Organisation Consolidation and Sustainability Project

Background

The partnership between the Norwegian Nurses Organisation (NNO) and the Zambia Union of Nurses Organisation (ZUNO) started in its current form in 2001 (at that time Zambia Nurses Association). With funding provided by Norad and NNO a Needs assessment survey was conducted among nurses, midwives and other health personnel.

It concluded that all these “caregivers” needed support to avoid HIV-infection, both at the workplace and in their social life, and that those already infected were in need of care and support to enable them to live positively and maintain their professional careers for as long as possible.

A project titled “Project cooperation on HIV/Aids among nurses and midwives in Zambia” was initiated. The project was running from 2002-2007, and focused mainly on “caring for caregivers” and establishment of support groups for nurses and midwives.

During this period, the Zambia Nurses Association (ZNA) had few members and little influence. After 15 years of process, ZNA was granted trade union status in 2007 – and the Zambia Union of Nurses Organisation was formed.

In 2008 and 2009-2011 new Norad funded projects were initiated, focusing mainly on developing the organisation. Following the latter project, called “ZUNO Institutional Capacity-building project”, an end of project evaluation was done, which showed areas in which ZUNO had great potential for improvement.

Therefore a new project was initiated – namely the “ZUNO Organisational Consolidation and Sustainability Project”. This project was running from 2012 to 2015, and was aimed at supporting ZUNO in becoming a strong, bold and sustainable organisation that protects and promotes the interests of nurses and midwives in Zambia. This is the end of project evaluation of that project.

Purpose/objective

The evaluation is an end of project evaluation that seeks to determine whether the objectives initially set have been met.

Methodology

The evaluation was based on document review, quantitative data collection and qualitative data collection.

Document review

The desk review was a synthesis of all relevant project documents. This included documents such as quarterly and annual reports, recognition agreements between various organisations and ZUNO as well as cooperative agreements.

Quarterly and annual reports from 2011 to 2015 were reviewed including training reports as well as financial reports. Collective agreements signed between ZUNO and various private institutions and government agencies were also reviewed to collect information on various indicators.

Information from these reports was used to complement information gathered through quantitative and qualitative interviews. Information on some of the indicators was collected from the various documents reviews and used to determine whether ZUNO had met those indicators.

Quantitative component

The study was conducted in three provinces namely Lusaka (3 districts), Central (2 districts) and Southern provinces (2 districts). The study population included 250 nurses and midwives sampled from various sampled health facilities.

Stratified sampling with proportional allocation was employed – meaning that institutions with larger numbers of nurses and midwives had larger percentages of the sample size allocated to them.

Qualitative component

This involved key informant interviews and focus group discussions with relevant stakeholders, including ZUNO staff members, nurses and midwives whether or not they were ZUNO members, and other key stakeholders such as Ministry of Health, General Nursing Council and University Teaching Hospital.

Purposive sampling was used to select the participants for the key informant interviews. Participants were recruited prior to data collection and data collection was done using key informant interview guides and focus group discussion guides.

Key findings

• ZUNO has approximately 10.600 members, out of which 7300 are paying members. The total number of registered Zambian nurses and midwives are 19500, but only approximately 13000 are currently working. Depending on how calculations are done, ZUNO is representing at least 55 % of nurses and midwives in Zambia
• 69% of the ZUNO members are paying its membership fee through the check off system
• As of 2014, more than 90% of ZUNO’s income was generated locally through membership fees and other revenue-generating activities
• The national office is fully functional, and in the provinces 9 out of 10 offices are fully functional. Branch levels on the other hand are not fully set up, and contributes to communication problems between ZUNO and its members
• 38% of the respondents (N= 250) did not know that ZUNO has offices country wide, and 46% reported that ZUNO offices were not easily accessible
• ZUNO officials on all levels (national, provincial and branch levels) and shop stewards have been trained
• More than 69% of student nurses and midwives become registered members of ZUNO after graduation
• ZUNO has successfully represented its members on various issues. However, about 35% of the members do not feel like they have been benefitted from being members of ZUNO
• ZUNO has established networks with international, regional and national organisations
• ZUNO has good relationships with various relevant ministries, the General Nursing Council etc
• ZUNO is the fourth largest trade union in the Zambia Congress of Trade Unions (representing 36 Zambian unions). ZUNO is also the largest health sector trade union and the lead union in negotiation with employers
• ZUNO is providing support to sister organisations in the regions, such as to Botswana, Tanzania, Malawi, Rwanda and Uganda.
• Recognition agreements with several institutions were signed
• ZUNO has succeeded in various advocacy, such as establishment of more nursing schools, government employment of nurses and midwives, better working conditions (such as work hours and clothing) 

Recommendations

• Branding and visibility o It is recommended that ZUNO improve its branding and visibility, both in media, and towards its members
• Communication o ZUNO should sensitize its members and improve communication between the organisation and its members o ZUNO should improve its  use of internet to communicate with its members
• Negotiation and representation o ZUNO should negotiate with government on salaries, allowances, work load and conditions o ZUNO should find ways of motivating its members
• Support to ZUNO Provincial Offices o ZUNO sub-national level offices need to be strengthened to better serve the members
• Professional development o ZUNO should work on improving standards in nursing schools o ZUNO should come in to help its members in professional development