In Kiribati, as in all PICs, a robust and high-quality nursing workforce constitutes the backbone to the country’s health service. Nurses require broad skills and abilities, as autonomous practitioners serving on the front lines of health provision, and as members of a multi-disciplinary team. Nurse education is provided by the School of Nursing and Health (SONH) at the Kiribati Institute of Technology (KIT), mainly under its core Kiribati Diploma of Nursing program. Midwifery education is also provided by SONH and undertaken by Registered Nurses as an 18 month, postgraduate qualification. The curriculum for the Diploma program currently being taught in Kiribati was imported many years ago from New Zealand, and there is recognition that it needs to be updated and contexualised for unique Kiribati needs.
The Government of Kiribati receives assistance from New Zealand to examine the relevance and quality of the Diploma of Nursing curriculum in relation to the specific health challenges, needs, plans, identified gaps and workforce requirements in Kiribati. The vision, health goals
and targets for Kiribati’s health service delivery are outlined in the Kiribati Ministry of Health Strategic Plan 2016-2019, the Kiribati Development Plan 2016-2019 (KDP) and the Kiribati 20-Year Vision 2020-36 (KV20). This review fits with the Kiribati strategic objective to address gaps in health service delivery and strengthen the pillars of the health system. It also considers opportunities and pathways for Kiribati nurses under the strategic aim of promoting the employability of Kiribati nursing graduates nationally and
providing a standard of training that prepares students to enter the international workforce.
Wintec was contracted by New Zealand Ministry of Foreign Affairs and Trade (MFAT) to carry out the review in 2017. Appropriate supporting documents were made available to
provide important contextual information on the special character of Kiribati’s situation as a nation, its current health challenges and goals, the healthcare system, the nursing workforce and the current nursing program. During September 2017, a team of three experts from New Zealand and Australia undertook a series of consultative and participatory meetings with relevant people in Kiribati, including from SONH, KIT, Government Ministries, Nursing
Council and health sector service providers. A draft report describing their analysis and findings from those meetings was presented to involved stakeholders in Kiribati in November (see Appendix 2 for schedule of meetings), and feedback from those stakeholder meetings has been incorporated into this final version of the report. The reviewers took a holistic approach to the Terms of Reference that went beyond a narrow focus on only the existing
Diploma program curriculum to adequately address wider priorities of concern. They identified 28 specific recommendations that are fully detailed in this report; only the most significant findings are outlined in this summary.
The overall aim of the new Diploma curriculum should be to provide a course of study that leads to registration with the KNC and to enable novice nurses to capably function in a broad range of clinical contexts specific to Kiribati needs and priorities. It is important the curriculum incorporates the specific local geographic and demographic elements and
reflects the unique i-Kiribati cultural values pertinent to effective local health service delivery.
Career extension pathways for specific local health needs, such as midwifery, Public Health and specialized care can be provided as additional local courses, where feasible, or
internationally where more appropriate due to budgetary and capability constraints. A stronger focus on Primary Health Care and health promotion is required, which will help
address serious concerns over the increasing prevalence of Non-Communicable Diseases (NCDs) such as diabetes, cardiovascular and respiratory deseases. To produce a
contemporary, locally appropriate curriculum the development must be owned ‘in country’ and involve all key stakeholders, a process that can be informed and guided by external
technical experts and internationally available standards, curricula and resources (such as the WHO global standards for the initial education of professional nurses and midwives). A curriculum review working group with representatives from key stakeholders would lead this
process.
The international support integrated into this locally owned process would assist program articulation to quality frameworks, such as the Pacific Qualifications Framework (PQF), and ensure any Kiribati Quality or Competency Framework is underpinned by a robust quality assurance system that informs institutional internal quality management systems, accreditation and audits. Doing this will also enhance transfer of credit opportunities to
facilitate international opportunities in nursing-related roles elsewhere. This report contains some analysis of nursing workforce trends and potential migrant work opportunities in Fiji, New Zealand and Australia.
A refreshed, contemporary curriculum would include maximizing the use of available IT infrastructure to promote blended learning approaches, increase student engagement and
improve the student experience. Utilizing practicing RNs as sessional or guest tutors and lecturers would further enhance the relationship between SONH and its clinical partners, provide opportunities for clinicians to share their knowledge and expertise with students, and augment the teaching role of Registered Nurses.
The provision by KIT of English language training courses, and re-location of the SONH from its current site to the KIT facility at Betio will realise cost savings through increased usage and consolidation of teaching spaces, administration, IT infrastructure and teaching personnel. Sharing facilities with other KIT programs, developing affordable and sustainable clinical simulation and library facilities and ensuring adequate workforce planning and
underpinning support systems are all important processes to consider in association with the Review - KIT Diploma in Nursing Final Report 1 December 2017 5 curriculum review. It is important to note that in 2017, KIT received provisional accreditation from the Educational Quality and Assessment Programme (EQAP) of the Secretariat of the Pacific Community (SPC) and KIT-SONH facility improvement and consolidation will be vital in securing full accreditation with this body.
A coordinated approach to achieving these aims is essential, driven by local Kiribati leaders and supported by ongoing technical assistance from donor partners.
Improving the quality of health services and the care
rovided to Kiribati people is at the heart of this review process. The team have listened carefully and sought to accurately capture the voices of the many individuals and groups with whom we have engaged and we trust that this is reflected within this report.