Development of a public health nutrition workforce: Nurses and midwives in Ghana

Background:  Nutrition competency of nurses/midwives is central to delivering effective public health. To strengthen the nutritional competencies of Ghana’s Registered Midwives, Registered General Nurses, Registered Community Nurses, and Enrolled Community Health Nurses we reviewed pre-service curricula and assessed competencies of nutrition tutors. 

Methods: Training Needs Analysis (TNA) was conducted with 11 tutors in 9 nursing/midwifery training centres for 3 main geographic zones. Tutor competencies were assessed through Objective Structured Clinical Examinations. Training centre curricula were mapped against the nutrition content stated in the 2007 Nurses and Midwives Council of Ghana curricula.

Findings: Tutors’ average knowledge scored highest for preventing micronutrient deficiencies (71%) and basic nutrition (45%), but low for out/inpatient management of severe acute malnutrition (0%/7%), maternal nutrition (11%) and breastfeeding/lactation (22%). Average scores were 64% for knowledge of and 20% for skill in assessing nutrition status, 52% for knowledge of and 3% for complementary feeding counselling skills. Tutors had no updates on current nutrition policies/strategies. In curricula mapping, basic nutrition courses did not link with applied nutrition courses. The essentials for practice: weighing scales, arm-circumference tapes, BMI wheels, counselling tools, nutrition guidelines, and treatment protocols were not universally available in training centres.

Interpretation: TNA findings were used to design resource packs to support tutors to teach nutrition to modern standards, aligned with Ghana’s National Nutrition Policy priorities; including lesson plans, practical activities and reference materials.  Curricula mapping informed the 2014/15 Ghana Nursing and Midwifery Council pre-service curricula core nutrition competencies for assessed programs. Tutors also underwent updated nutrition trainings.