity to achieve gender equality, aspiring for a world devoid of discrimination, bias, and stereotypes. #InspireInclusion. With a focus on Digital innovation and technology, we interviewed Mrs. Byabakama to learn more about her passion for nursing and as one of the pioneer nurse leaders in Uganda.

“Build a reliable support system both at work and at home.” Mrs. Byabakama

13 What is your greatest achievement?

I retired after 40 years of dedicated service as a nurse across all levels with a clean record. Notably, I served as the pioneer Senior Principal Nursing Officer (SPNO) at the Uganda Heart Institute, achieving various milestones.

What is on your bucket list?

Although I have accomplished many milestones professionally, I aspire to establish a NonGovernmental Organisation (NGO) with a primary focus on improving the living standards of elderly individuals living in poverty. My goal is to enable them to age gracefully and create awareness about non-communicable diseases among them. Initially, I plan to launch this initiative within Kyankwanzi District and subsequently expand to surrounding areas.

What would your advice be to the young women?

I would advise the younger women to find ways of living a purposeful life that they can achieve when they focus on continuous personal development, growth, and happiness.

The theme of IWD 2024 is Inspire Inclusion with a focus on DigitAll- innovation and technology for gender equality. What are your thoughts on the theme?

Embracing technology is crucial as it enables us to bridge gaps in vital areas such as education and health. Technology has the power to empower women by providing access to the latest educational materials and economic opportunities. Additionally, innovations in technology can significantly contribute to improving women's health, ranging from digital healthcare solutions to advancements in reproductive health and telemedicine.

Now with a focus on the profession of nursing, how can nurses and midwives in Uganda best position themselves to affect and meaningfully influence Health Policies that directly affect them?

Nurses and midwives in Uganda can focus on a few areas to position themselves and influence policies in various ways including; Education and Advocacy: ❖ Stay informed about health policies and actively engage in ongoing education. Find educational and informative groups and training and take part. ❖ Develop advocacy skills to effectively communicate concerns and proposals to policymakers. Many times, Nurses are missing out because we don't know the right clear communication to use to advocate for what we want to achieve. ❖ Collaboration and Networking: ❖ Join and actively participate in professional organizations to collaborate with colleagues.

Without partnerships, what you may achieve is very minimal. ❖ Engage with stakeholders, including other healthcare professionals, to form a unified front in advocating for policy changes.

14 ❖ Community Engagement and Communication: ❖ Communicate effectively through media platforms to raise awareness about nursing and midwifery concerns. ❖ Engage with local communities, showcasing the positive impact of nursing and midwifery to gain support for policy changes.

What do you observe to be the greatest barriers to higher-level leadership that women in Uganda face today and how can we overcome them?

We have to commend the government for its proactive efforts in narrowing the gender gap in leadership, evident through initiatives such as the promotion of girl child education.

Consequently, more women are assuming pivotal roles in leadership, including positions such as the Speaker, Vice President, and other key governmental roles. As of 2023, these endeavors have significantly bolstered the literacy rate of women, marking a notable increase of up to 38%.

However, despite these strides, Uganda still grapples with substantial barriers hindering women from attaining higher-level leadership positions. Persistent gender stereotypes, limited access to education, and the struggle to balance work and family obligations pose formidable challenges.

Moreover, the underrepresentation of women in decision-making bodies exacerbates the issue, often resulting in policies that inadequately address gender-specific concerns.

Gender-based discrimination and harassment further compound these obstacles, creating hostile environments that impede women's advancement. To surmount these challenges, a multifaceted approach is imperative. This includes fostering cultural shifts that challenge traditional gender norms, implementing family-friendly policies, advocating for gender quotas, and establishing confidential reporting mechanisms to address discrimination.

15 Furthermore, facilitating networking opportunities and mentorship programs, alongside championing gender-sensitive policies, are pivotal steps toward fostering an inclusive and equitable environment for women in leadership roles in Uganda.

Many times, we do not realize that you as our pioneer leaders have encountered any career barriers. Have you encountered any barriers to senior leadership? How did you negotiate some of them? And what advice do you have for a young aspiring nurse leader in Uganda?

Yes, I did encounter various barriers during my time, however, I always ensured that I communicated my reasons with clarity and had an open mind. My advice to aspiring nurse leaders would be: 1. Education and Continuous Learning: Invest in your education and professional development. Stay updated on the latest advancements in healthcare, leadership, and policy. Continuous learning enhances your knowledge base and prepares you for leadership roles. I had to take different courses to keep up with my learning.

2. Demonstrate Leadership Skills in Your Current Role: Regardless of your current position, exhibit leadership qualities. Take on projects, demonstrate initiative, and show a commitment to excellence. Leadership is often recognized through consistent, positive actions. I had different roles that I volunteered for or was nominated for, and this built my leadership skills.

3. Be Persistent and Resilient: Pursuing a leadership role may involve overcoming obstacles. Stay persistent in your goals and remain resilient in the face of challenges. Learn from setbacks and maintain a positive attitude. As I have shared, I had to overcome several barriers but that didn't deter my efforts or desire to move forward.

4. Embrace Challenges and Learn from Setbacks: Leadership roles come with challenges. Embrace them as opportunities for growth and learning. When facing setbacks, reflect on the experience, identify lessons learned, and use them to improve your skills and resilience.

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Balancing workplace demands and family responsibilities can be challenging, but with careful planning and effective time management, it's possible to find a healthy equilibrium. Here are some strategies to help manage this balance: ❖ Create a Schedule: Develop a schedule that allocates dedicated time for work, family, and personal activities. Use calendars, planners, or scheduling apps to help you organize and visualize your commitments. ❖ Delegate Tasks: Delegate tasks at work and at home when possible. Empower your colleagues and family members to share responsibilities. Delegating allows you to focus on high-priority tasks and reduces the feeling of being overwhelmed. ❖ Communicate Effectively: Communicate openly with your family and colleagues about your schedule and commitments. Keep them informed of any changes or challenges you may be facing.

Effective communication fosters understanding and support. ❖ Establish a Support System: Build a reliable support system both at work and at home. Communicate openly with your supervisor about your responsibilities and seek their understanding. At home, involve family members in decision-making and share responsibilities. I still have a support system that I use even now. ❖ Practice Effective Time Management: Prioritize tasks based on urgency and importance. Break down large tasks into smaller, manageable steps. Use tools like the Eisenhower Matrix to categorize tasks into different priorities.

Mrs Byabakama is now happily retired and is mentoring other Nurses and Midwives in Masindi. She continues to be active and supportive of the Leadership Think Tank.

By Dr Lawrence Cheng, MD (From Summer Issue of Live Pure Joy)

Finding work and family balance is constantly being discussed across the profession. How did you manage to balance workplace demands and family?

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Midwives/Nurses and celebrating International Women's Day (IWD): Spotlight on Front-Line Midwife-Nalujja Joselyn.

Interview By Judith Hope Kiconco.

Nalujja Joselyn: Midwife, Mother, Wife, General Executive Secretary at Nurses National Midwives Association Uganda (NMAU), Secretary for Busoga local maternity and Neonatal systems, Director at Afrozuri Foundation, and Co-Director at HABA Education services.

In celebrating International Women’s Day (IWD), the Think Tank also reached out to one of the front-line midwives in Uganda to hear what IWD means, a women’s empowerment moment that has inspired her, professional milestones in her career, top 3 habits for success, most significant barriers to higher-level leadership that women in Uganda face today, and how can we overcome them, how she has negotiated barriers, what advice she has for young women and lessons she has learned in this area that she can share with nurses and midwives struggling to find work-life balance.

“International Women’s Day is a celebration of resilience, empowerment, and unity. It’s a reminder of women's incredible strength and contributions worldwide”.

Midwife Nalujja Joselyn

18 BIOGRAPHY: Nalujja Joselyn is not only a practicing Midwife at Jinja Regional Referral Hospital but also the General Executive Secretary at the National Midwives Association Uganda (NMAU), Secretary for Busoga's local maternity and Neonatal systems, Director at Afrozuri Foundation, Co-Director at HABA Education Services, a wife, and a mother of two beautiful children, Lucas and Laura.

Her passion for maternal health radiates through every aspect of her life, from ensuring the well-being of pregnant women to advocating and improving sexual and reproductive health-seeking behaviors in communities through her organization, Afrozuri. She finds fulfillment in witnessing healthy pregnancies, healthy families, and thriving communities.

in my profession fearlessly go out of their way to serve and save the lives of others, like Nurse Doris Okudinia, who wheeled a patient on a wheelbarrow to Arua Hospital. Her courage inspired me to always stand up for what’s best for my patients, even facing challenges.

What are some of the professional milestones in your career/defining moments that have led you to where you are today?

Throughout my career, milestones like spearheading community health initiatives under the Afrozuri Foundation, being part of professional growth spaces like the midwife’s association and local maternity systems and meeting professional mentors at an earlier career stage have propelled me forward. Each opportunity and experience have shaped my skills, confidence, and commitment to improving myself and maternal healthcare.

Here is what she had to say about IWD 2024.

What does International Women’s Day (IWD) mean to you?

International Women’s Day (IWD) is a celebration of resilience, empowerment, and unity. It’s a reminder of women's incredible strength and contributions worldwide, a day to honor our achievements, and a time to recommit to breaking barriers. It’s an opportunity for us women to impact society socially and morally.

Share with us a moment of women’s empowerment that inspired you.

Well, there are so many women-empowering moments to mention. Still, I have seen women

What would you describe as your top 3 habits for success?

My top 3 habits for success include continuous learning and self-improvement, fostering strong relationships and networks, maintaining a positive mind, and having a supportive husband.

What do you believe are the most significant barriers to higher-level leadership that women in Uganda face today, and how can we overcome them?

The most significant barriers to higher level leadership for women in Uganda include gender stereotypes, limited access to education and resources, and cultural norms

19 that prioritize male leadership; it is worse in nursing /midwifery where one’s ability to lead is gagged with age, senior nurses and midwives in age take up a leadership position. To overcome these, we must advocate for gender equality in education and employment, promote mentorship and sponsorship programs for aspiring female leaders, and challenge traditional gender roles.

How have you negotiated some of the barriers women face to senior leadership positions to be where you are today?

I’ve negotiated barriers to senior leadership by actively seeking opportunities for professional development, building a supportive network of mentors and allies, and advocating for myself and other women in the workplace by demonstrating my capabilities and breaking down stereotypes.

I am assertive by God’s design as well.

How do you balance workplace demands while having time for your family? What habits and lessons have you learned in this area that you can share with nurses and midwives struggling to find work-life balance?

Balancing workplace demands and family life requires prioritization, effective time management, and open communication with colleagues and loved ones. I’ve learned to set boundaries, to say No to things I don’t believe in or cannot do, to delegate tasks when necessary, and to make time for self-care to avoid burnout. I advise nurses and midwives struggling with work-life balance to seek support from colleagues, friends, and family, prioritize self-care, and remember that asking for help is okay.

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REFLECTIONS ON THE BEAUTY OF MIDWIFERY AT QUEENS HOSPITAL, ROMFORD, LONDON

BY LILIAN NUWABAINE LUYIMA

In all cultures, the midwife’s place is on the brink of life, where intense human emotions, fear, hope, belonging, triumph, and incredible physical power enable a new human being to emerge.

While the UK-Africa Health summit held at the Royal College of General Practitioners, Euston from 18th to 19th March 2024 was well organized, insightful, and inspirational with global stakeholders, it was also an eye opener to me as a young NurseMidwife leader. Amongst the countless stakeholders at the summit, I was privileged to meet Ms. Wendy Olayiwola - the National Maternity Lead for Equality, National Health Service (NHS) England and NHS Improvement. I used this boundless opportunity to share about the status of Midwifery in Uganda.

However, due to time limitations, we agreed to hold the discussion a few days later.

Noticing that I still had a few days in London, I had a keen interest in visiting some of the NHS trusts/hospitals nearby. Ms Wendy took the initiative to link me to the Director of Nursing and Safeguarding Northeast London, Ms Marsha Jones. I was astounded by this news flash. It surely felt like a dream come true, especially for a Nurse-Midwife with humble beginnings like me. I had always desired to attach sight to the sang beauty of midwifery care practiced in developed continents like Europe. Also, I sought to benchmark and make facsimile of the best practices in Europe and transfer them to my home country Uganda, for better outcomes for mothers and their babies.

Quote “All mothers deserve the best care there is”.

On the 20th of March 2024, I paid a visit to Queen's Hospital, where I was warmly welcomed by Ms Lola Enifeni- global health policy One of the birth centers at Queen’s Hospital, Romford, London, United Kingdom for low-risk women and normal deliveries

21 specialist and matron for the Labour ward. Here are some key things that I observed which caught my attention: ❖ On average, the hospital conducts 20-25 normal deliveries on a daily ❖ A shift runs for 7.5 hours. ❖ Each shift consists of 13 registered midwives, 03 maternity support workers, and 2 obstetricians. ❖ Each labouring woman is taken care of by one midwife, thus a ratio of 1:1 ❖ Low-risk women i.e. without complications deliver from the birth centres within the hospital, and experience a homey kind of environment, with only midwives. ❖ The birth centres are spacious and tidy with water pools, birthing balls, delivery beds and stools, wireless CTG, Doppler, and many others.

Lilian meeting Ms Lola Enifeni, matron ❖ High-risk mothers go straight to the Labour ward. for the Labour ward at Queen’s Hospital ❖ Data is entered electronically via the intranet. ❖ Labour ward dashboard is updated on a daily and has a component of patients;’ experiences, hospital-acquired infections, complaints, ward-acquired pressure ulcers, and medication on top of the usual ❖ The hospital has emergency kits for managing emergency conditions like severe preeclampsia and eclampsia, postpartum hemorrhage etc. ❖ For each procedure or condition to be managed, one must follow the guidelines or protocols in place, short of that, one will need to justify why or even face legal implications. All protocols are available on the intranet e.g. protocol for spontaneous vaginal delivery, breech delivery, twin delivery, shoulder dystocia, caesarean section, eclampsia, etc. ❖ A maternal or neonatal death is barely heard of ❖ Common pregnancy complications in this hospital include hypertensive disorders e.g. preeclampsia and eclampsia. ❖ Postpartum haemorrhage is a rare complication for mothers after delivery.

A view of Queen’s Hospital, Maternity Center, Romford, London, United Kingdom

22 ❖ First line for management of 3rd stage of labour (use a mix of oxytocin and ergometrine) for nonhypertensive women, 5Ius. ❖ Labouring mothers are monitored using a Doppler or wireless CTG to allow movements freely during labour. ❖ They have a central monitoring point on top of the individual room monitoring for each mother. This helps the supervisors or experts to identify any unnoticed gaps during the labour monitoring process.

A snapshot of the labour ward dashboard at Queen’s Hospital, Romford, London, United Kingdom, which is update daily. ❖ The minimum education level for a midwife is 3 years (without research). A bachelor’s in midwifery is 3 years too but with research. ❖ Emergency response teams are well set, and everyone undergoes mandatory training in this. ❖ Patients are the number one priority, and any concern from a patient is a big concern and must be highly critiqued. ❖ The hospital has free WIFI accessible to everyone. ❖ Mothers whose babies die after delivery are isolated and put in a separate room and provided care. ❖ Health workers such as midwives have good customer care. ❖ Midwives have up-to-date knowledge, and skills and are always willing to share with others. ❖ Maternity care providers receive continuous professional development (CPD) sessions every 03 months. ❖ Guidelines/protocols in use are updated every 03 years, however, whenever new developments or evidence emerge, the team is informed timely. ❖ Respectful Maternity care is paramount. ❖ Teamwork is key.

With the above observations, I was so much challenged especially when I compared with our healthcare setting and care provided to our patients here in Uganda. I vowed to greatly contribute to better maternity care in Uganda.

23 I therefore recommend the government of Uganda invest more in formal midwifery education/training, practice, and workforce. Additionally, I recommend the Government of Uganda through the Ministry of Health and other relevant entities to ensure there is constant availability of supplies and equipment to enable all maternity care providers to provide care with ease.

The main entrance of Queen’s Hospital, Romford, London, United Kingdom

Left: Lilian Nuwabaine receiving donated training mannequins from Ms. Wendy Olayiwola - the National Maternity Lead for Equality, National Health Service (NHS) England and NHS Improvement and President of the Nigerian Nurses Charitable Association UK.

About the Writer: Lilian Nuwabaine Luyima; BSc Nurse & MSN-Midwife & Women’s’ Health Specialist & Heroes in Health Award Winning Midwife

24 DIASPORA UK - NEWS IN PICTURES

DIASPORA UK - NEWS IN PICTURES

If you are interested in attending the ICN Congress 2025, check out the website ICN Congress 2025 Helsinki | ICN International Council of Nurses or contact Elizabeth Pearson for more information and guidance.

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USEFUL CONTACTS

Please find below a list of useful contacts to forward your concerns appropriately.

UNMC queries:- info@unmc.ug UNMU:- info@unmu.ug CPD APP concerns: martin@unmc.ug National Organisations Education and training Standards:- Department of Nursing at Ministry of Health HET (Min of Education and sports) QUESTIONS? CALL: 0417 893600 (PRO) Mobile 0777108170 Some of the associations AGNMU: graduates@agnmu.org Critical Care Association:president@ccnau.org Midwifery Association: nationalmidwivesassociationug@gmail.com Nursing and Midwives Society: info@nursesandmidwivessociety.org Emergency Care Society of Uganda:- admin@ecsuganda.org Palliative Care Association of Uganda:- pxau.admin@pcau.org.ug Others NMLTT (Think-Tank Leaders):- uganursemidwife.leaders@gmail.com Writing articles for publication on the NHCC Uganda website:editors.nhccuganda@gmail.com Global networking Nursing Now Campaign Uganda:- nursingnowuganda@gmail.com

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ACADEMIC RESOURCES

Access to Health Care journals (Discounted at 30%) In partnership with UGANDA NURSES and MIDWIVES ASSOCIATION UK (UNMA-UK), Markallen group UK (https://www.markallengroup.com/ma-healthcare/) has offered a 30% discount on their online subscriptions (MA Healthcare titles only) for UNMA-UK members. This was also extended to Nurses and Midwives in Uganda as per the UNMA-UK mission.

Use the confirmed discount code [UNBA30] to access a range of their healthcare journals.

The Think Tank Newsletter editing team accepts articles on a rolling basis under the sub-themes below. ● ● ● ● ●

Research and Innovation Continuing Professional Development (CPD) Policy Leadership/Governance Clinical Practice Covid Response.

Think Tank is committed to supporting nurses and midwives through strategic advocacy. Advocate for Nurses and Midwives. Please send us your current email address to be included on our mailing list.

Our faith in you is steadfast. May you continue to rise to the challenge in this international year of the Health and Care Workers by WHO - 2021. More than ever, this nation needs you. We thank you, and May God bless you.

Copy to:

The Hon Minister for Health The Permanent Secretary, Ministry of Health The Permanent Secretary, Ministry of Education and Sports Commissioner Nursing Services, Ministry of Health Commissioner Health Education & Training, Ministry of Education and Sports The President of the Uganda Medical Association All Nurses and Midwives

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NMLTT NEWSLETTER EDITING TEAM

Ms Eli a eth Pearson NMLTT Steerin Commi ee Editor

Ms dith iconco NMLTT Steerin Commi ee Editor

Ms Trac o indo ama NMLTT Steerin Commi ee Editor

Informed disclaimer:- All editing team members are Nurses, and they are all volunteering their time and expertise. However, the views expressed in the articles are of the authors or writers solely. Although the editing team does its very best and is responsible for vetting the information, the authors’ opinions remain. it is, therefore, upon the authors to make sure that what they submit is referenced appropriately and accurately.