The meaning of capacity building for the nurse workforce in sub-Saharan Africa: An integrative review

Background: Capacity building is an international development strategy which receives billions of dollars of investment annually and is utilized by major development agencies globally. However, there is a lack of consensus around what capacity building, or even capacity itself, means. Nurses are the frequent target of capacity building programming in sub-Saharan Africa as they provide the majority of healthcare in that region. Objectives: This study explored how capacity was conceptualized and operationalized by capacity building practitioners working in sub-Saharan Africa to develop its nursing workforce, and to assess Grindle and Hilderbrand's (1995) Dimensions of Capacity model was for fit with capacity's definition in the field. Design: An integrative review of the literature using systematic search criteria. Data sources searched included: PubMed, the Cumulative Index for Nursing and Allied Health Literature Plus, the Excerpt Medica Database, and Web of Science. Review methods: This review utilized conventional content analysis to assess how capacity building practitioners working in sub-Saharan Africa utilize the term capacity in the nursing context. Content analysis was conducted separately for how capacity building practitioners described capacity versus how their programs operationalized it. Identified themes were then assessed for fit with Grindle and Hilderbrand's (1995) Dimensions of Capacity model. Results: Analysis showed primary themes for conceptualization of capacity building of nurses by practitioners included: human resources for health, particularly pre- and post- nursing licensure training, and human (nursing) resource retention. Other themes included: management, health expenditure, and physical resources. There are several commonly used metrics for human resources for health, and a few for health expenditures, but none for management or physical resources. Overlapping themes of operationalization include: number of healthcare workers, post-licensure training, and physical resources. The Grindle and Hilderbrand (1995) model was a strong fit with how capacity is defined by practitioners working on nursing workforce issues in sub-Saharan Africa. Conclusions: This review indicates there is significant informal consensus on the definition of capacity and that the Grindle and Hilderbrand (1995) framework is a good representation of that consensus. This framework could be utilized by capacity building practitioners and researchers as those groups plan, execute, and evaluate nursing capacity building programming.