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By DONGMO Nicaise Flore (Download pdf version)

The Problem of “Backpack Nurses” In Sub-Saharan Africa: The Case of Cameroon


INTRODUCTION

According to Le Petit Larousse de la Médecine, a nurse is a person authorized to ensure the supervision of the sick and to treat them on medical prescription or according to his own role. The nurse, thus, occupies a place of choice in the health care system of a state. To practice as a nurse in Cameroon, one must first acquire this quality. Thus, the exercise of the nursing profession presupposes “skills” specific to this profession, acquired through competitive examination and training in nursing schools.

The nursing profession is indispensable because it is at the heart of monitoring quality of care indicators, risk management, and patient safety. It is also responsible for identifying patient needs, making nursing diagnoses, formulating care objectives, implementing appropriate actions, and evaluating them. The nursing profession is, therefore, subject to professional, ethical, and deontological rules drawn up by the National Order of Nurses, which ensures that these ethical principles are maintained, and that the competence required to practice the profession is developed. This body also prepares the Code of Ethics, which sets out the duties of nurses in their relations with patients, other members of the profession, and other health professionals.

This is the reason why nurses practice their profession, preferably in public or private hospitals. Moreover, protocols developed according to a rigorous methodology favor the formalization of empirical knowledge in the sense that they are the product of a consensus and contribute to the legitimization of nursing know-how. It is, therefore, clear that the hospital is the ideal place for nurses to carry out their duties effectively. However, we are witnessing the emergence of the phenomenon of “backpack nurses” in Cameroon. The “backpack nurse” can be defined as a nurse who practices on private clientele and goes from home to home to provide care on his own account.

Given the seriousness of this phenomenon, which clearly poses a problem in the governance of the public health sector in Cameroon, it is important to research its causes, manifestations, and implications. After such an analysis, some useful recommendations will be formulated in order to eradicate this new phenomenon that is corrupting the Cameroonian health system.

Causes of the Emergence and Spread of the “Backpack Nurse” Phenomenon

The phenomenon of “backpack nurses” originates from the multitude of training schools created by the Cameroonian government and individuals, combined with the low recruitment rate of the latter in-hospital training. For example, in 2020, there were 69 schools where about 900 nurses were trained. Of these, only 221 were integrated into the public service, i.e., 24.55%. Therefore, about 76% of candidates who have been trained as nurses and who have not been integrated or do not practice in a health structure are reconverted into the practice of “backpack nurses.” This means the phenomenon is caused in large part by the unemployment of trained nurses. Moreover, the phenomenon is accentuated by the harshness of the socio-economic context. In fact, the low salaries received by some nurses employed in both the public and private sectors force them to “supplement their income” by offering care services to patients at home.

In addition, some staff, such as state-registered nurses, do not respect the health protocols and precautionary measures attached to the practice of certain medical acts. Several questions escape those who individually engage in these practices, namely, how is therapeutic monitoring organized? Are therapeutic assessments carried out prior to the administration of care? What is the degree of responsibility in the event of an inconvenience? Indeed, providing care at home implies risk assessment, establishment and management of patient-related risks, reporting and analysis of incidents, ability to follow up on incidents, and implementation of solutions capable of minimizing the risks of their occurrence. However, these good medical practices are foreign to the phenomenon of “backpack nurses.”

Consequences of the “Backpack Nurse” Phenomenon

The phenomenon of “backpack nurses” is growing, with consequences at several levels.

At the level of the patients, their health remains precarious because there is a strong fear that the care administered was not carried out under the required conditions of safety and precaution. In some cases, this can lead to the development of other pathologies in the patient due to the drug interaction. The risk of mortality is also high, which can be explained by the abusive use of drugs of dubious origin. The impact of this type of practice, combined with other risk factors, is confirmed by the fact that the person prescribing and administering care not only does not master pharmacology but also has no notion of a drug interaction.

At the level of the nurse, the consequences are also unfortunate. Indeed, he/she may be repudiated from the nursing profession because of the non-respect for the principles of professional ethics and deontology. Beyond the illicit sale of medicines of dubious quality, home care exposes the practitioner to criminal and civil liability for usurpation of office and especially for gross negligence.

As for the consequences on the health system, it results in a low rate of attendance to health centers and hospitals by patients. As a result, the public health system is biased in that it becomes difficult to know the existing and most recurrent pathologies in the community. The cause of this situation lies in the fact that the data of these patients followed at home are not traceable. They are not recorded anywhere. Consequently, health information, which is one of the pillars of public health, is biased and exposed to epidemic risks.

CONCLUSION

All in all, the phenomenon of “backpack nurses” is a growing scourge. It is an evil that undermines the health of the population and the Cameroonian health system. It is mainly practiced by young nurses. The patients concerned are generally the vulnerable segments of the population.

In light of these observations, we make the following recommendations:

To the Political Authorities

  • To recruit more trained nurses to strengthen the human resources of the hospital.
  • Make the fight against the phenomenon of “backpack nurses” a priority of health policy.
  • Increase health financing and access to care for all at reduced costs.
  • Accelerate the operationalization of universal health coverage for all.

To Backpack Nurses

  • Refer or direct patients to legal health care facilities.
  • Abandon this illegal practice and reorient themselves by respecting professional ethics.

To Patients

  • Avoid home care to avoid endangering their lives.
  • Refer to practicing health professionals in a health facility for any health problem.

Translated from French

Senior Nurse Epidemiologist