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Abstract Background Elderly health care training and aging science remain the least prioritized discipline of medical education in many African countries. With scant scientific evidence on elderly health care in low-income countries, coupled with limited exposure to elderly health care training, this project aimed to equip undergraduate health professional students with elderly health care assessment skills and research through an online course and a clinical placement. Methods Students (3rd year) underwent online elderly health care training through the Alison courses published by the Advanced Learning Academy in Ireland. The students were then subjected to an online exam with a pass mark of 80%. Students were also trained on standard elderly health care assessment tools through a one-day session. For practical skills on data collection, each student assessed 15 elderly patients at the Mulago National Referral Hospital Assessment Centre. All tools once filled in were assessed for completion. A one-day reflection session was held with students, faculty and the project leads to share findings from the various tools used to assess elderly individuals. The students shared their experiences and provided feedback on the online training as well as the hardships they may have experienced while administering the tools. A certificate of participation was provided to the students at the end of the project. Results All the students (10) gained knowledge on elderly assessment skills, the impact of aging on various body systems, and how to manage common occurrences among elderly individuals. The average score in the post-exam was 82% (standard deviation ± 2.01). All students (10) reported having had this as their first training on the assessment of functionality among elderly individuals. Conclusions The students gained knowledge of elderly health assessments as well as the impact of aging on various body systems. They also gained insight into how to care for the elderly holistically with an added understanding of how to manage spinal and traumatic brain injuries.

Abstract Background Midwives are essential providers of primary health care and can play a major role in the provision of health care that can save lives and improve sexual, reproductive, maternal, newborn and adolescent health outcomes. One way for midwives to deliver care is through midwife-led birth centres (MLBCs). Most of the evidence on MLBCs is from high-income countries but the opportunity for impact of MLBCs in low- and middle-income countries (LMICs) could be significant as this is where most maternal and newborn deaths occur. The aim of this study is to explore MLBCs in four low-to-middle income countries, specifically to understand what is needed for a successful MLBC. Methods A descriptive case study design was employed in 4 sites in each of four countries: Bangladesh, Pakistan, South Africa and Uganda. We used an Appreciative Inquiry approach, informed by a network of care framework. Key informant interviews were conducted with 77 MLBC clients and 33 health service leaders and senior policymakers. Fifteen focus group discussions were used to collect data from 100 midwives and other MLBC staff. Results Key enablers to a successful MLBC were: (i) having an effective financing model (ii) providing quality midwifery care that is recognised by the community (iii) having interdisciplinary and interfacility collaboration, coordination and functional referral systems, and (iv) ensuring supportive and enabling leadership and governance at all levels. Conclusion The findings of this study have significant implications for improving maternal and neonatal health outcomes, strengthening healthcare systems, and promoting the role of midwives in LMICs. Understanding factors for success can contribute to inform policies and decision making as well as design tailored maternal and newborn health programmes that can more effectively support midwives and respond to population needs. At an international level, it can contribute to shape guidelines and strengthen the midwifery profession in different settings.

Abstract Introduction Adequate and intensive nursing care was a key characteristic of recovery of the COVID-19 patients globally and in Uganda. However, there is limited literature on the experiences of nurses who participated in the care of COVID-19 patients in Uganda, East Africa, and Africa at large, yet imperative in designing approaches to increase the efficiency of the health systems’ response to future pandemics. To address this gap, this study aimed to explore the experiences of the nurses who managed COVID-19 patients at Mulago National Referral Hospital in Uganda. Methods This was an exploratory qualitative study that used purposive sampling to identify 21 nurses who treated COVID-19 patients at Mulago National Referral Hospital in Uganda. Focus Group Discussions were used to collect data. Thematic Analysis was used to analyze the data. Common codes were identified and grouped to create subthemes and major themes. Results Six themes were identified: 1) Motivation to work on COVID-19 patients, 2 ) Roles performed by nurses, 3) High workload and professional role strain, 4) Challenges with maintaining personal health and relationships, 5) Institutional and government support, 6) Acquired professional knowledge and skills to manage critical patients and epidemics. Most of the nurses faced work burnout, social isolation, stress, and psychological trauma. However, interprofessional collaboration, financial incentives, government recognition, and provision of personal protective equipment, were key motivators for the nurses. The majority reported to have gained new knowledge and skills in the management of pandemics and highly infectious diseases. Conclusion The nurses experienced negative scenarios like work burnout due to high workload, social isolation, and psychological stress. Therefore, there is a need for health systems to develop approaches and policies that support nurses’ well-being. Nevertheless, key attributes like resilience, adaptability, and diligence to serve enabled them to persevere despite the hardships faced.

Abstract Background Given that there are hardly any comprehensive frameworks to guide institutions on approaches to use as they implement interprofessional education and collaborative practice during international electives, we developed and piloted a framework to address this gap. The purpose of this study, therefore, was to explore the experiences of faculty and students regarding the use of the developed interprofessional education and collaborative practice framework during international electives. Methods This was an exploratory qualitative study. The study participants included faculty and students from four health training universities in Africa who participated in the pilot of international electives guided by the framework developed. Deductive thematic analysis was used to analyze the data. The codes were categorized as per the major themes. Results The major themes regarding the framework included (1) The Strengths, (2) Weaknesses, (3) Opportunities, and (4) Threats. All participants perceived the framework as useful and appropriate to enable the acquisition of interprofessional education and collaborative practice skills objectives set. The framework’s duration of the elective was seen as a weakness with the need for an increment in the duration. The opportunities the framework presented included: acting as a starting point to structure and implement interprofessional education across various training institutions in Africa, advancing research, and networking opportunities to share the best practices. The main threat included siloed training where the current training curriculum of the students does not have opportunities that allow the students to study with, from, and about each other. Conclusions The framework developed to guide the implementation of interprofessional education and collaborative practice during international electives is feasible and enabled students to achieve the interprofessional education and collaborative practice objectives set while appreciating the transcultural similarities and differences in another country.

Abstract Background Investment in nursing and midwifery leadership and governance are key suggested approaches by the World Health Organization (WHO) Africa Regional Office to address the shortages in the nursing health workforce. However, there are few if any studies that have investigated the existence and operationalization of the nursing and midwifery leadership and governance structures in Africa. This paper fills this gap by, providing an overview of nursing and midwifery leadership, governance structures, and instruments in Africa. Methods We conducted a descriptive cross-sectional study of the nursing and midwifery leadership, structures, and instruments in 16 African countries using quantitative methodology. Data was analyzed using SPSS IBM 21 statistical software. Data was summarized in frequencies and percentages and presented as tables and charts. Results Only (9,56.25%) of the 16 countries included had retrievable evidence of all expected governance structures while (7, 43.75%) lacked one or more of the structures. A quarter (4, 25%) of the countries did not have a department of nursing and midwifery or chief nursing and midwifery officer at their Ministry of Health (MOH). The dominant gender representation across all the governance structures was female. Only Lesotho (1, 6.25%) had all expected nursing and midwifery governance instruments while the remaining (15, 93.75%) had either one or four of these instruments missing. Conclusions The lack of complete nursing and midwifery governance structures and instruments in various African countries is a matter of concern. Without these structures and instruments, the strategic direction and input of the nursing and midwifery profession cannot be maximized for the public good in relation to health outcomes. Addressing the existing gaps requires a multipronged approach with the need to strengthen regional collaboration, and advocacy, creating awareness, and advancing nursing and midwifery leadership training to enable nursing and midwifery governance capacity development in Africa.

BackgroundInternational electives provide a learning platform where interprofessional education and collaborative practice (IPECP) skills can be cultivated. However, hardly any frameworks to guide the implementation of interprofessional education (IPE) during international electives, especially in the context of low-income settings have been published. To address this gap, this study used the modified Delphi approach to develop an IPE framework guide for international electives to be used by health professions training institutions in Sub-Saharan Africa.MethodsA rapid literature review and a study among students and faculty in four African health professional training institutions were done to inform the process. This was followed by the modified Delphi technique that used three Delphi rounds with a panel of eight experts to build consensus on the final framework for IPE during international electives. The level of consensus was set at ≥70% on each of the statements in all rounds.ResultsOut of the 52 statements in round 1 (n = 37, 71%) reached consensus while (n = 15, 29%) of the statements did not reach consensus and were discussed in round 2. Round 2 led to 42 statements to be utilized for round 3. In round 3, all statements (42) reached a consensus and an IPE framework to guide the implementation of international electives was developed. The framework consists of three sections. Section one highlights the various IPECP competencies to be gained by learners in the areas of teamwork, interprofessional communication, roles and responsibilities of interprofessional collaborative practice, values and ethics of interprofessional collaboration, and reflection and evaluation of oneself and the team. Section two gives guidance on the structuring of the IPE international electives in health professional training institutions. This includes subsections on operational/institutional needs, acculturation considerations, teaching strategies, assessment strategies, mode of delivery, and public health considerations. Section three consists of the various practical guides and approaches that health professional training institutions could use according to what works best in their setting.ConclusionThe modified Delphi technique was an adequate approach to aid the development of an IPE framework to guide implementation during international electives in various health professional training institutions.

# Background Faculty perspectives are key drivers of learning during international electives (IEs). However, in Africa, there is limited literature on these perspectives on interprofessional education and collaborative practice (IPECP) during IEs. Therefore, this study explored faculty perspectives toward IPECP within an international elective context from selected African institutions. # Methods This was an exploratory qualitative study. The study participants included faculty from four health professional training universities in Africa. Thematic analysis was used to analyze the data. Common codes were identified and grouped to create subthemes and major themes. # Results Four themes were identified: (i) The importance of IPECP during IEs, (ii) Approaches to IPECP during IEs, (iii) Perceived key barriers, and (iv) Perceived institutional support for IPECP during IEs. Most of the participants perceived IEs as a platform that can be used to cultivate IPECP with a multicultural perspective while promoting cross-border partnerships to advance health care. Suggested teaching approaches included case studies, joint clinical ward rounds, and simulations, among others, with an openness to having an online, blended, or physical mode of delivery. A framework to guide the implementation of IPECP during IEs was considered important, and most participants thought that their institutions had the infrastructure to support IPECP-IEs. # Conclusions Faculty reported enabling perspectives of IPECP during IEs, emphasizing the need for a framework to guide and structure implementation. IPECP-IEs were perceived as a unique platform to cultivate IPECP skills with a multicultural component.

Abstract Background For effective delivery of international experiential training programs, many universities in the global north, have created partnerships with universities in the global south especially in Africa to enhance their capacity and diversity of learning for their students. However, there is hardly any literature that exhibits the importance of African instructors in international experiential learning programs. This study aimed at establishing the importance of African instructors in international experiential learning programs. Methods This was a qualitative case study that examined the importance of instructors and experts from Africa in influencing student learning processes and outcomes in the GCC 3003/5003 - Seeking Solutions to Global Health Issues. Semi-structured interviews with (2) students, (2) University of Minnesota lead faculty for the course, and (3) in-country instructors/experts from countries in East Africa and the Horn of Africa were conducted. Data was analyzed thematically. Results Four themes were identified: (1) Filling gaps in knowledge, (2) Orchestrating partnerships for practical exposure, (3) Improving the quality of training, and (4) orchestrating professional personal growth for students. The African in-country course instructors/experts contributed to student learning by providing a true picture reflection of happenings on the ground. Conclusion The importance of in-country African instructors’ can be viewed as that aimed at validating students’ ideas to apply to the local settings, streamlining students’ focus, providing a platform for multi-stakeholder engagement to a particular topic, coupled with bringing an in-country context experience in the classroom.

BackgroundGiven the significant gap in International Electives (IEs) opportunities for African health professions students, ECFMG|FAIMER through its Global Educational Exchange in Medicine and other health professions (GEMx) program launched a pilot African regional elective exchange program in 2016. During IEs, students have a choice of discipline they would like to learn, and the location, often at a host institution in a different country. This study provides an overview of health professional students’ experiences through participation in the pilot GEMx regional elective exchange program in Africa.MethodsThis was a quasi-experimental, single-group post-test-only study using the survey method. Data were collected online using a self-administered survey through SurveyMonkey. Students (N = 107) received emails with a link to the survey as they completed the electives. The survey was open for a month for each student and weekly reminders were sent.ResultsThe survey obtained a 100% response rate. All postgraduate and undergraduate students from various professional training programs (n = 107) reported gaining knowledge that was applicable back home. Over 43.4% (n = 46) reported having formed professional networks that are valuable for career progression. More than half 59.8% (n = 64) gained clinical skills and learned various procedures while 26.2% (n = 28) recognized the need for increased reliance on history taking for disease diagnosis. More than a third, 34.6% (n = 37) appreciated the different cultures and the effect of cultural beliefs on health outcomes.Discussion and conclusionsThe GEMx regional elective exchange program in Africa provided a useful platform that enabled health professional students at undergraduate and postgraduate levels in their respective disciplines to gain enhanced perspectives on health issues, acquire clinical knowledge and skills applicable to their home country, strengthen personal and professional development, and develop positive attitude change in various health care delivery approaches.

Abstract Background Nurses contribute the largest portion of Uganda’s health workforce providing care to individuals of all ages and communities. However, despite the growing number of the elderly population in Uganda with improved life expectancy, there is hardly any study that has looked at the elderly health care competencies in the nursing training programs at various levels. This paper provides an overview of the gaps in elderly health care competencies in nursing education in Uganda. Methods We conducted a descriptive qualitative cross-sectional study that involved document review, Key Informant Interviews (KIIs) with nursing leaders, and Focus Group Discussions ( FGDs) with faculty at all levels of nursing training and nurses in practice. Data was analyzed using latent and manifest content analysis with Open Code software 4.03. Common categories were identified and incorporated into a matrix to create themes. Results Almost all the curricula and minimum standards for training nurses at certificate, diploma, and degree levels lack a module and nursing competencies on elderly nursing care. This is aggravated by a lack of faculty trained in elderly health care skills, and a lack of specialized wards for nursing elderly care clinical training among others. Conclusions There is hardly any elderly health care training module and elderly nursing competencies at all levels of nursing training in Uganda.

Background: Given the significant gap in International Medical Elective (IME) opportunities for African health professions students, the Educational Commission for Foreign Medical Graduates and the Foundation for Advancement of International Medical Education and Research (ECFMG|FAIMER) launched an African regional elective exchange program through the Global Educational Exchange in Medicine and the Health Professions (GEMx) in 2016. This paper provides an overview of the development of the GEMx program, the pillars of implementation, and lessons learned. Methods: The authors conducted a longitudinal qualitative study utilizing in-depth interviews with institutional leaders, program leaders, and faculty, participant observation through symposia, strategic planning meetings, staff meetings, and document review of the annual progress reports, strategic plans, and newsletter articles, abstracts, and concept notes. Common categories were identified and incorporated into a matrix to create themes. Data were analyzed using the manifest content approach guided by a literature review. Results: The key pillars for implementation of the GEMx Africa regional elective exchange program included: the commitment from African training institutional networks and their member institutions that enabled electives to be offered, the GEMx Charter (multilateral agreement) that enabled reciprocity and diversity of elective opportunities, GEMx web-based application system that enabled the centralization of the application process and real-time feedback on acceptance, GEMx Africa Regional Coordination Center in Kampala, Uganda that lead the development and implementation in Africa, and ECFMG mini-grants that helped defray elective costs. Conclusions: Through the development of multilateral partnerships across the continent, the GEMx regional elective exchange program contributed towards bridging a long-existing gap of inadequate opportunities for African health professions students to enhance their global exposure and strengthen their knowledge and skills. .

Abstract Background An elective is part of the curriculum where students have the flexibility to choose both the study topic and location. International medical electives are a well-established part of curricula at most medical schools in high-income countries. They are highly valued by students and have proven educational benefits, though do come with challenges, such as lack of reciprocity. Low and middle-income countries frequently host students from high-income countries providing learning opportunities, yet also carry the burden of supervision and resource consumption, whilst their students get few elective opportunities. This study explores the value and feasibility of South-South Medical Elective Exchanges (SSMEE), which creates elective opportunities for African medical students in other African countries to create reciprocity within the elective system. Method A qualitative evaluation of the South-South Medical Elective Exchanges was conducted using a case study approach. Four African medical schools, College of Medicine, Malawi; University of Rwanda, Rwanda; University of Witwatersrand, South Africa and Makerere University, Uganda participated in the pilot study in 2017/18. Each institution selected two students to participate in a four-week elective to another participating institute. Participating students completed a pre-elective questionnaire and a post-elective interview exploring expectations, learning outcomes, challenges and how they are applying this learning. Data was analysed thematically. Results Data presented is from six of the eight participating students. All students found the elective a valuable experience and learning was demonstrated in four key areas: clinical knowledge and skills; attitudes; personal and professional development and global perspectives. For some, it challenged their assumptions of what an elective is because valuable learning can be achieved whilst remaining in Africa. The main challenge found related to funding the elective. Conclusions The SSMEE model is feasible and provides valuable learning for participating students and their peers/colleagues. Financing electives remains the biggest challenge. Since this pilot study, SSMEE has become part of a regional elective exchange network in Africa with an additional four institutions in three other countries. As such SSMEE has resulted in increased opportunities for African medical students and better educational outcomes that are likely to have a positive effect on healthcare systems in Africa.

BackgroundThe severe deficit of health care workers in Uganda necessitates hospitalized patients to be cared for by a relative. These informal caregivers constitute a crucial component of patient care. Mulago Hospital in Kampala, Uganda, is one of the nation's national referral hospitals, receiving very sick patients. Although studies have been conducted on challenges facing informal caregivers in the home setting, no study has addressed the caregiver burden in the hospital setting.MethodsA survey of 100 randomly selected informal caregivers was conducted in Mulago Hospital's internal medicine wards to evaluate informal caregivers' demographics, impact on patient care, and challenges.ResultsChallenges include emotional burdens, lack of sanitation, accommodation, sufficient health workers, finances, and recognition. Recommendations were given to ensure improve informal caregivers' situations.ConclusionsDespite hardships, informal caregivers recognize the importance of familial presence, thereby setting a new standard for patient care by recreating the comfort of home care in the hospital. Studying the characteristics of these care givers and more fully delineating the sacrifices they make and the challenges they faced provides the basis for a series of recommendations to hospital management aimed both at improved patient care and care of the informal caregiver.

Background: For many medical and allied health students from African countries, the opportunity to undertake a global health elective abroad is unaffordable or inaccessible. Therefore, an imbalance has emerged where many African institutions host students from developed countries but their own students rarely go on electives in developed countries. Global Educational Exchange in the Medical and Health professions (GEMx), a service programme of the Educational Commission for Foreign Medical Graduates (ECFMG) partnered with the African Forum for Research in Health (AFREhealth) to implement a south-to-south student exchange pilot through intra-institutional partnerships. The aim was to provide affordable global-health learning opportunities to African students. Methods: 13 medical and nursing institutions in eight African countries participated in the AFREhealth pilot. Institutions entered into a multilateral agreement. The GEMx web-based system was used to centralise elective placements where students gained access to opportunities and applied online. Host institutions waived their administrative fees and provided a manager to support incoming students. ECFMG hired a contractor to do partnership development and work with students and leaders at participating institutions. ECFMG GEMx provided student mini-grants to cover travel, accommodation, and living expenses. We used SurveyMonkey to collect feedback from students, institutions, and AFREhealth leadership and to run descriptive analysis. Findings: Between April, 2017, and June, 2018, GEMx facilitated 48 student exchanges in medicine, nursing, and pharmacy in Ghana, Kenya, Malawi, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe. 20 students (42%) reported that they had not previously gone on an elective exchange in another country and that this opportunity would not have been possible without GEMx. The most common learning experiences reported by institutions were that students: learned about and compared different health systems; improved clinical skills and gained knowledge that is applicable back home; increased confidence; developed professional networks; and managed and cared for patients who differed from those in their previous educational experience. These findings correlated with feedback collected from students. Interpretation: Translation and implementation for impact in global health requires models that provide opportunities for global exposure to various health-care settings. With little global exposure for African medical and allied health professional training students, the south-to-south model provides a suitable and cost-effective platform to address the gap. Outcomes from the pilot showed a strong commitment from intra-institutional partners within AFREhealth to the south-to-south model. Although ECFMG GEMx funding made student exchanges possible for the AFREhealth student exchange pilot, additional funding contributions are needed to expand the south-to-south student exchange programme. Funding: ECFMG Challenge Grant.

Aging entails health challenges globally, but pertinent data from low-income countries like Uganda remains scarce. A cross-sectional study was carried out at Mulago National Referral Hospital in Kampala, among 134 patients (38% men and 62% women) aged ≥60 years. Data was collected on sociodemographic characteristics, medical disorders, cognitive function, hearing handicap, and functional status, that is, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL). The participants had high independency in BADL (89%) and IADL (75%). The most common medical conditions were bone/joint pain (35%), hypertension (24%), and visual problems (20%). More women (54%) than men (37%) reported bone and joint pain. The majority (80%) of the participants did not report any hearing handicap, and half (54%) did not have any cognitive impairment. Dependency in IADL was associated with advanced age, being female, and being financially dependent, and the risk of having a hearing handicap was higher among those above the median age (68 years). In adjusted models, the effects remained similar although statistical significance was only achieved for advanced age versus dependency in IADL (RR: 2.38, 95% CI: 1.12–5.08) and hearing handicap (RR: 2.67, 95% CI: 1.17–6.12). Thus, socioeconomic status and gender are relevant aspects when attempting to understand the health profile of the elderly in Kampala, Uganda.