Advanced Practice Nursing in Africa

Part of the Advanced Practice in Nursing book series (APN)


In Africa, health systems will collapse without nurses. The growth of APN programs in Africa is indicative of the recognition of this role in the roll out of universal healthcare. This chapter highlights the development of the Advanced Practice Nursing role in Africa with examples from many of the countries including a description of the origins of the role, educational programs, and legislation or policies that promoted its development. Key leadership actions are highlighted including the role of key stakeholders in the region. While Africa has many challenges, including limited resources, opposition from the medical profession, inefficient regulations and policies, and lack of benchmark educational programs, it also has many opportunities for expansion of the APN role. These opportunities are highlighted including the influence of nursing leaders and other stakeholders as well as through increased resources for health.


Regulation Scope of practice Education & training Role of the APN 


  1. Ahmed M, Vellani CW, Awiti AO, Ahmed M, Vellani CW. Medical education: meeting the challenge of implementing primary health care in sub-saharan Africa. Infect Dis Clin N Am. 2011;25(January):411–20. Scholar
  2. Anathan J. Family nurse practitioners: essential to eswatini’s health. Boston: Seed Global Health; 2018. Accessed 16 May 2019.Google Scholar
  3. Asuquo EF, Etowa J, John M, Ndiok A, Sampson-Akpan P, Edet O. Assessing nurses’ capacity for health research and policy engagement in Nigeria. J Appl Med Sci. 2013;2(4):35–51.Google Scholar
  4. Bryant-Lukosius D, DiCenso A. A framework for the introduction and evaluation of advanced practice nursing roles. J Adv Nurs. 2004;48(5):530–40.
  5. Christmals CD. The development of an advanced practice nursing (child health nurse practitioner) curriculum framework for sub-Saharan Africa: a multi-method study. Johannesburg: University of Witwatersrand; 2018. Scholar
  6. Christmals CD, Aziato L, Ditlopo P, Rispel L. “We are not doing too well” Factors that influence nurses’ ability to provide leadership for universal health coverage reforms in Ghana. In: 2nd International Leadership Conference, Accra; 2019. p. 1–15.Google Scholar
  7. Coetzee M, McKerrow NH, Chimwaza A, Molyneux E, North N, Sieberhagen S. Building paediatric nurse training capacity for Africa, in Africa. Lancet Glob Health. 2016;4(7):e449–50. Scholar
  8. Dlamini CP, Kaplan L, Stuart-Shor E, Mathunjwa-Dlamini TR. Report on the landscape assessment of readiness to introduce the family nurse practitioner role in Swaziland. Mbabane: Seed Global Health; 2018. Scholar
  9. Dlamini CP, Khumalo T, Nkwanyana N, Mathunjwa-Dlamini T, Macera L. Nsibandze BS, Kaplan L, Stuart-Shor EM. Developing and implementing the Family Nurse Practitioner Role in Eswatini: Implications for education, practice and policy. Global Health. 2020;86(1):50, 1–10.
  10. Duma S, Dipenaar J, Bhengu B, Oosthuizen A, Philips M, Naude S, Uys LR. Specialist and advanced specialist nursing and midwifery practice. Trends Nurs. 2012;1(1).Google Scholar
  11. East LA, Arudo J, Loefler M, Evans CM. Exploring the potential for advanced nursing practice role development in Kenya: a qualitative study. BMC Nurs. 2014;13(1):33. Scholar
  12. Fairall L, Bachmann MO, Lombard C, Timmerman V, Uebel K, Zwarenstein M, et al. Task shifting of antiretroviral treatment from doctors to primary-care nurses in South Africa (STRETCH): a pragmatic, parallel, cluster-randomised trial. Lancet. 2012;380(9845):889–98. Scholar
  13. GCNM. Ghana college of nurses and midwives: what we do. 2019. Accessed 19 May 2019.
  14. Geyer N. Enabling legislation in diagnosis and prescribing of medicine by nurses/health practitioners. Curationis. 2001;24(4):a873. Scholar
  15. GhanaWeb. University of Development Studies to run courses in nursing. General News 1999-05-24. 1999. Accessed 22 May 2019.
  16. International Council of Nurses. Nurses: a force for change. Geneva: International Council of Nurses; 2015a. Scholar
  17. International Council of Nurses. Nursing and health policy perspectives. Int Nurs Rev. 2015b:283–4.Google Scholar
  18. Kleinpell R, Scanlon A, Hibbert D, Ganz FD, East L, Fraser D, et al. Addressing issues impacting advanced nursing practice worldwide. Online J Issues Nurs. 2014;19(2):1–12. Scholar
  19. Kober K, Van Damme W. Public sector nurses in Swaziland: can the downturn be reversed? Hum Resour Health. 2006;4:1–11. Scholar
  20. Kolars JC, Cahill K, Donkor P, Kaaya E, Lawson A, Serwadda D, Sewankambo NK. Partnering for medical education in sub-Saharan Africa: seeking the evidence for effective collaborations. Acad Med. 2012;87(2):216–20. Scholar
  21. Kunaviktikul W. Nursing and health policy perspectives. Int Nurs Rev. 2014;61:1–2.CrossRefGoogle Scholar
  22. Mathunjwa M, Potgieter E. The roles of family nurse practitioners (FNPs) in Swaziland and their needs for continuing education. Afr J Nurs Midwifery. 2004;6(2):13–9. Scholar
  23. Msuya M, Blood-Siegfried J, Chugulu J, Kidayi P, Sumaye J, Machange R, et al. Descriptive study of nursing scope of practice in rural medically underserved areas of Africa, south of the Sahara. Int J Afr Nurs Sci. 2017;6:74–82. Scholar
  24. Mtuya CC, Blood-Siegfried J. Development of the NP Role in Tanzania. In: 10th ICN NP/APN conference. Rotterdam, Netherlands; 2018. pp. 1–20.
  25. Mwangi SW. How international council of nurses can export advanced registered nurse practitioner policies to Africa. Geneva. 2017.
  26. Picard LA. Rural development in Botswana: administrative structures and public policy. J Dev Areas. 1979;13(3):283–300. Published by: College of Business, Tennessee State University. Rural Development in Botswana: Administrative Structures and Pub. Scholar
  27. Pulcini J, Jelic M, Gul R, Loke AY. An international survey on advanced practice nursing education, practice, and regulation. J Nurs Scholarsh. 2010;42(1):31–9. Scholar
  28. Rispel LC. Transforming nursing policy, practice and management in South Africa. Glob Health Action. 2015;1(28005):8–11.Google Scholar
  29. Rispel LC, Blaauw D, Chirwa T, de Wet K. Factors influencing agency nursing and moonlighting among nurses in South Africa. Glob Health Action. 2014;7(1):23585. Scholar
  30. Sanne I, Orrell C, Fox MP, Conradie F, Ive P, Zeinecker J, et al. Nurse versus doctor management of HIV-infected patients receiving antiretroviral therapy (CIPRA-SA): a randomised non-inferiority trial. Lancet. 2010;376(9734):33–40. Scholar
  31. Sastre-Fullana P, de Pedro-Gomez J, Bennasar-Veny M, Serrano-Gallardo P, Morales-Asencio J. Competency frameworks for advanced nursing practice: a literature review. Int Nurs Rev. 2014;61:534–42. Scholar
  32. Schober M. Introduction to advanced nursing practice. An International Focus. Prepared under the auspices of the ICN. Cham: Springer; 2016.CrossRefGoogle Scholar
  33. Seed Global Health. Training a generation of liberian nurse anesthetists. Boston: Seed Global Health; 2017. Accessed 14 May 2019.Google Scholar
  34. Sietio OS. The family nurse practitioner in Botswana: issues and challenges. In: The 8th international nurse practitioner conference in San Diego, California, USA. (267); 2000. pp. 1–8.
  35. Terry B, Bisanzo M, McNamara M, Dreifuss B, Chamberlain S, Nelson SW, et al. Task shifting: meeting the human resources needs for acute and emergency care in Africa. Afr J Emerg Med. 2012;2(4):182–7. Scholar
  36. Tong B. Describing the health care needs of school-age children in sub-Saharan Africa in order to develop a model of a nurse-run school-based health clinic. Yale School of Nursing Digital Theses. Yale University. 2015.
  37. Wolf L, Brysiewicz P, Lobue N, Heyns T, Bell SA, Coetzee I, et al. Developing a framework for emergency nursing practice in Africa. Afr J Emerg Med. 2012;2(4):174–81. Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Nursing Education AssociationPretoriaSouth Africa
  2. 2.Department of Nursing EducationUniversity of WitwatersrandJohannesburgSouth Africa
  3. 3.Research on the Health Workforce for Equity and Quality Center for Health Policy, School of Public HealthUniversity of WitwatersrandJohannesburgSouth Africa

Personalised recommendations