Nurse education, foreign aid and development: a case study from Bangladesh

Abstract

Over an eight year period, from 1990 onward, British Government Technical Co-operation Training (TCT) awards were provided to Bangladeshi trained nurses for study at post-graduate level in the UK. From 1994 the TCT awards were incorporated into a UK donor-funded project Strengthening Nurse Education and Services (SNES). The design of the project envisaged that by providing the awards, a "critical mass" of educated nurses would be created and empowered to lead the nursing profession out of its very weak position within Bangladesh's health system. My thesis will argue that this initial vision is still far from realisation and will analyse the many interrelated factors hindering its achievement. The investigation covers four perspectives: a) the way nursing developed on the Indian Sub-continent and historical factors in Bangladesh that impinged on the project; b) issues surrounding foreign aid to developing countries generally and to Bangladesh in particular; c) the design of the project and its place within the Bangladesh health system; d) the outcome of the project and suggestions for further research. It will be argued that shifts in aid policy together with the nature of foreign aided "projects" contributes to a lack of sustainability. This puts any actual or potential gains from such investments at risk. Over time, aid priories change in response to the political environment. In 1995, the thrust of the UK's Department for International Development aid policy was "to improve the quality of life of people in poor countries by contributing to sustainable development and reducing poverty and suffering" A key strand in this policy was to "help people achieve better education and health and widen opportunities - particularly for women." To this end, the project being evaluated in this thesis fits comfortably by seeking to improve the capacity of nurses to deliver quality health care through enhanced professional education. In the process it sought to widen opportunities for women who form 90% of the nursing workforce in Bangladesh. As the project drew to a close at the end of 1998, there was very little evidence to suggest any improvement in nursing care had occurred. However a later examination suggests some positive featured had emerged.