Health is the most precious commodity and the public deserves the highest standard of healthcare from the professionals. Nursing officers form the largest group of healthcare professionals. The quality of health services indicates the degree of progress and evolution in a country. Civilised nations treat their sick and needy with dignity, individuality, and investment in improving the healthcare infrastructure. Mauritius claims to be a model in the African continent for growth and development. If this is true, then the healthcare systems and standards merit scrutiny. Has Mauritius got a health service that puts patients first? How do people feel about nurses, doctors and hospitals? How does the MOH measure the quality of care? What incentives and opportunities do nursing officers have to improve care and their education? This paper investigates some of the above questions to raise awareness of the public to ask value for money and to inject some innovative suggestions within the health debate.

- People First

The health services are not free. We pay for them through taxation. Therefore it is our right to demand value for money and expect the highest standard of services. Health systems and strategies must put people first as paying clients with unique needs and concerns. Any health service or healthcare personnel that do not uphold this principle is not credible and is likely to be of poor quality. Each and every Mauritian healthcare worker (beginning with the cleaner up to the Minister of Health) has to look in the mirror and ask few simple questions: Am I putting the patient first? Am I giving the best that I can to the patient? Those who do not should not be in healthcare, especially nursing. Nursing is about being in touch with the needs and feelings of patients. Any nurse with the desire to be in a job to earn money only is misguided. A nurse gives a little bit more of him/herself to the patient. People value nurses because of their closeness to the patient and the unique relationship the nurse establishes. Nursing care is very intimate, personal, and individual. Patients cherish that intimacy much more than hitech medical advances. It is that intimacy that raises the standard of care to the level that makes the patient satisfied. Certainly, people appreciate the medical expertise and knowledge to prescribe drugs and perform operations that save lives. But without the nursing expertise the patient may develop complications, may not heal, and may become more seriously ill. So, if Mauritius wants to raise the standard of care, then it must seek to expand the expertise of the nursing officers. The United Kingdom has rightly realised and acknowledged the distinctive, unique and characteristic contribution nurses can and do make and deserve to be raised up to consultant level. Consultant nurses in England are making tremendous and exceptional clinical contributions to develop new services of high quality.

Mauritius should take a leaf out of UK?s recognition of nursing officers and energise our nurses to rise to the challenge of improving care and to put the people first. Any ministry of health services and health advisers that ignores or subjugates the role of the nurse suffers the ultimate fate of neglect, poor standards of care and abandonment by the public. This is not new but was asserted by the great visionary Florence Nightingale. It was true during her time and it is true now and in the future. Nursing is rightly a recognised and established profession with its body of knowledge and theories making dynamic and pragmatic contributions to health promotion, prevention, and qualitative research. The medical schools in UK have learnt from Faculty of Nursing on how to develop reflective, experiential, interpersonal, and problem-based curricula to strengthen evidence-based practice. Mauritius must do the same for the sake of the people and for the sake of high performance from nursing officers.

- Continuing Professional Development

If the MOH and the people of Mauritius want a vibrant health service, then massive investment is needed in the further and higher education of all healthcare professionals especially nursing officers. The MOH must be applauded for cementing the development and implementation of BSc Nursing Studies between the University of Mauritius and Middlesex University in the UK. Such development is a hallmark that slowly but surely the MOH and Mauritius are recognising nurses must play a greater part in the administration, development, and implementation of care. It is delightful to see a large group of nursing officers (the first cohort of about 150) are about to complete the course. These nursing officers are the pioneers and a rocky but essential road awaits them upon graduation. They will demonstrate that nurses with degrees can and will make a difference to care planning, care delivery, nursing research, education, and patient satisfaction. Research in the UK, Australia, Canada, and the US has consistently shown that nurses with higher degrees have made significant contribution to nursing and care practices. This is what Mauritius needs to do. Failure to educate the nurses is failing the people of Mauritius because the people deserve better. Without reforming nursing education and delivery of care, the people of Mauritius will have to suffer the indignity of poor standards of care for a while longer. Poor standards are just not acceptable.

We must summon the political will and commitment to fund continuing professional development and see the transfer of nursing education to the University of Mauritius. Europe, Scandinavia, Australasia, North America, USA, Africa and now Eastern Europe have made the transfer to university-based education for nurses because nurses need to develop nursing theories, nursing research and nursing practice. All these countries have experienced tension and skirmishes between the Ministry of Education (MOE) and the Ministry of Health before, during and after the transfer of nursing education to universities. Mauritius will not be different and ultimately all MOH have realised and accepted that nursing education belongs to the MOE. In the Mauritian context nurses are highly under-educated and ill-equipped. They have to care for an increasingly more aware and more sophisticated people with rising number of foreign nationals. They have to be educated to be up to date with the latest development in care and to provide the best. This is what is needed for us to compete in the global arena of the health sector. We should be in healthcare what we are in the tourism industry. Tourism and education have shown leadership, direction and now we want the same from the MOH. As a nation, we must not be shy in demanding quality from the MOH; this means quality healthcare staff, quality services and a strong patient-centred approach upholding the Patients Charter and Rights. The challenge is here. Will the MOH rise to it? Will the people demand value for money from the MOH? What is the MOH doing or has done to raise standards of care over the last few years?

- Incentives and Opportunities

Many nursing officers have moved to the UK, Canada and other countries. The principal reasons seem to be: (1) Poor level of pay, (2) Poor career structure and (3) Poor educational and professional opportunities. Those nursing officers thinking of moving on know the grass is not always greener overseas but they are prepared to make the significant substantial sacrifice, suffer the pains of leaving loved ones to get better opportunities and incentives to excel. When a Ministry is not prepared to facilitate the path and provide incentives for its staff to excel, then that Ministry does not deserve to exist. We know given the right condition, many Mauritians would prefer to stay in Mauritius. Many developed countries are benefiting from the training that Mauritius has given its nurses. Why is Mauritius failing to utilise its nurses for its people? Can Mauritius survive such a brain drain? Why is the MOH not doing anything to retain our nurses? Importing doctors from the Indian subcontinent is not the solution to improving care.

The incentives and opportunities that must be provided to our nurses are:

A total restructuring of the Health Service is overdue moving away from the old-fashioned medical model to a patient-centred approach to Operational Management. The present medical model is antiquated and unresponsive to the current and future needs of the developing population of Mauritius. The patient and choice must be the centre of all activities in the new modern health service.

Abolish promotion by Seniority and institute a competitive appointment system where experience is supported by evidence-based competence and appropriate qualifications. Many young, bright and vibrant nurses see no future in this country because they have to queue up for the next twenty odd years to be promoted to ward manager level. This system is demotivating, destructive and stifling new brains. Nurses feel they are caged within one role and one status for the best part of their nursing career. Such a system does not and will not utilise the abilities of the workforce, does not provide opportunities and incentives to self-actualise, to push the boundaries of excellence through service development.

It is a mistake to assume that staying in one role for twenty years ensures competence for promotion. Such a system is good only for breeding dead wood. Some people learn more in one post within couple of years and maximise their experience through practice and higher studies. People become creative and resourceful managers and leaders because they have a certain aptitude and not by serving time in a post. Thus, the MOH needs to make this conceptual leap and stop promoting ?dead wood? for the sake of the people. Promotion by seniority is a waste of human resources and must be stopped now. What is needed is a system, which valorises proven ability to manage and innovate patient care upholding human and nursing values.

Creation of new clinical specialist posts such as in the management of diabetes, hypertension, and cardiac nursing for which nurses are trained and educated to degree level. Mauritius is well known around the world for its high rate of diabetics and hypertensives. The MOH should be more imaginative and innovate Diabetic and Hypertension Clinics under the leadership of graduate nurses to lead the practical management of these diseases. This will not only benefit directly the patient but will also motivate the nurses to undertake research in the prevention of these chronic problems and revitalise health promotion. This is how the MOH can really make a difference and not only retain the nurses who are leaving Mauritius but make the lives of ordinary people more comfortable. After all, the MOH is also responsible for quality of life.

A structured programme of continuing professional development that deepens the knowledge of the nurses, makes sense of their experiential knowledge and equips them to develop theories of nursing. All nurses should be compelled to attend a week of study per year to refresh, to up date, and to extend their nursing knowledge and competence. Failing to update the nurses is denying the people the standard of care they deserve, it is failing the people and putting the citizens of this country at risk. It is criminal not to up date professionals and allow ?rusty? practices to go on for years.

Establish a National Nursing Development Unit so that nursing officers can begin to scrutinise their practice through research and development. Care will not improve until Mauritian nurses undertake small-scale evaluative and investigative studies to put the microscope on nursing and healthcare practices. This type of approach will help develop a brand new way of working and discover the unique nursing knowledge, which exists in Mauritius. Such a unit will not only help Mauritius but it can extend into Africa and work with nursing research units in Australia, South Africa, and Europe. This the route which will bring our Health Service into the 21st century with the respectability that developed countries enjoy.

Innovate a Positive Health Improvement Programme, which champions health education and health improvement. The lack of practical advice about healthy living is astounding. Admittedly, there is some health programme on TV but there is no healthcare professional especially designated to work with the people and ground the information from TV to reality. There is a void as far as creative strategies to improve health is concerned. The MOH must make the leap from lifeless posture to an invigorated master plan that actively brings the people in contact with nurses for better and fruitful health education and improvement. What we need is a bottom-up approaches not a top down discouraging and depressing strategy that emphasises the hierarchy.

The closure of large asylum mental hospital must be hastened to bring our mental health sufferers into the 21st century. Mauritius must be ashamed to call itself a progressive society if we delay or ignore the plight of those at Brown Sequard. What is the point of calling for national fervour at the Jeux Des Iles when so many unfortunate mental health sufferers Mauritians find themselves in a deplorable condition? What Eric Milazar is doing for athletics we should do for the mentally ill of Mauritius and release them from the shackles of stigma, indignity and sentence of misery! A new modern psychiatric services is essential to care for our people with mental health problems and alcoholism. The treatment of alcoholics in one congested ward in a hospital such as at Flacq is criminal and unacceptable. Proper alcoholic units with modern facilities must be developed.

Development of a New Nursing Education Curriculum which is grounded in problem-solving approaches, turning experience into knowledge and clinical practice into the application of concepts to contexts. Nursing education around the world has made groundbreaking contribution to the educational process and reflective learning. Nurses of today and the future need to be educated to learn from experience, as nursing is very rich and each encounter with a patient is a microcosm of knowledge. This is what helps evidence-based practice and the application of knowledge into practice to make a difference for the patient and to the standard of service. Coupled with the reorganisation of the Health Service the nurses deserve a radical curriculum, which will prepare them to face the challenges of today and tomorrow.

Nurses deserve a just reward for their efforts and expertise. Although nursing is rich in job satisfaction, nurses live in a real world where they need a decent salary to survive and care for their offspring. The Pay Review Body must be encouraged by the MOH to reward extra responsibilities, higher levels of knowledge, practice and research work. A new scale of pay that recognises these challenging posts must accompany clinical specialist role..

- Conclusion

Health is and must be the priority of any civilised society. Thus, it must be high on the political and people?s agenda. Mauritians care about their health, must demand better standards and they deserve a modern responsive Health Service which meets their needs as individuals, as a family and a community. A progressive new Health Service with imaginative and ingenious restructuring and development can stop the flow of nurses to richer countries. Nurses must be remunerated and rewarded financially for their skills and expertise but more importantly they want to work in a Health Service that provides opportunities for professional developments. The creation of clinical specialists brings higher levels of care for the patient, provides opportunities to nursing officers to study nursing at higher levels and undertake nursing research and discover substantive Mauritian nursing knowledge. The Mauritian Health Service can become dynamic, innovative and a place for knowledge creation. The challenge is here. Do we have the political will?

Dr Taleb Durgahee