Monday, 28 March 2022

Nursing in Egypt: Where does it fall short and how can it be improved?

With both quality and quantity shortfalls, how are Egypt’s private sector healthcare providers addressing their nursing staff woes? A lack of adequate formalized training in patient management and soft skills combined with a shortfall in the number of graduates force healthcare providers to provide constant, on-the-job training to nurses to deliver on healthcare requirements. With telehealth, healthtech and healthcare management education receiving increased private investments and as the government rolls out the EGP 600 bn universal healthcare program to serve a population that is expected to balloon to 160 mn by 2030, the sector is increasingly feeling the shortage of qualified nurses, who represent the biggest occupation in healthcare provision.

Nurses make up a large proportion of healthcare staff and are responsible for delivering a major part of healthcare at hospitals, accounting for 23-25% of total hospital staff, Cleopatra Hospitals Group (CHG) Chief Human Resources Officer Marwa El Abassiry tells Enterprise. Douaa Moussa, Alameda’s chief HR officer, puts the percentage of nurses closer to 40-60%. “Nurses are the backbone of any healthcare organization. We can run a hospital without any other function, but nurses alone can run a hospital,” she tells us. By way of comparison, in the US, nurses make up an estimated 30% of hospital staff, representing the largest occupation in any hospital.

In fact, nurses are so important that the notion of robots replacing human nurses is seen as simply impossible. “Automation can make the administrative job of nurses easier, but it will never replace the nurse. The psychological, mental and physical side of nursing cannot be automated,” says Tabibi 24/7 CEO Dr. Ehab Attia. Similarly, Amany Nazif, head nurse at Alameda Group, tells us that “nursing is a science and an art,” and that a robot may be able to administer medicine but it cannot give a patient the care that a human nurse can give.

And yet, despite the critical role they play, qualified nursing staff in Egypt is lacking — a problem that begins with the state of nursing education. There are two ways to become a licensed nurse in Egypt: The first route is completing a five-year technical post-secondary school nursing diploma from an Education Ministry Institute, which combines classroom instruction with hands-on practice at hospitals. The second is a four-year bachelor of science nursing program. All nurses must apply for a license to practice and join the National Professional Nurses Association.

Most local universities offering nursing education rank between 1,001-1201 globally, with only Cairo University ranking 571-580. The next five Egyptian universities in the rankings — Al Azhar University, Alexandria University, Assiut University, the British University in Egypt, and Suez Canal University — ranked 1,001-1,200, with the remainder ranking 1,200+ or not receiving a ranking at all. QS World University rankings rely on six main criteria: Academic reputation, employer reputation, faculty-student ratio, citations per faculty, international faculty ratio, and international students ratio. As we noted previously, QS’ rankings are weighted more towards the reputation criteria than citations or research output, which suggests that the quality of alumni on the job heavily influences a university’s ranking.

Within these programs, there are gaps, the most significant of which are patient management and interpersonal skills, our sources tell us. Nazif tells us that one of the main areas that needs development among nurses is adopting a service attitude, with many nurses lacking interpersonal skills like how to greet patients and how to present themselves. Top nursing programs internationally, like the top-ranked globally University of Pennsylvania’s nursing program for example, stress community involvement and cultural awareness of nurses.

Put all these factors together, and the result is often seeking talent from abroad. Some major healthcare providers, including Alameda Group — which owns Dar El Fouad and As-Salam Hospitals — have increasingly begun targeting foreign nurses from the Far East.

In a bid to plug the talent gap, private hospitals and home care facilities rely on in-house training. Healthcare providers we spoke with told us that they often onboard nurses during the final training year at nursing school, taking them on as interns to complete their training on-the-job. In order to deliver on the quality of service, CHG, Alameda and Tabibi run internal training programs that focus primarily on communication, leadership, tech, and reporting. Alameda Academy is getting ready to launch specialized certificates in ICU nursing, dialysis and management and leadership, our sources told us.

The focus is primarily on soft skills: While technical know-how is strong in Egyptian nursing education, soft skills training, especially in the areas of patient management and stress management, are regularly given through on-the-job training programs, with most nurses receiving two classroom courses monthly in addition to their on-going on-the-job training, El Abassiry tells us. One source who asked to remain anonymous suggested that BSc holders typically have better theoretical knowledge, but sometimes lack sufficient practical experience. However, the employers we spoke with did not show a preference for either, relying heavily on on-the-job training and internships. Our sources declined to disclose the general costs of continuous training for nursing staff.

But there are external markets that continue to be a drain on Egypt’s qualified nursing staff: A global shortage of nurses means that many Egyptian nurses opt to travel to the GCC, Europe, Canada and the US in pursuit of better salaries and working conditions, with the GCC representing the biggest market for them. Our sources tell us that nurses at private hospitals especially are targeted for recruitment. And even here at home, private hospitals are also in constant competition with home nursing, which is becoming increasingly popular, especially as companies like 7keema and Tabibi 24/7 have institutionalized home nursing. Home care makes up 70% of Tabibi’s services, with 30-40% of their revenues coming from home nursing alone, Attia says. This demand is only expected to grow, he tells us, as the percentage of the population over 60 increases to reach an estimated 14% of the population by 2050.

Your top education stories for the week:

  • Four Egyptian research institutes made the top 10 of Scimago’s inaugural MENA research centers ranking: The National Research Center (#1), the Agricultural Research Center (#4), the Egyptian Atomic Energy Authority (#5) and the Egyptian Petroleum Research Institute (#7).
  • Encouraging technical grads to become entrepreneurs: The Education Ministry and the Micro, Small and Medium Enterprise Development Agency (MSMEDA) have signed an agreement to provide training and guidance for graduates of technical schools to launch their own projects.
  • SODIC x Educate Me: SODIC is backing access to quality education through Educate Me, which operates a community school in Talbeya, Giza, and runs training and development programs for both public school teachers and students across a number of governorates.

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