Poor compliance with private nursing and midwifery practice guidelines in urban settings in Uganda

Résumé

Background: Optimal compliance with private practice guidelines is one of the core components of quality improvement in nursing and midwifery professions. Private nursing and midwifery practice guidelines in Uganda were introduced in 2019. However, little has been documented about compliance with these guidelines, despite playing a crucial role in ensuring safe nursing and midwifery practice and maintenance of professional standards. We assessed the compliance with private nursing and midwifery practice guidelines of Uganda (2019) and explored barriers to optimal compliance with these guidelines in private health facilities licensed by the Uganda Nursing and Midwifery Council (UNMC) in Kampala Metropolitan Area (KMA). Methods: We utilized a parallel convergent mixed-method design to enroll 52 health facilities in the quantitative study, and 11 nurses and midwives in private practice were selected purposively in the qualitative study between March and June, 2023. Quantitative data were collected using an audit checklist to assess the 21 elements of the private nursing and midwifery practice guidelines of 2019. The primary outcome was compliance with private practice guidelines, and a health facility was regarded as compliant if it had 90% of the 21 elements assessed. An interview guide was used to collect qualitative data from nurses and midwives in private practice. Descriptive statistics were used to summarize the quantitative findings, and inductive thematic analysis was used to analyze the qualitative data. Results: The private health facilities studied had been operational for a median period of 11 (interquartile range (IQR): 4, 22) years. Most of the facilities were maternity centers (82.7%), and about half of the facility managers had the highest academic qualification of a diploma (55.8%). Only 9.6% of the health facilities complied with the private nursing and midwifery practice guidelines. Barriers to compliance with the guidelines included a lack of awareness about guidelines, limited resources, and inadequate engagement with the regulators. Enablers of optimal compliance with the guidelines included simplifying administrative procedures and adequate dissemination of guidelines. Conclusion: There are critical gaps in compliance with private nursing and midwifery practice guidelines in urban settings in Uganda, with low overall compliance driven by lack of awareness, resource constraints, and weak regulatory engagement.

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