COVID-19: The Role of Nurses and Midwives in the UK and Africa

THE FIGHT AGAINST COVID-19
THE ROLES OF NURSES AND MIDWIVES IN THE UK
AND AFRICA
SUMMARY REPORT
WEDNESDAY, 03 JUNE 2020

Introduction ................……………………………………………….…………………………………………………….………………………………....3
Keynote: 2020 - A Year of the Nurse ……….....………………….…………………………………………………….…………………………….......5
Role of Nursing Now ……….…………………………………………………..…………………………………………………….………………...….....7
Case Study: Nursing Now Uganda ….……….…………………………………………….…………………………………………………………......7
Topic 2: Nurses and midwives at the forefront of the covid-19 response - experiences & challenges ……….…………….……………...9
Topic 3 Supporting and empowering the Nurse ………....……………………………………………….…………………..…….……....………..11
Case Study: Nursing Now Nightingale Challenge Program ………….…………………………………………….……………………………....13
Closing Remarks: H.E. Julius Peter Moto, Uganda High Commissioner to UK ……….………………………………………………………..…14
About SSCG Consulting ………………...………………………………………………....…….……………………………………………………......15
About Uganda UK Health Alliance (UUKHA) …..……………………………………....…….……………………………………………………......16
Contact us …………………………………………………………………………………....…….……………………………………………………......17
2
TABLE OF CONTENTS

On 3rd June 2020, SSCG
Healthcare in collaboration with
One Africa Network (OAN),
Uganda UK Health Alliance
(UUKHA) and Nursing Now held a
webcast themed “The Fight
Against COVID-19: The Role of
Nurses and Midwives in the UK and
Africa”.
CHAIR:
Lord Nigel Crisp KCB
Co-Chair - Nursing Now
CO-CHAIR:
Beatrice Amuge
Chief Nurse - Ministry Of
Health, Uganda
Prof Dame
Donna Kinnair CEO &
General Secretary of the
Royal College of Nursing
Tracey Collins
Head of Global Nursing
Health Education England
Ged Byrne MBE
Director of Global
Engagement
Health Education England
Dr Catherine Hannaway
Programme Director
Nightingale Challenge
Northern Ireland
Prof Mark Radford
Chief Nurse NHS Health
Education England &
Deputy Chief Nursing
Officer of England
Heather Caudle
Chief Nurse
Surrey and Borders NHS
Foundation Trust
Dorcas Gwata
Global Mental Health
Nurse Expert and African
Diaspora Affairs Analyst
Ms. Annet kanyunyuzi
Senior Nursing Officer Jinja
Regional Referral & President
Uganda National Midwives
Association
Ms. Elizabeth Ekong
Lecturer Uganda Christian
University & Chairperson
Uganda Nurses and
Midwives Council (UNMC)
Catherine Odeke
Coordinator
Nursing Now Uganda
3
This follows the declaration from the
WHO to celebrate the 200th
anniversary of the birth of Florence
Nightingale, a nurse, innovator,
reformer and leader of improved
healthcare, by marking 2020 as the
year of the Nurse and Midwife.
The critical role that nurses and
midwives are playing in keeping the
masses healthy through patient and
social care as well as community
work and education has resulted in
a call for global leaders to commit
to investing more resources in nurses
and midwives.
The WHO reports that the world will
need up to 9 million nurses and
midwives by 2030 to achieve
universal health coverage. This
includes the ability to deal with
pandemics such as COVID-19 while
still maintaining the same level of
care for patients experiencing other
illnesses.
The purpose of the webcast is to
explore and highlight how nurses and
midwives within Black, Asian and
Ethnic Minorities (BAME) communities
are responding to the pandemic and
the extent to which sufficient
resources and support have been
provided to aid them in the fight
against COVID-19.
INTRODUCTION

The environment within which nurses
and midwives work can be
challenging and potentially harmful to
their physical, mental and emotional
state. Empowering nurses and
midwives both at work and in their
personal lives is potentially one of the
quickest ways to increase advocacy
for healthy living globally both in this
COVID-19 environment and in general.
There are simple and effective
measures that can be taken now to
empower nurses to successfully carry
out their duties. These include:
• Providing appropriate and sufficient
Personal Protective Equipment (PPE)
to minimise risk of exposure which in
turn provides them with assurance of
their safety.
• Strengthening the nursing system by
championing advocacy for mental
and counselling services within the
profession to provide support for
their mental and emotional needs.
Nurses & midwives
are the backbone of health
systems, key to achieving
universal health coverage
4
INTRODUCTION

Update on the UK’s National
Nursing Workforce: Planning
for the response to COVID-19
“Nursing will continue to be integral
to COVID-19 planning and
response”
Prof. Mark Radford
Chief Nurse
Health Education
England
5
Nursing has been fundamental in
linking both the health care and
social care systems. There are
currently 650,000 nurses registered
across all UK domains (England,
Scotland, Wales and Northern
Ireland) with 380,000 registered
nurses (RNs) working in NHS
England. These NHS England
nurses are supported by
approximately 250,000 support
workers allied to nursing and there
are about 50,000 nurses working in
social care provision; i.e. working
in care homes for the elderly.
This ability to link both healthcare
and social care systems has been
central to the planning and
response process as nurses have
played key roles in areas like
primary care, research, and public
health and leadership.
The relationships and leaderships
across systems/organizations in the
UK (and the world) were
leveraged to ensure that
everyone works together in
dealing with the COVID-19
response.
England's healthcare system,
comprising both health care systems
and social care systems, allows for
nurses to work across both the
National Health Service (NHS) and
independent healthcare providers.
Nursing colleagues from China
and Italy have been especially
generous in sharing their COVID-19
experiences and shared critical
data that has been helpful in
developing England's response.
KEYNOTE: 2020 - A YEAR OF THE NURSE

The initial response developed was
centered on two areas to improve
preparedness: Supporting and
Strengthening the workforce in
relation to the hospitals' response
to COVID-19 by ensuring there
were high-level emergency and
high-dependency critical care
capabilities.
Nationally, many nurses who
worked in traditionally
non-emergency and non-critical,
high-dependency areas were
rapidly trained to make sure there
was enough personnel to handle
the impending wave of the
pandemic. There has since been
public health nursing and
increased testing and support as
social care colleagues have
provided aid in care homes.
Even though things have changed
from the early phase, there is still
work to be done as the UK comes
out of lockdown. Nursing will
continue to be integral to
COVID-19 planning and response.
6
In the UK, hundreds of thousands
have been infected and nearly
40,000 have died of the pandemic
with nurses making up a significant
number of the deceased. Many
colleagues from Black, Asian and
other ethnic minority backgrounds
have been disproportionately
affected compared to other
demographics.
More robust assessments need to
be put in place to better support
these colleagues as they continue
to be instrumental in England's
(and the UK as a whole) response
to COVID-19.
In the coming years,
medical/health care personnel will
still be dealing with the pandemic
response.
Nursing will still be critical notably
around testing strategies, shielding
complex patients and the public
health agenda in dealing with
existing issues pre COVID-19 such
as a rise in domestic violence,
catering to children's needs,
support for physical and mental
health all while collaborating with
global partners.
KEYNOTE: 2020 - A YEAR OF THE NURSE

Understandably with the
pandemic, demand for nurses
has exponentially increased
and what has followed is a
notable interest in more people
looking to pursue nursing as a
career.
THE ROLE OF NURSING NOW
7
As the coronavirus pandemic
persists globally, nurses and
midwives continue to be at the
forefront of the coronavirus
response by providing selfless
care and quality treatment for
the sick, championing community
dialogue and creating awareness
of the virus along with conducting
research and collecting clinical
data on the virus' impact.
Nursing Now is not just focusing on
fast-tracking frontline staff
through targeted training
programs, but also on leadership
and professional development
opportunities for early career
nurses as a measure of sustaining
the profession.
Nursing Now is one of more than
1000 organisations actively
participating in the “Nightingale
Challenge” that was launched in
mid 2019 to develop the next
generation of young nurses and
midwives as leaders, practitioners
and advocates in health and aims
to demonstrate that nursing and
midwifery can be an exciting and
rewarding career. The global goal
is to have at least 20,000 nurses
and midwives aged 35 and/or
younger benefiting from this
challenge.
Nursing Now was launched in
Uganda on 22nd March 2018.
Prior to the pandemic, Nursing
Now was advocating to have
the Commissioner Health
Services - Nursing & Midwifery
position filled as it was a key
post in driving nursing and
midwifery services in Uganda.
Approach
The nurse & midwife leaders
leveraged their position as a
group backed by Nursing Now
to gain an audience with the
Ministry of Health's Permanent
Secretary (PS) and plead the
case for the funds to be
managed by the Think-Tank and
spent on solving two key issues:
• Inadequate Personal
Protective Equipment (PPEs)
• Logistics for frontline health
workers nursing COVID-19
patients such as
transportation, food &
accommodation.
They also raised the issue of a
lack of nurses in the National
Task Force committees with the
PS.
Problem
When the pandemic hit Uganda,
nursing & midwifery leaders came
together to form the Nurse and
Midwife Leaders Think-Tank Group.
The Think-Tank raised funds to
support their nursing and midwifery
community. These funds would
have had to be transferred to the
Office of the Prime Minister through
which a committee would have
been convened to apportion the
funds. Other nursing and midwifery
leadership positions also needed to
be filled.
CASE STUDY: NURSING NOW IN UGANDA

Result
The Think-Tank was allowed to
manage the funds which were
used to purchase PPEs that were
distributed to the National Referral
Hospital Mulago and Entebbe
Regional Referral Hospitals where
the majority of covid patients were
admitted.
The Commissioner Health Services
-Nursing and Midwifery position
was filled along with 2 assistant
commissioner positions. One of
these assistant positions was
allocated to the nurses while the
other was to be filled by an
appointee from either one of the
referral hospitals.
Key takeaways
The pandemic has caused a
growing interest in nursing as a
career. This needs to be leveraged
to maximise the growth of the
nursing workforce and strengthen
global healthcare capabilities.
Nurses and Midwives need to be
involved in the planning and
response to pandemics like
covid-19 to ensure sufficient
first-hand experience in patient
care is considered and measures
to protect the frontline personnel
are implemented.
8
Next steps
The main challenge that Nursing
Now Uganda is facing is the lack
of funds for commissioning and
operating nursing activities.
The next steps for the organization
are:
• To conclude on the formation of
the national Nurses and
Midwives Association
• Profile and highlight nurses
making an impact
• Mobilize support for training of
nurses as well as for the
professional development and
peer leadership and mentorship
of nurses.
CASE STUDY: NURSING NOW IN UGANDA

“The main challenges faced by
nurses & midwives during the
covid-19 pandemic can be
categorized as Occupational,
Psychological and Physical”
Ms. Annette Evelyn Kanyunyuzi
President, Uganda Midwives
Association.
NURSES AND MIDWIVES AT THE FOREFRONT OF THE COVID-19 RESPONSE - EXPERIENCES & CHALLENGES
9
Occupational challenges
Low supply of personal protective
equipment (PPE)
According to Ms. Heather Caudle,
Chief Nursing Officer at the Surrey
and Borders Partnership NHS
Foundation Trust, a lack of
sufficient PPE was a big challenge
across the UK. Their Trust managed
to resolve this by tapping into local
suppliers and collaborating with
other private and public sector
organisations to provide PPE for
their staff.
Overstretching of medical facilities
Ms Heather Caudle also shared
how from mid April, there was a
gradual increase in service
request. People's psychosis and
delusions were increasingly
incorporating issues of the
pandemic which were in turn
compounding their existing
diagnoses. The solution was to
increase the safe haven hours for
the public to drop-in to seek help.
Psychological challenges
Mental health
Ms Dorcas Gwata, Nurse Advisor,
Tropical Health and Education
Trust (THET) expressed that the
mental health impact of Covid-19
on healthcare workers would
directly impact their places of
work. Ms Heather Caudle
supported this by pointing out that
the Trust had to introduce a
psychological PPE, an internal
tool, developed to support staff
overcome psychological
challenges. Weekly online
meetings were also started with
nurses to do wellness checks.
Ms. Annette Evelyn Kanyunyuzi,
President, Uganda Midwives
Association added that
psychological distress can be
triggered intrinsically or externally
especially since the pandemic
conditions are unpredictable. The
distress associated with
lock-downs tend to be abrupt and
this pressure can affect them
mentally.
To help support nurses and
midwives, there is a need for the
right work environments to be
created where their voices can be
heard and acknowledged, and
issues resolved. The ability to care
for one’s self should also be
encouraged to ensure one
remains healthy.

Physical challenges
The Disproportionate Impact of
COVID-19 on the Black, Asian and
Minority Ethnic (BAME) Groups
According to Ms Dorcas Gwata,
the story of epidemics is the story
of inequalities. People from
low-income countries have tough
choices to make especially in
trying to balance between
poverty and pandemic.
The impact of COVID-19 in terms
of mortality and morbidity on the
BAME group has exacerbated the
inequality issues faced by nurses
and midwives from the BAME
communities.
For example, Zimbabwean nurses
and caregivers have the same
fears as their global counterparts
from the BAME communities; do
they have transportation to/from
work, do they have enough
money to feed their families?
10
Key takeaways
COVID-19 has impacted nurses
and midwives in different ways.
The main challenges that have
been identified in the UK and
Uganda are low supply of PPE,
mental health and exacerbating
inequality already evident in the
BAME communities.
The issue of PPE is one that is easily
resolved. The deeper conversation
is on how policies can be created
or adjusted to address the
psychological stress and inequality
faced by nurses and midwives
from the BAME communities.
The nurse/midwife is also a mother,
a father, a brother, a daughter in
addition to being a healthcare
provider.
The bold new normal needs to
move away from bedside nursing
and address nursing inequalities at
policy level. The BAME
communities need to be part of
the conversation to create
inclusive strategies and policies
that will consider the impact
COVID-19 is having on their
physical health as well as its role in
compounding inequality within
the group.
NURSES AND MIDWIVES AT THE FOREFRONT OF THE COVID-19 RESPONSE - EXPERIENCES & CHALLENGES

The Effect of COVID-19 on the
Nursing Now Nightingale
Challenge Program
Dr. Catherine Hannaway, Program
Director Nightingale Challenge
CASE STUDY: NURSING NOW NIGHTINGALE CHALLENGE PROGRAM
11
To support these young leaders in
their journey, counterparts from
other countries are invited to
participate and speak to the
program participants.
Problem
The global travel restrictions
resulted in various trips being
cancelled e.g. a trip to the
ECSACON conference and
another to Uganda for the Nursing
and Midwifery Conference. In
addition, a young nurse from
Uganda, Winnie, was unable to
participate in a trip to London for
the Commonwealth Nurses and
Midwives Conference.
Approach
The first virtual workshop/event
directly linked the participants with
counterparts from Aga Khan
University in Kampala.
Two Facebook groups were set
up, one for any young nurse or
midwife 35 years and younger
from anywhere in the world to
apply for the Nightingale
Challenge, while the other was
just for people in Northern
Ireland.
A global buddy-mentoring system
was also setup to allow the Irish
participants to have a global
buddy. The goal is to learn from
past programs and build on that
to produce future programs.
Result
The mentoring and networking
were great though more work
needs to be put into the virtual
approach to produce more
results.
Next steps
To support the program
participants, more one-on-one
sessions are required. Global
learning visits will resume as soon
as the pandemic allows but in the
meantime the program has been
extended to June 2021.
The Nightingale Challenge in
Northern Ireland is running a 1 year
global leadership program for the
country for 30 of its young nurses &
midwives. The program consists of
5 learning events where the young
nurses & midwives come together
to learn.
The workshops are about
leadership skills, advocacy, policy
making, quality improvement,
global health issues as well as
population health. The focus is
glocal, i.e. global at the local
level.
Key takeaways
Support for nurses and midwives is
available despite the difficult
circumstances brought about by
COVID-19.
Learnings need to be shared,
included in policies and applied
across the entire nursing and
midwifery community.

How the NHS is supporting its
international nursing and
midwifery workforce
Ms. Tracey Collins,
Head of Global Nursing, Health
Education England
SUPPORTING AND EMPOWERING THE NURSE
12
To facilitate this, a temporary
register was created to allow this
international workforce to be able
to work as Registered Nurses (RNs).
Of the 3,000 nurses, 2,400 are now
on the temporary register and are
able to work in support of the
frontline healthcare workers.
Providing online resources
Free online resources have been
developed and are available for for
all international staff with a
specific component created for
those looking to work in the NHS.
With a large number of BAME
workers being susceptible to
COVID-19, and some losing their
lives to the virus, support call lines
have been set up through which
these workers can seek support
whenever they need it.
Well-being mobile apps have been
introduced and are freely available
to help in maintaining psychological
well-being through community
support from local
Pre COVID19, international nurses
were required to undergo a
supervisory period within which they
would get acclimated to the UK
system.
Creating a staffing registry
Due to the pandemic, the
international workforce has had to
be utilized sooner than normal
because of the large number of
healthcare/medical personnel
needed for deployment to make
sure that there was enough staff to
handle the effects of the
pandemic.
workers to help colleagues
who have recently moved to the UK
address fears and other challenges
they may be facing.
With reference to a pilot project
that was being run prior to the
pandemic, the power of social
media can be used to provide peer
support and bring groups of nurses
together where they can
share experiences. Professional
experiences, reflective practices,
fears in the COVID-19 and provision
supportive networks are all things
that can be shared and aid in
better understanding and
management of their physical and
mental well-being.

CLOSING REMARKS
13
“The COVID-19 pandemic seems
to have caught everyone
unaware. For this reason, better
contingencies need to be in place
to make sure that our health
sector workers are better taken
care of should this happen again.
No nurses means no health, and
no health means no wealth”
H.E. Julius Peter Moto
Uganda High Commissioner
to United Kingdom
an indication of the government of
Uganda's commitment to support
nurses. Uganda was also the first
African country to embrace the
Nursing Now campaign.
Despite existing challenges, nursing
as a profession has grown
countrywide. Uganda continues to
train personnel as well as
rehabilitate and equip hospitals and
health centers in the endeavor to
serve the nation.
COVID-19 having affected
Uganda's physical need, the
country's short to mid term tax
revenue targets will not be realized.
However, using locally generated
funds and bilateral/multilateral
loans will ensure that the
government continues to provide
better working resources to its
citizenry, especially for the nurses,
midwives and other healthcare
workers who continue to manage
the pandemic.
There is a continued need to
further strengthen capacity
building for nurses, not just in
Uganda but across the African
continent. It is also imperative
that we keep building our
respective economies. As Nursing
Now takes the mantle of
advocating for nurses, a mutual
collaboration between countries
should be done to encourage
the sharing of experiences
between nurses globally.
Africa still experiences deadly
diseases like Malaria, TB and Ebola.
The addition of COVID-19 to this list
has overwhelmed even the best
prepared countries in the world.
Uganda is one of the countries that
has faced this sudden
overstretching of its capacity in its
healthcare workforce despite the
strides the country has made.
There are now 73,000 publicly
employed nurses in comparison to
3,000 in 1986. This is a 2333%
increase in the number of nurses,

14
ABOUT SSCG CONSULTING
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work with entrepreneurs, leaders
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We offer a wide variety of
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More about SSCG Healthcare
services at
www.sscg-group.com/healthcare.
SSCG Consulting is global strategy
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We provide advisory, consulting
and operation support to clients
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economy. Our mission and
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Faced with rapidly changing
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value, stay profitable and
competitive.

15
ABOUT UGANDA UK HEALTH ALLIANCE (UUKHA)
The Uganda-UK Health Alliance is
an umbrella Organisation for UK
Institutions and organisations
undertaking healthcare capacity
building activity in Uganda. Without
controlling or inhibiting individual
organisational members, the
Alliance has provided a
system-platform to allow each
member to maximise their impact
by linking them to other agencies
working in the same geographical
region or sharing similar activities.
UUKHA has also created
mechanisms to support and better
coordinate its member organisation
and ensure that their activities map
to the priorities of the prevailing
Ugandan government and Ministry
of Health.
More at www.uukha.org.

16
Eugene Nizeyimana
CEO, SSCG Consulting
Eugene.Nizeyimana@sscg-group.com
+(44) 07873150562
Moses Mulimira
Coordinator, Uganda UK Health Alliance (UUKHA)
moses.mulimira@hotmail.co.uk
+(44) 7828060143
Contact us for further details and discussion on how you can participate or become a sponsor.
CONTACT US

17
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COVID-19: The Role of Nurses and Midwives in the UK and Africa

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