Thursday 25 June 2020


UGONSA has written the Delta State government over the recent move by the State to start the controversial LCN programme. The letter, Ref No. UG/NAT/20/DSCOH/01 dated June 23, 2020, and titled, "BEFORE THE HEALTH SYSTEM OF DELTA STATE IS DESTROYED" was addressed to the Delta State Commissioner of Health and copied to the Governor and Director of Nursing, Delta State. Below is the full text of the letter:

The Delta State Commissioner of Health,
Delta State Ministry of Health,
Asaba, Delta State.
We warmly extend to your person and esteemed office the Nightingales' greetings from the leadership and members of the University Graduates of Nursing Science Association (UGONSA), the professional association of nurses with a minimum qualification of first degree in nursing.

      2.  The news reaching us that the Delta State Ministry of Health (DSMOH) under your able watch is planning to introduce a Licensed Community Nursing (LCN) programme in the State prompted us to write you to give you insight on the dark sides of the programme lest it further dilutes the health system of the State. 
     3.  We make haste to reach out to you because we believe you must have been misled by the faulty circular on the LCN programme, Ref No. N&MCN/SG/RO/CIR/24/VOL.4/152 dated March 3, 2020, which emanated from the Nursing and Midwifery Council of Nigeria (NMCN) (marked and attached as Annexure A). The circular falsely alleged that the reason the council was introducing the LCN programme is that there is a “gross shortage of nurses” occasioned by a mass migration of Nurses & Midwives to urban areas and other countries. This incorrect statement is capable of deceiving any well-meaning person and the unsuspecting public on the issue of availability of nurses for employment in our health system.

     4. One thing with nursing is that it is very complex and forms the nucleus of healthcare delivery be it medical, surgical, psychiatry, rehabilitation, palliative or, any other type of care. Such a complex role can only be handled efficiently and effectively by sound brains which the existing nursing programmes attract and parade in adequate numbers and not daft school leavers which the purported LCN programme seeks to flood nursing with.

     5. The existing nursing training in Nigeria meets the best international standard and verily equips the Nigerian nurses with the necessary knowledge, skills and latitude for critical thinking, clinical reasoning & judgment, and the clinical competence to play and coordinate independent, dependent and interdependent roles in the healthcare delivery system anywhere in the world. Hence, when they migrate outside the country they are able to fit in and perform excellently well in the health system of the developed world such the US, Canada, UK, Ireland and so on, where our political class throng for treatment for lack of confidence in our own health system. What this shows is that the Nigerian nurses are not the reason our health system is backward but the faulty system and faulty policies such as this misguided introduction of LCN programme.

     6. The LCN programme primarily seeks to lower the existing standard of nursing education via the introduction of a 2-years programme for a lower cadre of Nurses with having a very poor O’level result (.i.e. at least a credit in English and Biology) being the principal admission requirement. Contrasted with the current situation for the existing nursing programmes in the schools of nursing and the departments of nursing in the university where entry requirements of five credits in English, Maths, Biology, Chemistry and Physics is the basis for admission you will understand that the LCN is nothing but a fig tree to hand over the complex roles of nursing to individuals that have limited mental capability to carry out such roles when we have enough qualified unemployed nurses and midwives currently roaming the streets in search of nursing & midwifery jobs.

      7. That the NMCN issued the LCN circular on a false and faulty premise of “gross shortage of nurses” has been attested to by series of empirical facts. Mounting evidence shows that unemployed nurses and midwives are in excess and want to be employed and deployed to rural community settings. For example, a study conducted by this association (marked and attached as Annexure B) showed that at least 41% of Nigerian Nurses & Midwives produced in a session remain unemployed, and 95% of them are willing to work in the rural community settings if given the opportunity. Again, the National Association of Nigerian Nurses and Midwives (NANNM) Delta State Council in her enumeration of unemployed nurses and midwives of Delta State origin found that about 1500 nurses and midwives of the State origin are unemployed (kindly refer to the report marked and attached as Annexure C).

     8. From the foregoing, you can see that the problem is never a shortage of qualified nurses and midwives for employment but a gross shortage of opportunity for them in our healthcare delivery system even in rural community settings.

     9. On this note, we respectfully admonish that you should jettison the negative deception of the NMCN LCN circular and move to positive a direction that will strengthen the root of the healthcare system which is shaky everywhere in Nigeria (and not only in Delta State) by creating employment opportunity in the rural communities for the teeming number of unemployed nurses and midwives of Delta State origin with commensurate motivation of rural posting allowance.

    10. Furthermore, in the spirit and letters of the task-shifting & task-sharing policy and to ensure that highly skilled and competent nurses that have diagnostic and prescriptive authority are available all the time in the rural communities, we recommend and urge that the Delta State Ministry of Health (DSMOH) partners with the NMCN and the departments of nursing in the universities offering nursing in Delta State to create an Advanced Practice Registered Nurse Programme (Nurse Practitioners’ programme) for the holders of Bachelor of Nursing Science (BNSc) degree who majored in Public health nursing awardable and licensable via a masters’ degree in Community Health Nursing  (Please kindly refer to page 14 of the Task-shifting & Task-sharing policy document on Recommendations on the Service delivery at the Community Level hereby marked and attached as Annexure D).

    11. Having Community Health Nurse Practitioners working in association with Community Health Physicians in the rural communities of Delta State for prompt diagnosis and treatment of diseases & illnesses, as is obtainable in developed countries, will go a long way in changing the narratives of inadequate healthcare coverage bedeviling the rural communities.    

The good people of Delta State deserve to be cared for by educated, well-trained, competent, and highly skilled nursing workforce and their health and well-being should be the priority of the State government. Therefore, we respectfully demand that the DSMOH

                I.  totally stops its voyage into the training of the so-called LCNs which portends entrusting the lives of the good people of Delta State unto the care of the weakest brains among the secondary school leavers. Nursing is a complex profession that deals with human lives. Those whom people’s lives are entrusted unto their care must have the requisite mental capability and must be well educated, trained, skilled and competent to carry out such tasks effectively and efficiently.
         II. starts recruiting and deploying to the rural community settings at least 100 (one hundred) Registered Nurses and Midwives including those with BNSc degree every year to boost the availability of skilled nursing workforce in the rural areas.

         III. liaise with the NMCN and the universities offering nursing in Delta State to start offering Masters’ degree in Community Health Nursing leading to licensure as Advanced Practice Registered Community Health Nurse (.i.e Community Health Nurse Practitioner) who will work in association with Community Health Physicians to diagnose, and prescribe treatments for common diseases and ailments in the rural community settings in the spirit and letter of the task-shifting & task-sharing policy.

Submitted with deepest sense of respect and responsibility.


CHIEF (HON.) S.E.O. EGWUENU                  NURSE P.O. ETENG
  National President                                         Ag.National Secretary

CC: Director, Nursing Services Delta State.
        His Excellency, The Governor of Delta State.  

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