Quality Assurance in Nursing and Midwifery Education in Pakistan; Issue and Challenges

Abstract

Quality is a subjective term that means excellence and reliability of performance. Quality assurance (QA) is concerned with reviewing the performance of services after the utilization of the services. QA is the systematic process of determining whether the services meet specified requirements. The concept of QA is rooted in middle ages, and its practices became more indispensable and popular in the USA during World War II.¹ It is disclosed by current research that QA develops and maintains a set of requirements for manufacturing steadfast products or services. Indeed, the QA system considerably enhances customer confidence and credibility as well as the productivity of the organization which improves work process and efficacy.^2,3 In higher education, the term quality assurance is increasingly used to refer to academic standards; that is, the level of academic excellence achieved by graduates not only maintained but improved consistently. Ensuring quality in higher education is critical for production of competent graduates.⁴ Nursing is considered the backbone of any health system; therefore, maintaining an optimum number of competent nurses is one of the key priorities of any health system. Pakistan is facing a critical shortage of nurses for its rapidly growing population, and the country is estimated to have a shortfall of up to 1.3 million nurses as per the nurse population ratio.⁵ To cope with this huge shortage, Pakistan has recently allowed the opening of more nursing colleges; however, this has posed certain challenges to the system, including assuring and maintaining quality in these new schools. World Health Organization, Eastern Mediterranean region, has identified six standards for nursing and midwifery education; these include; a governance structure that encourages autonomy, an administrative structure with the responsibility to carry out the policies of the institution, a conducive teaching and learning environment, graduates of the programs must be prepared for professional practice according to standards, a sufficient number of faculty and sufficient infrastructure and teaching learning strategies.⁶ There is a need to ensure quality in nursing and midwifery education in Pakistan to ensure graduates possess the required competencies and can work competently at local, national, regional, and international level.⁷ The challenges to ensure these standards are strengthening regulatory bodies, ensuring an optimum number of faculty and infrastructure, induction of quality students, and provision of optimum clinical training facilities for students.⁸

QA is recognized as increasingly essential for nursing education to ensure high-quality nursing delivery to sick patients. It is established that there is little evidence to endorse the existence and implementation of a comprehensive and vigorous QA system in Pakistan. Pakistan Nursing Council (PNC), as a regulatory body of Nursing in Pakistan, is mandated to establish minimum criteria for establishing nursing, midwifery, or a public health school institute.⁹ PNC is the country’s key regulator of nursing and midwifery education. Along with this, with the establishment of BSN programs across the country, the health sciences universities are also one of the key stakeholders of nursing and midwifery education regulation. Likewise, the Higher Education Commission of Pakistan sets the curriculum for undergraduate nursing programs in liaison with the Pakistan Nursing Council. To ensure minimum quality, there is a need for strong coordination among key regulatory bodies. There is a need to develop a robust mechanism for ensuring minimum standards in nursing and midwifery education nationwide.