The World Health Organization estimates that the world needs 4 million additional healthcare workers and those we have are poorly distributed. Africa has 25% of the global disease burden, but only 3% of healthcare resources and 1% of health workers. In contrast, North America has 3% of the disease burden, but 25% of healthcare resources and 30% of health workers.

Of the approximately 60 million health workers, roughly 9 million are doctors and 14 million are nurses and midwives. The ratio of nurses to doctors varies widely: about four to one in many developed countries. In Africa, however, nurses greatly outnumber doctors.

Africa has 2.3 healthcare workers per 1000 population, compared with the Americas, which have 24.8 healthcare workers per 1000 population. Only 1.3% of the world’s health workers care for people who experience 25% of the global disease burden. The Americans saw importance of advanced registered nurse practitioners but in Africa we are yet to see their importance despite having the highest disease burden.

The poor health of so many people in sub-Saharan Africa has been widely known for years. Over the past decade, however, Africa’s health care crisis has received renewed attention because of factors such as the spread of HIV/AIDS and a greater understanding of the link between health and economic development. These attentions have produced important results. In a growing number of African nations, the catastrophic rate of new adult HIV infections appears to be falling: according to the UNAIDS (the Joint United Nations Programme on HIV/AIDS), the number of new infections in sub-Saharan Africa declined by approximately 25 percent in 2008. Similarly, tuberculosis rates are slowly decreasing across the region. Malaria incidence and mortality are declining in Africa courtesy of African nurses who are the primary healthcare providers.Nevertheless; the primary healthcare providers of the continent (whose number is declining) are already facing daunting challenges to the delivery of minimum standards of health care and are now also being potentially overwhelmed.

Despite the disease burden in Africa, Many highly qualified African nurses tend to move from clinical practice  to management and education or migrate to developed countries because they see little opportunity for advancement while remaining in clinical practice, lack of established posts and career opportunities; poor remuneration and conditions of service, including retirement provision; governance and health service management shortcomings; This trend put more pressure to already inadequate health systems in Africa. The sub-Saharan Africa has been badly damaged by the migration of their nurses. There are 57 countries with a critical shortage of nurses and the remaining highly qualified ones are not maximally utilized due to lack of favorable laws that recognizes nurses’ education and expertise.


The advancement of non-communicable diseases in Africa need people who can implement health promotion and intervention strategies and build a strong collaboration in health delivery systems that is led by all health professional, advanced registered nurse practitioners included. There are strong reasons for this. One is the presence of nurses in underserved regions. Most people in low –and middle–income countries live in rural areas; the WHO reports that more than three quarters of doctors are concentrated in cities. In Kenya for example, the health system is classified into levels i.e. community unit, dispensary, healthcentres, sub county hospitals, county hospitals and national hospitals. The dispensaries and health centers are mostly in villages away from towns and nurses are mostly posted in those primary healthcare facilities to provide all the services raging from family planning, immunization, medical diagnosis, minor surgical interventions and prescription to management of the facilities. The nurse is required only to refer if the condition of the patient is too complicated for him/her to handle or when the patient need major surgical intervention. The Kenyan nurses are well trained to handle all this but the law regulating them plus other laws regulating African nurses are very shallow and most of them do not have clauses on scope of practice for nurses according to their level of education and expertise. These System wide legal barriers sometimes impede health care delivery in our region and add more confusion in nursing practice.

Fellow learned colleagues, we must ask ourselves as profession and stakeholders, if the African nurses can do all these without clear legislation how about if we advocate for policies that recognizes Advanced Registered Nurse Practitioners (ARNP)


Samuel wainaina submitting   Kenyan nurses memorandum in Kenya parliament.


in Africa, a highly qualified cadre of nursing with more education and expertise. A comprehensive approach that strengthens key elements of nursing regulating law is required if we want to remove the African nurses from legal dilemmas. We must agree to go back to drawing board and restrategize on how we can make ARNP dream come true in Africa nursing profession. It’s high time the International Council of Nurses/advanced practice nursing network push for establishment of clear protocol on Advanced Registered Nurse Practitioner practice in Africa to save more lives and improve job satisfaction among the highly qualified nurses’. I have written to various African nurses’ leaders requesting them to start a campaign that aim at changing the laws regulating nurses in their respective countries and adopt the most progressive nurses regulation laws in the world. I have also formulated draft laws which need to be harmonized with various law governing nurses in Africa with an aim of empowering African nurses.


Many developed countries have succeeded in exporting democracy to undemocratic countries through NGOs without their government being in forefront. In the field of international relations, scholars now speak of these NGOs as “non-state actors”, The  said NGOs’ have emerging influence in the international policy arena where previously only states played a significant role. International council of nurses being an international NGO that represent nurses globally through their associations can also use the same policy to export ARNP policies to African countries through subsidiary NGO. African Nurses are the main professional component of the ‘front line’ staff in most health systems in Africa and their contribution is recognized as essential to delivering safe and effective care. The African states only need to be shown there are other organizations who believe in nurses’ expertise and education apart from their associations.

We propose ICN/advanced practice nursing network to come up with a subsidiary organization that shall provide humanitarian assistance to communities through nurses who provide more than 90% of reproductive health services. The organization with the help of local nurses associations may be mandated to come up with research papers outlining the achievements of nurses in health delivery and then use those research papers to advocate for ARNP policies in their respective countries.


Though NGOs have few formal powers over international decision-making, they have many accomplishments to their credit. In recent years, they have successfully promoted new environmental agreements, greatly strengthened women’s rights, and won important arms control and disarmament measures. NGOs have also improved the rights and well-being of children, the disabled, the poor and indigenous peoples. Some analysts believe that these successes resulted from increasing globalization and the pressure of ordinary citizens to control and regulate the world beyond the nation state.

NGO work led to:

  1. The adoption of the Montreal Protocol on Substances Depleting the Ozone Layer in 1987.
  2. The International Campaign to Ban Land Mines, an NGO coalition, was prime mover in the Mine Ban Treaty of 1997.
  3. The Coalition for an International Criminal Court was indispensable to the adoption of the 1998 Treaty of Rome.
  4. Another NGO mobilization forced governments to abandon secret negotiations for the Multilateral Agreement on Investments in 1998.
  5. In the late 1990s, the NGO Working Group on the Security Council emerged as an important interlocutor of the UN’s most powerful body, while the Jubilee 2000 Campaign changed thinking and policy on poor countries’ debt.

At the same time, an increasingly influential international NGO campaign demanded more just economic policies from the World Trade Organization, the International Monetary Fund and the World Bank. These recent NGO victories have often been due to effective use of the internet, enabling rapid mobilization of global constituencies.

Fellow learned colleagues, African nurses    need support from international council of nurses and advanced practice nursing network for ARNP dream to come true. It’s our humble plea that all nurses’ organizations’ hold hands together and makes nursing profession the best in Africa.






Lead Nurse Africa is a Pan-African nursing organization dedicated to public health promotion and professional development.


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