From Task Shifting to Advanced Practice Nursing in Primary Care: A Contextualized Framework for LMICs Informed by...

Area of Science:

• Nursing Science
• Health Policy
• Global Health

Background:

• Healthcare systems globally face increasing demands and workforce shortages.
• Advanced Practice Nursing (APN) is a key strategy to improve care delivery, especially in primary care within low- and middle-income countries (LMICs).
• The Philippines, a LMIC, experiences challenges in its healthcare system that necessitate innovative care delivery models.

Purpose of the Study:

• To explore the current state and potential for Advanced Practice Nursing (APN) in primary care facilities in the Philippines.
• To develop a contextualized APN framework relevant for LMICs.
• To identify barriers and enablers for the institutionalization of APN roles.

Main Methods:

• A qualitative case study approach was employed in a rural Philippine setting.
• Data collection involved interviews and focus group discussions with 41 nurses, physicians, academics, policymakers, and care recipients.
• Thematic analysis of qualitative data and descriptive analysis of quantitative data were conducted, integrated within an APN framework.

Main Results:

• Nurses in the Philippines informally perform advanced practice roles, including direct patient care, leadership, collaboration, and evidence-based practice, despite the absence of a formal APN policy.
• Key competencies for APN include health promotion, systems thinking, and policy implementation.
• Significant barriers to APN institutionalization include a lack of regulatory frameworks, formal educational pathways, and adequate financing.

Conclusions:

• A contextualized APN model is proposed for LMICs, particularly for primary care settings with workforce shortages and high burdens of non-communicable diseases.
• Formalizing APN roles requires strategic investments in education, certification, financing, and regulation.
• Recognizing APN functions through competency-based systems can enhance access to quality care and contribute to Universal Health Coverage (UHC) in underserved areas.