Understanding of and attitudes towards nursing education reform at medical colleges in Kyrgyzstan: A mixed-method study.

AIM: To determine teachers' understanding of and attitudes towards nursing education reform at four medical colleges in Kyrgyzstan. BACKGROUND: The quality of nursing education at undergraduate and postgraduate levels has a major impact on patient outcomes and the development of nursing as a profession and a science. INTRODUCTION: Lower middle-income countries have sought to advance their nursing education by adopting the experiences of high-income countries. METHODS: A mixed-method cross-sectional study design was used. The STROBE combined checklist was followed. A cohort of all faculty members at four colleges were included (N = 150). The questionnaire consisted of 10 groups of questions and statements. Both quantitative and qualitative data were collected. FINDINGS: A total of 56.4% of respondents were familiar with the European approach to nurse education; 73.3% of respondents with a nursing education reported being familiar with the European approach, compared to 40.7% of respondents with a medical education. Qualitative written comments yielded 57 superscripts of codes, 14 subcategories, 5 categories and 2 themes as drivers and barriers of reform. DISCUSSION: The survey revealed weak support for the nursing education reform. Respondents do not envisage nurse education being offered at all three levels of higher education (bachelor's, master's, and PhD), and even fewer recognise nurses as leaders of healthcare institutions. IMPLICATION FOR NURSING: Teachers in nursing programmes should mostly be nurses with academic careers. IMPLICATION FOR HEALTH POLICY: Nursing is still not recognised as an extremely important health profession that needs to be developed. This misunderstanding and negative attitude towards the role of nurses in the health care system are evident in both the quantitative and qualitative parts of the study.

Reforms in medical education: lessons learnt from Kyrgyzstan.

Human resources are one of the six building blocks of a health system. In order to ensure that these resources are adequately trained to meet the evolving needs of populations, medical education reforms are needed. In Kyrgyzstan, like in many other low- and middle-income countries, human resources for health are a key challenge for the health system in both the quantity and having their training aligned with the health system priorities. Here we present the experience of the Medical Education Reform Project, a project aimed at improving the quality of health professionals through reforming medical education, funded by the Swiss Agency for Development and Cooperation, as a collaborative effort between partners in Kyrgyzstan and Switzerland since 2013. We used a qualitative study taking a cooperative inquiry approach with an experiential perspective in order to present the implementation of the Medical Education Reform Project in Kyrgyzstan. In order to look at the different components impacting the reform process, a framework comprising: Setting the direction; Building a consensus; Engaging stakeholders; Pilot projects and evaluation; Capacity building; Timing, and Key partners was used to disentangle the lessons learnt. Champions and partnering with key institutions were essential in building consensus, as was the catalytic and facilitating role the project played. This enabled active engagement of a variety of stakeholders in the reform process using different means of interaction ranging from large roundtable discussions, workshops, trainings and even study tours. Pilot projects and research provided tangible actions that could be used to further the reforms. For capacity building, the project offered a wide range of activities that improved clinical competencies, empowered stakeholders, and strengthened organizational capacity. The timing of this reform process in medical education was facilitated by the overall reforms and policies in the health system.

Feasibility of a mass vaccination campaign using a two-dose oral cholera vaccine in an urban cholera-endemic setting in Mozambique.

We conducted a study to assess the feasibility and the potential vaccine coverage of a mass vaccination campaign using a two-dose oral cholera vaccine in an urban endemic neighbourhood of Beira, Mozambique. The campaign was conducted from December 2003 to January 2004. Overall 98,152 doses were administered, and vaccine coverage of the target population was 58.6% and 53.6% for the first and second rounds, respectively. The direct cost of the campaign, which excludes the price of the vaccine, amounted to slightly over 90,000 dollars, resulting in the cost per fully vaccinated person of 2.09 dollars, which is relatively high. However, in endemic settings where outbreaks are likely to occur, integrating cholera vaccination into the routine activities of the public health system could reduce such costs.