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Skills Gap among Sexual and Reproductive Healthcare Professionals in Cameroon

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  • Higher Teacher Training College, University of Yaounde I

Abstract and Figures

Over the last 10 years, the state of sexual and reproductive health in Cameroon has been challenging with rising levels of sexually transmitted diseases, the high fertility rate, and high infant and maternal mortality rates. Some researchers attributed these challenges to the limited number and quality of sexual and reproductive health personnel working in health facilities across the country. The North West Region of Cameroon was taken as a unit of study to probe into the skills gap among sexual and reproductive health practitioners. A total of n = 302 participants at a confidence interval of 95 per cent were selected using a stratified random sampling technique to take part in the study. The results indicated that a good number of them have no prior experience in the field of sexual and reproductive health. On the other hand, most of the practitioners' skills level is situated between intermediate and competent with very few of them being at the expert skills level. It was therefore recommended that most of the participants need improvement in (i) computer or information technology skills; (ii) research skills; and (iii) leadership development of the specialty. These areas need to be dealt with, as a matter of priority, through training and professional development to enable these professionals to deliver better service in the sexual and reproductive healthcare sector. It was also recommended that, in line with the critical role that sexual and reproductive health practitioners play in Cameroon's health system, the Ministry of Public Health and other role players in the health sector make sufficient investments in the improvement of the health workforce's accessibility to information and communication technology.
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Article
Africa Journal of Nursing and Midwifery
https://doi.org/10.25159/2520-5293/4096
https://upjournals.co.za/index.php/AJNM/index
ISSN 2520-5293 (Online)
Volume 1 | Number 1 | 2019 | #4096 | 21pages
© Unisa Press 2019
Skills Gap among Sexual and Reproductive Healthcare Professionals in Cameroon
Michael N. Nkwenti
https://orcid.org/0000-0002-6095-5074
University of Yaoundé, Cameroon
nkwentimichael@gmail.com
Ishan Sudeera Abeywardena
https://orcid.org/0000-0002-5042-670X
Commonwealth of Learning, Canada
iabeywardena@col.org
How to cite this article: Nkwenti, M., & Abeywardena, I. (2019). Skills Gap among Sexual and
Reproductive Healthcare Professionals in Cameroon. Africa Journal of Nursing and
Midwifery, 21(1), 21 pages. doi: https://doi.org/10.25159/2520-5293/4096
Abstract
Over the last 10 years, the state of sexual and reproductive health in Cameroon
has been challenging with rising levels of sexually transmitted diseases, the
high fertility rate, and high infant and maternal mortality rates. Some
researchers attributed these challenges to the limited number and quality of
sexual and reproductive health personnel working in health facilities across the
country. The North West Region of Cameroon was taken as a unit of study to
probe into the skills gap among sexual and reproductive health practitioners. A
total of n = 302 participants at a confidence interval of 95 per cent were
selected using a stratified random sampling technique took part in the study..
The results indicated that a good number of them have no prior experience in
the field of sexual and reproductive health. On the other hand, most of the
practitioners’ skills level is situated between intermediate and competent with
very few of them being at the expert skills level. It was therefore
recommended that most of the participants needs improvement in (i) computer
or information technology skills; (ii) research skills; and (iii) leadership
development of the specialty. These areas need to be dealt with, as a matter of
priority, through training and professional development to enable these
professionals to deliver better service in the sexual and reproductive healthcare
sector. It was also recommended that, in line with the critical role that sexual
and reproductive health practitioners play in Cameroon’s health system, the
Ministry of Public Health and other role players in the health sector make
sufficient investments in the improvement of the health workforce’s
accessibility to information and communication technology.
Keywords: sexual and reproductive healthcare; sexual and reproductive healthcare
professionals; skills gap; health facilities; Cameroon
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3
Introduction
As society evolves, new health challenges emerge necessitating sexual and
reproductive healthcare professionals to upskill themselves (Karimian et al. 2018).
According to the World Health Organization (2015), the world had 1.2 billion
adolescents in 2016, with 110 million in West and Central Africa. The United Nations
(2017) observed that sub-Saharan Africa is the region where adolescents make up the
greatest proportion of the population, with 23 per cent of the region’s population aged
1019 years. Adolescence is regarded as a time of transition from childhood to
adulthood when various biological, psychological and social transitions take place
(Fatusi and Hindin 2010). A person’s sexual and reproductive health plays an integral
role during this period and can be very challenging (World Health Organization 2004).
The biological transition is reflected in adolescents’ appearances, voice changes and
sexual activeness, whereas the psychological transition is reflected in the social
transition towards their human rights (World Health Organization 2004).
The challenges encountered by adolescents around the world are enormous. Young
female adolescents face a higher risk of complications and death as a result of
pregnancy than other women (World Health Organization 2014). Every day,
approximately 830 women die from preventable causes related to pregnancy and
childbirth with 99 per cent of all maternal deaths occurring in developing countries
(World Health Organization 2016). Additionally, an estimated 3 million girls aged 15
19 undergo unsafe abortions every year (World Health Organization 2015). Another
deadly disease referred to as human papillomavirus (HPV), primarily acquired during
adolescence, can lead to cervical cancer (World Health Organization 2018). In 2017,
there were 2.1 million adolescents worldwide living with the human
immunodeficiency virus (HIV) (UNAIDS 2017). Adolescent sexual and reproductive
health can also affect their mental health and other health domains, have long-term
effects on education, employment potential, economic well-being and their overall
ability to reach their full potential (Chandra-Mouli, Lane, and Wong 2015).
According to the United Nations’ World Population Prospectus (2017), the Republic
of Cameroon is an African country located in the western part of Central Africa, with
an area of 475 440 square kilometres. The country has an estimated population of
about 24 320 621 people as of December 2017, which is equivalent to 0.32 per cent of
the world’s total population. The country is bordered by Nigeria in the north-west,
Chad in the north-east, the Gulf of Guinea in the south-west, the Central African
Republic in the east, Chad in the north and Congo-Brazzaville, Gabon, and Equatorial
Guinea in the south (World Population Review 2018). Cameroon has 10 regions,
360 districts, 360 municipalities and 14 urban communities with English and French
being the two official languages (Engen 2013; Ngah, Kingue, Paule & Bela, 2013;
Sawe 2017). Out of the country’s 10 regions, the North West and South West Regions
are predominantly English-speaking, while the other 8 regions are predominantly
French-speaking (Engen 2013; Ngah, Kingue, Paule & Bela, 2013; Sawe 2017).
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Additionally, the more than 250 ethnic groups in Cameroon fall under the Bantu,
Semitic or Nilotic language groupings (Engen 2013; Ngah, Kingue, Paule & Bela,
2013; Sawe 2017).
Cameroon is a member of the Economic Community of Central African States
(ECCAS), the Economic and Monetary Community of Central Africa (CEMAC), the
Council for Peace and Security in Central Africa (COPAX), the African Union (AU),
the Commonwealth of Nations, and the Organisation Internationale de la
Francophonie (OIF) (Engen 2013; Ngah, Kingue, Paule & Bela, 2013; Sawe 2017). In
2016, the World Bank classified Cameroon as a lower middle-income country, with a
GDP of US$32.22 billion (World Bank 2016). Despite its economic growth, close to
40 per cent of the population still live below the poverty line with 33 per cent living
on less than US$1 per day (World Bank 2016). The poorest regions are the North and
Far North, where the poverty rate is more than 60 per cent, while in Yaoundé and
Douala poverty rates are below 6 per cent (National Institute for Statistics 2012). This
economic inequality ranks the country 153 out of 188 countries on the Human Poverty
Index (World Bank 2015). The life expectancy at birth has increased from 51 years in
2000 to 57.3 years in 2015 (Cameroon Ministry of Public Health 2016b). The country
faces the double burden of communicable and non-communicable diseases (Cameroon
Ministry of Public Health 2016a).
In recent years, the state of sexual and reproductive health in Cameroon has been
challenging with rising levels of sexually transmitted diseases, the high fertility rate
and high maternal mortality rate (Foumane et al. 2013; Tebeu et al. 2015). The
National Health Development Plan 20162020 (Cameroon Ministry of Public Health
2016a) and the Sectoral Health Strategy 20162027 (Cameroon Ministry of Public
Health 2016b) observed that infant and child mortality decreased between 2011 and
2014. This decrease is significant among children under 5 years old, which dropped
from 122 deaths to 103 deaths per 1 000 live births (Cameroon Ministry of Public
Health 2016a).
The governments stated goal was to reduce infant mortality rates from 103 per cent to
76 per cent and child mortality rates from 66 per cent to 39 per cent in 2015
(Cameroon Ministry of Public Health 2016a). Despite the improvements, the targets
were not met (Cameroon Ministry of Public Health 2016a). Also, these strategy
documents observed that maternal mortality has been aggravated over time, from 430
in 1998 to 669 in 2004 and then to 782 maternal deaths per 100 000 live births in 2011
(Cameroon Ministry of Public Health 2016a). Further, the rates of deliveries attended
by trained or skilled care providers decreased notably in the West (93.30% to 92.30%)
and the littoral (without Douala) regions (93.80% to 88.50%) (Cameroon Ministry of
Public Health 2011; 2016a). In major cities like Douala, it dropped from 97.10 per
cent to 95.20 per cent and in Yaoundeé from 94.20 per cent to 90.50 per cent
(Cameroon Ministry of Public Health 2011; 2016a). The strategy documents further
5
observed that there is a need to improve the quality of reception and care for pregnant
women in hospitals (Cameroon Ministry of Public Health 2016a).
To remedy some of these challenges, the 20162020 strategy framework (Cameroon
Ministry of Public Health 2016a) states that the HIV/AIDS mortality rate will be
reduced by 75 per cent; the health of mothers, newborns, children, adolescence and the
youth will be improved by 50 per cent; the maternal mortality rate will be reduced by
30 per cent; and sexual and reproductive health for adolescents, the youth and women
will be significantly improved (Cameroon Ministry of Public Health 2016a). As
measures envisaged, the two strategy documents stressed the need for the state to
partner with local communities to promote the health of vulnerable and
underprivileged groups, especially women (Cameroon Ministry of Public Health
2016a; 2016b).
The Sectoral Health Strategy 20162027 document observed that the problem of
quality is a major issue plaguing the training of medical personnel (Cameroon
Ministry of Public Health 2016b). In 2013, the Cameroon Medical Council assessed
the training strength of the private faculties of medicine in Cameroon. The outcome
revealed that, apart from the four state faculties of medicines, only two of the six
private institutes of medicine met the minimum required standards of medical training
(Ngah et al, 2013). To remedy this situation, the state has resorted to giving subsidies
to these training faculties to step up their quality of training. With this effort, the
subsidy given by the state accounts for just about 1 per cent of the amount needed to
train these medical doctors. Regarding the continuous professional development
(CPD), the Health Sector 20162027 strategy paper remarked that in-service training
is largely insufficient for all categories of health personnel (Cameroon Ministry of
Public Health 2016b). Since the year 2015, only 0.1 per cent of the Ministry’s budget
is allocated for in-service training annually.
The quality of training could account for the reasons why there are high infant and
maternal mortality rates (Alongifor 2016; Asamoah et al. 2011). Similarly, little
attention accorded to training of health professionals can have an impact on the quality
of services provided by the personnel (Ngah et al, 2013). This might be one of the
reasons why the strategy papers further state that health services will be provided by
skilled, confident and suitably equipped staff. As part of the action plan to achieve the
envisaged goals, the document states that “for a better performance of the health
sector, it will be necessary to reinforce the capacity of stakeholders to promote all
aspects of health” (Cameroon Ministry of Public Health 2016, 69). Given these
targets, this study aimed to identify the skills gap among sexual and reproductive
healthcare professionals in Cameroon with a focus on skills, knowledge, attitudes and
values underpinning effective performance.
Many researchers have clearly demonstrated that nurses and midwives provide
outstanding contributions to health improvements of patients, such as satisfaction, a
6
decrease in patient morbidity and mortality, stabilisation of financial systems through
decreased hospital readmissions, the length of stay, and other hospital-acquired
infections and conditions (Kendall-Gallagher et al. 2011; Pintar 2013). Studies also
show that midwifery, including family planning and interventions for maternal and
newborn health, could avert a total of 83 per cent of all maternal deaths, stillbirths, and
neonatal deaths (Patel et al. 2013). Recent studies indicate that midwives can provide
87 per cent of the needed essential care for women and newborns, when educated and
regulated in accordance with international standards (Smith et al. 2014). Substantial
reductions in child deaths are possible, only if intensified efforts to achieve
intervention coverage are implemented successfully (Davis et al. 2012). Midwives
must be leaders in the design, implementation, and evaluation of the ongoing change
in their care environments. Furthermore, midwives must take leadership roles in
building professional and inter-professional partnerships, developing leadership skills
and competencies, and working in mutually respectful teams to enhance the quality of
the care services (Walker et al. 2013). On the basis of these assertions, a requirement
by nurses and midwives for the efficient delivery of sexual and reproductive health
services was access to knowledge using proven models. Competencies are knowledge,
skills and attitudes required by the nurses and midwives to effectively carry out their
jobs.
Theoretical Framework for the Analysis of Health Practitioners Skills
Miller’s Model of Competence
To identify the competences required by nurses and paramedics in the effective
execution of their daily tasks, the Pyramid of Clinical Competence developed by
Miller (1990) served as the theoretical framework. Miller (1990) upholds that nurses
and paramedics must go through four sequential training steps before performing
duties on real-life patients. This model was developed to test the competencies of
health personnel in the exercise of their duties. These four sequential stages are as
presented Figure 1.
Figure 1: Pyramid of clinical competence (adapted from Miller 1990)
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The knows stage is a stage where health students are expected to master the
different lessons taught in class by their trainers (Miller 1990). At this stage the
students are expected to learn the different functions of the human system, to know
how they function, and to be able to explain this knowledge to a third a party.
The knows-how stage is the step where the trainees know how to carry out various
tasks related to their area of study (Miller 1990). However, the fact that trainees know
how to perform a task does not mean that they will be able to do it in real-life
situations (Mehay and Sackin 2010). It is for this reason that a researcher intimates
that at the level of know-how, the trainees should be able to learn related skills and
how knowledge is employed (Stalburg 2002).
Shows how is the stage where the trainees should show friends and mates what they
are able to do (Miller 1990). Therefore, at this level, the trainees are expected to move
out from cognition and thinking to behaviour and practice (Statman 2013). Thus, the
trainees should be able to correctly perform medical functions with the use of models
and other multimedia.
The “does stage requires the medical personnel to carry out health operations
independently (Miller 1990). This stage marks the disappearance of all assistance and
media to move to hands-on practice.
Miller’s (1990) model has guided the development of competency frameworks for
nurses and paramedics in many countries and organisations. To select the choice of
competency standard to guide the assessment of nurses and paramedics skills gap in
Cameroon, some competency frameworks were reviewed as seen in the Table 1.
8
Table 1: Competency framework for the assessment of nurses and paramedics skills
gap
Society of
Sexual Health
Advisers
(SSHA)(2013)
“Competency
Framework for
Sexual Health
Advisers (2013)
The State of South
Carolina Competency
Assessment for Tier 1
Public Health
Professionals (2014)
Australasian
Competency
Standards for
Sexual and
Reproductive
Health and HIV
Nurses (2011)
4 Domains
8 Domains
7 Domains
Professional,
ethical and legal
practice
Assessment,
planning and
delivery of care
Public health
role and
responsibilities
Personal and
professional
development
Analytical or
assessment skills
Policy development or
programme planning
skills
Communication skills
Cultural competency
skills
Community
dimensions of practice
skills
Public health sciences
skills
Financial planning and
management skills
Leadership and
systems thinking skills
Effective
communication
Assessment,
care planning
and clinical
management
Health
promotion and
patient
education
Research
Legal and
ethical nursing
practice
Collaborative
care and
partnerships
Leadership and
development of
the speciality
Limited and not
easy adaptable
to Cameroon
sexual and
reproductive
health needs
Limited mostly to
primary healthcare
practitioners with very
little covered in the
area of sexual and
reproductive
healthcare
Addresses health
related factors
and torches issues
of sexual,
reproductive
health and
HIV/AIDs.
Designed to target
similar
practitioners in
the Cameroon
sexual and
reproductive
healthcare chain
9
Table 1 indicates the individual competency frameworks reviewed in this study to
identify the most appropriate framework required by nurses and paramedics in
Cameroon to implement the national multisectoral programme to combat maternal and
child mortality. The Australasian Competency Standards for Sexual and Reproductive
Health and HIV Nurses (2011) were found to be closely related to the needs of
Cameroon. It should be noted that the country has not yet develop competency
standards for nurses and paramedics.
Australasian Competency Standards for Sexual and Reproductive Health and
HIV Nurses
The 2011 Australasian Sexual and Reproductive Health Association (ASHHNA)
Competency Standards were developed specifically for registered nurses working in
sexual health, sexual and reproductive health and HIV outpatient, community and
ambulatory care settings. These categories of personnel are also found in the
Cameroon health system. ASHHNA postulates that the competency standards and
performance criteria may be used to
assist with training and development of nurses new to the speciality,
provide guidelines of best practice for registered nurses employed in
specialised sexual and reproductive health and/or HIV services,
provide a mechanism for the recording of individual performance and
assessments,
assist in identifying areas of practice where further training and ongoing
professional development are required,
assist in the documentation of professional development achievements and
plans to guide peer reviews, and
guide the development of postgraduate scholarship and clinic-based training
programmes for the specialities.
For this study the competency frameworks were modified and used to assess nurses
and paramedics skills gap. The competencies that are divided into seven domains are
a combination of skills, knowledge, attitudes and values that underpin effective
nursing or midwifery performance in the individual area and context of practice
(Australasian Sexual Health and HIV Nurses Association Incorporated 2011). The
domains are:
effective communication;
assessment, care planning and clinical management;
10
health promotion and patient education;
research;
legal and ethical nursing practice;
collaborative care and partnerships; and
leadership and development of the speciality.
The domains are made up of a series of sub-competencies that nurses and paramedics
should demonstrate in order to perform effectively in their jobs. Since the publication
of this framework, many researchers have adapted it when mapping out nurses and
paramedical practitioners skills prior to a capacity building programme both for initial
and professional development (Fronek et al. 2011; Higgins et al. 2013).
Methodology
A survey-based research design was adopted for the study to probe the skills gap and
preferred training modes of sexual and reproductive healthcare professionals, such as
midwifes, nurses and paramedics. Since the study was survey-based, there were no
ethical concerns associated with the study. Only participants who had voluntarily
signed the consent form were surveyed. Confidentiality of participants was maintained
via the anonymous nature of the survey questionnaire, and processing of the data
adhered to the declaration of Helsinki (Declaration of Helsinki 2013). No personal
information was collected during the study.
The study was completed in two stages. The first stage was the review of previous
research work and reports detailing training or capacity building for sexual and
reproductive healthcare professional in Cameroon. Through the literature review,
evidence of local needs analyses and training initiatives was identified. The second
stage consisted of the survey study of professionals working in sexual and
reproductive health. This stage investigated the skills gap among these staff in eight
domains and their preferred mode of learning. A questionnaire was administered
among healthcare professionals working in public, private and faith-based health
posts, health centres and clinics located in urban, semi-urban and rural areas.
The Sample
The participants of the study were nurses, midwifes, community health workers and
paramedics working in the maternity units in public, private and faith-based health
institutions in some divisions of the North West Region of Cameroon. Based on public
health statistics for 2011, there were 1 590 nurses, 47 community health workers and
377 paramedics making a total of 2 014 staff working in the North West Region of
Cameroon (Cameroon Ministry of Public Health 2011). Assuming that this number
11
had witnessed an estimated growth of 10 per cent, we estimated the total population to
be 2 215 staff working in this Region by 2017. Considering a confidence level of
95 per cent, we estimated that a sample size of 333 would adequately represent the
population. This population was selected through the stratified random technique. The
questionnaire was administered to this number and 302 responses were received at a
rate of 90.69 per cent.
Survey Instruments
The questionnaire for the study was a combination of closed- and open-ended
questions adapted from the competency framework instruments by the Australasian
Sexual Health and HIV Nurses Association Incorporated (2011). Competencies are
probed in eight domains which are a combination of skills, knowledge, attitudes and
values that underpin effective nursing or midwifery performance in the individuals’
area and context of practice. The domains probed are: (i) effective communication (14
test items); (ii) assessment, care planning and clinical management (16 test items);
(iii) health promotion and patient education (8 test items); (iv) research (4 test items);
(v) legal and ethical nursing practice (4 test items); (vi) collaborative care and
partnerships (12 test items); (vii) leadership and development of the specialty (7 test
items); and (viii) computer or information technology skills (5 test items). A five-point
Likert scale was used to represent the skills level ranging from (i) no prior experience;
(ii) beginner skills; (iii) intermediate skills; (iv) competent skills; and (v) expert skills.
Additionally, details on computer or smartphone ownership and use (five test items);
and preferred training mode (four test items) were probed. The quantitative data
collected through the survey questionnaire were analysed using the SPSS Version 20.0
statistical package concentrating on frequency count, mean and standard deviation
(STD). Missing data were computed using the conditional mean imputation techniques
(Briggs et al. 2003; Graham 2009).
Validity was established through content and construct evidence (Fraenkel and Wallen
2006). Content-related validity in this study was based on ensuring the adequacy with
which the test items adequately and representatively sample the content area to be
measured. On the other hand, the researchers ensured that construct-related validity
was maintained by accurately measuring the theoretical, non-observable construct
(Fraenkel and Wallen 2006; Lodico, Spaulding, and Voegtle 2006). Regarding
reliability, the test instruments used for the study were adapted from similar studies.
Reliability was further obtained by piloting the instruments. The scores obtained from
the returned pilot questionnaires were assessed using Cronbach’s alpha. Cronbach’s
alpha is a standard and one of the most widely used reliability estimation indices
(Hogan, Benjamin, and Brezinski 2000). The closer alpha is to 1.0, the more internally
consistent the construct.
12
Fieldwork
The interviewers were carefully screened to be culturally sensitive, to be
knowledgeable about the environment and to have experience in surveys or work
related to human resources for health. They consisted of secondary school teachers,
primary healthcare practitioners and healthcare facility coordinators. Local authorities
were contacted for approval to conduct the survey. Visits were made to the relevant
health facility manager within the public, private and faith-based facilities. During the
visits, the purpose and procedures of the survey were explained to them. Some
accepted and some refused because the team did not have a prior written approval
from the Cameroon Ministry of Public Health although the sub-director for in-service
training and continuous development had been briefed about the study. For the survey,
each targeted facility was visited and the questionnaire was administered to a sample
of eligible participants. In the cases where some practitioners were not represented or
the desired numbers were not met, more representatives were sought in other facilities.
Results
A total of 302 participants (n = 302) took part in the study. Within this sample,
70.2 per cent were females. The majority of the participants (83.6%) fell within the 26
35 year age range. This indicates that the respondents were relatively mature and
could confidently express their views. Table 2 indicates the professional category,
qualifications and the level of experience of the participants. The data indicate that the
majority of participants have some working experience in their areas of specialisation
and could effectively assess their abilities in each of the domains surveyed.
Table 2: Professional category and qualifications of participants
Designation
Registered
nurse
Midwife
Nursing
aid
Community
health
worker
Lab
technician
n
104 (34.4%)
25 (8.3%)
67 (22.2%)
39 (12.9%)
67 (22.2%)
Qualifications
Certificate
Diploma
Higher
diploma
Degree
Other
n
75 (24.4%)
106 (35.1%)
46 (15.2%)
42 (13.9%)
33 (11.4%)
Work
experience
< one year
Years
6+ Years
Missing
data
n
48 (15.9%)
93 (30.8%)
148 (49%)
13 (4.3%)
13
Out of the seven divisions in the North West Region, only five took part in the study
as seen in Table 3. A total of 61.6 per cent of the participants were drawn from the
Mezam Division which is the largest in the Region in terms of surface area and
population density, hosts the Regional headquarters, has many health facilities, and is
very accessible in comparison to other divisions. A total of 51.3 per cent of the
participants were drawn from health facilities located in urban areas because of the
high population density. Similarly, 48.6 per cent of the participants were drawn from
public health facilities because the government is the largest health provider in the
Region and the country followed by the private sector and faith-based health facilities.
Table 3: Distribution of participants per division and type of health facility
Division
Mezam
Momo
Bui
Boyo
Ngohkentunja
n
186 (61.6%)
29 (9.6%)
40 (13.2%)
20 (6.6%)
27 (8.9%)
Location
Rural
Semi-urban
Urban
n
91 (33.1%)
56 (18.5%)
155 (51.3%)
Type of
health
facility
Clinic
Health post
Health centre
n
18 (6.0%)
180 (56.9%)
104 (34.4%)
Nature of
health
facility
Public
Private
Faith-based
n
147 (48.6%)
117 (38.7%)
38 (12.6%)
Table 4 summarises the mean skill level of the participants based on the eight domains
and Likert scale described in the methodology section. The STD measures how
concentrated the data are around the mean; the more concentrated, the smaller the
STD. Based on the results, it can be observed that the STD is not too concentrated
around the mean score which indicates that most of the participants have some
competencies in the different domains.
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Table 4: Mean skill level of participants based on domain
Domain
Mean
STD
Effective communication
2.86
1.53
Assessment, care planning and clinical management
2.58
1.52
Health promotion and patient education
2.76
1.90
Research
2.40
1.70
Legal and ethical nursing practice
2.91
1.62
Collaborative care and partnerships
2.76
1.45
Leadership and development of the specialty
2.51
1.34
Computer or information technology skills
2.26
1.75
The mean scores were further expanded to determine the skill levels in each of the
domains, as seen in Table 5, These scores were based on the Likert scale: no prior
experience (NE), beginner skills (BS), intermediate skills (IS), competent skills (CS),
and expert skills (ES).
Table 5: Level of skills in each domain
Domain
Frequency (%)
NE
BS
IS
CS
ES
Effective communication
4.13
9.55
25.65
41.60
19.07
Assessment, care planning and
clinical management
6.60
12.40
25.30
38.20
17.50
Health promotion and patient
education
6.30
12.70
24.50
38.40
18.10
Research
10.46
18.56
28.16
30.16
12.66
Legal and ethical nursing practice
5.94
9.64
21.94
40.44
22.04
Collaborative care and partnerships
6.34
9.04
24.84
38.24
21.54
Leadership and development of the
specialty
9.20
11.30
29.20
34.50
15.80
Computer or information
technology skills
16.83
24.19
21.13
17.76
20.09
Details of computer or smartphone ownership and use by the participants are
summarised in Table 6, and their preferred modes of training are highlighted in
Table 7.
15
Table 6: Computer or smartphone ownership and use
Do you own a computer?
Yes
91(30.1%)
No
211(69.8%)
Do you have access to a computer at your
work that could be used for learning or
training?
Yes
90 (29.8%)
No
212 (70.2%)
Do you have access to a smart phone that
could be used for learning or training?
Yes
217 (71.9%)
No
85 (28.1%)
How often do you use a computer?
Every day
40 (13.2%)
Several times per
week
65 (21.5%)
Less than once per
week
73 (24.2%)
Often
124 (41.1%)
Where do you access the Internet?
At home or residence
65 (21.5%)
At work
22 (7.3%)
Internet café
24 (7.9%)
Mobile phone
180 (59.6%)
Other
11 (3.6%)
Table 7: Participants’ preferred mode of training
Mode
Yes
No
I prefer online (e-Learning) training
93 (30.8%)
204 (68.3%)
I prefer classroom-based training
215 (71.2%)
86 (28.4%)
I prefer work-based training
250 (82.8%)
51 (16.9%)
I prefer training through my mobile phone
118 (39.1%)
183 (60.6%)
Figure 2 summarises the skills gaps among these nursing and paramedical
professionals in descending order.
Based on Figure 2, we have identified that 50 per cent or more of the participants need
improvement in (i) computer or information technology skills; (ii) research skills; and
(iii) leadership development of the specialty. As such, we recommend that these areas
be dealt with, as a matter of priority, through training and professional development to
enable these professionals to deliver better service in the sexual and reproductive
healthcare sector.
16
Figure 2: Summary of the skills gaps among nursing and paramedical professionals
From the findings in Table 6, we identify that approximately 70 per cent of the
respondents lack access to a computer at home or at work which can be used for their
CPD. The data further suggest that the use of a computer is very limited. In contrast,
71.9 per cent of the respondents have access to a smartphone which could be used for
learning purposes. Further, 81.1 per cent of the respondents have access to the Internet
at home or on their smartphone. Based on these results, we recommend that suitable
future training and CPS be carried out through mobile based learning.
The results in Table 7 indicate that the majority of the participants prefer classroom-
based or work-based training in comparison to online learning or mobile based
learning. From this, we identify that there is a need for advocacy, sensitisation and
capacity building among nursing and paramedical professionals in terms of self-
directed learning using online or mobile-based platforms. To rectify this gap, we
recommend capacity building for sexual and reproductive healthcare professionals on
technology enabled learning and self-directed learning.
Discussion
On the basis of Miller’s (1990) framework, nurses and paramedics must go through
four sequential training steps before performing duties on real-life patients. Miller
(1990) classified the four sequential steps as: know; know how; show how; and does.
These were reformulated in this study for the purpose of clarity in the questionnaires:
beginner skills; intermediate skills; competent skills and; expert skills. An additional
stage, no prior experience, was added to make it five sequential stages because it was
noticed that there are some personnel working as nurses and paramedics without prior
training. The expert skills level is the most desirable level of competency in any field
17
of work and most especially in the domain of health. In all eight domains surveyed in
this study, the skills level varied from no prior experience to expert skills with much
concentration around intermediate and competent skills levels. A good number of the
participants in all eight domains reported that they had no prior experience, which is a
call for concern. This could be one of the reasons why there is a high infant and
maternal mortality rate (Alongifor 2016; Asamoah et al. 2011). These researchers had
raised the issue of infant and maternal mortality rate remaining high for a long time,
which, according to them, might have been as a result of poor and unqualified staffing.
The variation in skills level in each of the domains aligns with the works of Miller
(1990). There is a need for CPS at each level of skills development because those at
the basic skills level can explain their theoretical knowledge with very limited
practical skills (Miller 1990). Those with intermediate skills simply have know-how
knowledge (Miller 1990). The nurses and paramedics at this level find it difficult to
perform a task in real-life situations (Mehay and Sackin 2010). These categories of
practitioners are required to attend more programmes for CPD to learn related skills
and how knowledge is employed (Stalburg 2002). Similarly, the practitioners at the
competent skills level should be upgraded to move out from cognition and thinking to
behaviour and practice (Statman 2013).
Conclusion and Recommendations
The state of sexual and reproductive health in Cameroon has been challenging with the
rising levels of sexually transmitted diseases, the high fertility rate and high maternal
mortality rates. This study has identified that the nurses and paramedics working in
this domain have varying skills levels in the eight domains of internationally
acceptable competencies. The assessment of the practitioners’ skills was conducted
using the Miller (1990) competency framework for nurses and paramedics. Test items
were adapted from the ASHHNA Competency Standards for Sexual and Reproductive
Health and HIV Nurses (2011). The analysis of the collected data revealed that the
practitioners are at different skills level with a good number of them having no prior
experience in the field of sexual and reproductive health. This category of personnel
could be very dangerous in the health sector and this might be one of the reasons why
there is still a high infant and maternal mortality rate. However, most of the
practitioners’ skills levels are between the intermediate and competent skills level with
very few of them being at the expert skills level. On the basis of these findings, it is
recommended that:
Firstly, it has been identified that most of the participants need improvement in
(i) computer or information technology skills; (ii) research skills; and
(iii) leadership development of the specialty. These areas need to be dealt with, as
a matter of priority, through training and professional development to enable
these professionals to deliver better services in the sexual and reproductive
healthcare sector.
18
Secondly, in line with the critical role that sexual and reproductive health
practitioners play in Cameroon’s health system, it is imperative that the Ministry
of Public Health and other role players in the health sector make sufficient
investments in the improvement of the health workforce’s accessibility to
information and communication technology. This need cannot be overemphasised
as evidence abounds about the critical role that information and communication
technology now plays in the improvement of learning and access to information.
Thirdly, a similar assessment with a proportionate sample size allocated to each
type of sexual and reproductive health practitioners should be extended to other
parts of the country to enable evidence-based formulation of in-service training
and CPD curricula across the country. The assessment could include a few
objectively structured clinical exam sections to assess and validate selected key
competencies against the participants’ self-reported level of confidence.
Fourthly, the survey results indicated that the majority of the participants prefer
classroom-based or work-based training in comparison to online learning or
mobile-based learning. From this, we identify that there is a need for advocacy,
sensitisation and capacity building among nursing and paramedical professionals
in terms of self-directed learning using online or mobile-based platforms.
The contribution of this study is that it acts as an input for research initiatives which
aim to improve the sexual and reproductive healthcare sector in Cameroon. As future
work based on this study, the Commonwealth of Learning aims to collaborate with the
Ministry of Public Health in Cameroon to develop skills among the sexual and
reproductive healthcare professionals so that they can be skilled, confident and
suitably equipped staff.
Acknowledgements
This project is funded as part of the Grant #2015-2585 generously made by
The William and Flora Hewlett Foundation, USA.
The Commonwealth of Learning (COL (www.col.org)), is an
intergovernmental organisation created by Commonwealth Heads of
Government to promote the development and sharing of open learning and
distance education knowledge, resources, and technologies. Hosted by the
Government of Canada and headquartered in Burnaby, British Columbia,
Canada, COL is the world’s only intergovernmental organisation solely
concerned with the promotion and development of distance education and
open learning. COL actively helps developing nations improve access to
quality education and training. This study was conducted as part of the Open
Educational Resources for Skills Development (OER for SD) project of COL.
19
We acknowledge the support of Mr Mbah Aloysius in supervising the data
collection and Mr Kenne Lambo Belmon for assisting with the data entry. We
also thank all the professionals who participated voluntarily in the study.
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