This paper compares and contrasts nursing education within Saudi Arabia and Sri Lanka. Saudi Arabia was picked because it is a growing economy with increasing influence in the world. Sri Lanka is not often thought of for health care, yet within Sri Lanka has been a health system for centuries. For these reasons, these two countries are explored. The nursing requirements in Saudi Arabia are for nurses to have a minimum of a high school education, and two additional years of instruction in nursing which can be acquired via a hospital-based training program (Almalki, Fitzgerald & Clark, 2011). In Sri Lanka, nurses undergo training supervised by the government, which requires that individuals acquire a minimum of 3 years of nursing-specific training (Jayasekara & McCutcheon, 2006). The review begins with a look at Saudi Arabian political history, followed by a comparison of the same in Sri Lanka. Various categories of review including government influences in nursing education, the current status of nursing education and post-graduate requirements are included for each country, along with a comparison and contrast, below.
Political History and Development of Nursing Education
The political history of Saudi Arabia supports nursing education in the public and private sector (Almaki, Fitzgerald & Clark, 2011). Little documentation exists on the nursing profession for many years in Saudi Arabia, although in the 1950s researchers believe that care first delivered by physicians was more aligned with nursing practice (Almalki, Fitzgerald & Clark, 2011). The first official schools for nurses weren’t started until the late 1950s and 1961, when the first certificate school for female nurses opened its doors (Almalki, Fitzgerald & Clark, 2011). In Sri Lanka, nursing has been supported for many years by the public sector (Jayasekara & McCuthceon, 2006). Nursing education was first passed down from family to family in Sri Lanka, and eventually formalized into a State-supported system. More on the political history of Saudi Arabia and Sri Lanka is provided in the next section.

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Saudi Arabia. Saudi Arabia, like many countries, currently has an ongoing shortage of qualified nurses, and high turnover among current staff, resulting in a large percentage of expatriate nurses, with 29.1 percent of the staff currently an expatriate (Almalki, Fitzgerald & Clark, 2011). Nursing staff is much lower in the private sector than in the public sector although both realize nursing shortages (Almalki, Fitzgerald & Clark, 2011). Historically in Saudi Arabia, nursing was not distinguished from medicine; rather the same individual practiced in both capacity (Almaki, Fitzgerald & Clark, 2011). Nursing became a stronger and more distinct entity in the Early Islamic period (Almalki, Fitzgerald & Clark, 2011). Nursing skills were often learned within families, with healers teaching nurses initially. Eventually the nursing practice distinguished itself into an entity supported by the government and private institutions to meet public health needs. The political history of Sri Lanka similarly supports nursing education.

Sri Lanka. Sri Lanka has a varied political history, with State officials taking authority over health care to individuals living in communities (Jayasekara & McCuthceon, 2006). History reveals that Sri Lanka had a health system in place for years to meet community needs, with cave inscriptions located on early walls describing the physician teacher health provider in 250 B.C.E. (Jayasekara & McCuthceon, 2006). Early hospitals were overseen by Buddhists for Buddhist monks (Jayasekara & McCuthceon, 2006). The first hospital created for public health was built in the late 1850s, although its primary purpose was to halt the spread of disease (Jayasekara & McCuthceon, 2006). The first nursing training program did not form until 1879, and was a government-sponsored program. Free health services are available in Sri Lanka, which made health more widely available to the public at large, including training.

Comparison of Countries. In close comparison, the two countries share more similarities than differences. In Sri Lanka health is government-sponsored, or free to people. The health system has been in place for centuries, with records of health offered as far back as 250 B.C. While health training programs did not surface until nearly 1880, there is ample evidence suggesting health care was supported. In Saudi Arabia, the health system in modern culture is well developed, although health provision is not offered to all. Public and private health systems exist, with a majority of nursing professionals designated as expatriates.

Government and Nursing Organization Influencing Nursing Education
The government strongly influences nursing education in both Saudi Arabia and in Sri Lanka. In Sri Lanka, the State sponsors the 11 nursing educational facilities available to would-be incumbents. Within Saudi Arabia, the Ministry of Health oversees nursing education, with collaboration with many other state agencies. The influence of government and nursing organizations on nursing education within Saudi Arabia and Sri Lanka are reviewed thoroughly in this section.

Saudi Arabia. The government is an important influencer of nursing in Saudi Arabia. In Saudi Arabia, organizations including the Ministry of Health or MOH working with the World Health Organization initiative the first educational facilities for boys in 1958 (Almalki, Fitzgerald & Clark, 2011). Just 3 years later, the first 2-year nursing schools were opened for women in two major cities (Almalki, Fitzgerald & Clark, 2011). Later the Department of Health Education and Training grew with support of the MOH, to supervise health organizations including schools for nurses (Almalki, Fitzgerald & Cleark, 2011). Among the achievements include extending nursing education from 2 to 3 years. Other government agencies that influence nursing include the Medical Services of Army Forces and the National Guard Health Affairs, to name a few; the King Faisal Specialist Hospital offers diploma level education at the hospital level (Almaki, Fitzgerald & Clark, 2011).

Sri Lanka. In Sri Lanka, the government has primary authority over nursing (Jayasekara & McCuthceon, 2006). The National Health Policy was formed in 1992, which adopted many of the same health principles created by the MOH (also in Saudi Arabia) although there was little distinction between primary health and nursing at this stage (Jayasekara & McCuthceon, 2006). The Ministry of Health directs most aspects of health education in addition to contributing to the field of and oversight of nursing education.

Comparison of countries. There are a couple of differences evident from the comparison of government influence in Sri Lanka and Saudi Arabia. Many government agencies support nursing and health care in Saudi Arabia and in Sri Lanka. In Sri Lanka, the government provides free health care, and oversees all health-related education. This is not the case in Saudi Arabia, where private institutions also offer certificate or diploma training programs. It could be that Saudi Arabia has more difficulty recruiting nurses as a high percentage of providers are not citizens of Saudi Arabia.

Current System of Nursing Education
Within both Saudi Arabia and Sri Lanka, there are established requirements for nurses and their education. In Saudi Arabia there are currently more nursing educational facilities than in Sri Lanka. Saudi Arabia is still host to public and private nursing educational facilities, while Sri Lanka boasts a public supported nursing educational system. The current state of affairs in Saudi Arabia and in Sri Lanka are described in this section.

Saudi Arabia. Currently, the system of nursing education in Saudi Arabia is such that a public office oversea education. The Ministry of Higher Education or MOHE, growing from the MOH, supports post-secondary health institutes and other certifying agencies. These include not only junior colleges but also health institutes providing hospital-based training (Almalki, Fitzgerald & Clark, 2011). The MOHE was responsible for developing the first university nursing college, the College of Nursing at King Saud located in Riyadh, offering a bachelor of nursing (Almaki, Fitzgerald & Clark, 2011; Tumulty, 2001). Only students with high school graduation can transfer to nursing school. Hospital-level programs train high-school graduates via a 2-year program followed by 6 months of clinical practice. Private organizations also offer nursing training where students earn certificate upon graduation; many of these programs provide hospital-level or diploma programs to students.

Sri Lanka. In Sri Lanka, the government overseas health for the public (Jayasekara & McCuthceon, 2006). With respect to nursing education, a 3-year general education course is available for nurses in training; these include medical and surgical training, along with maternity training (Jayasekara & McCuthceon, 2006). There are a total of 11 schools currently available in Sri Lanka that are supported by the Ministry of Health or MOH (Jayasekara & McCuthceon, 2006). These schools have more than 1,000 students graduate from them annually (Jayasekara & McCuthceon, 2006).

Comparison of Countries. Saudi Arabia and Sri Lanka, when compared, share many current nurse education similarities. Saudi Arabia offers 2 year and 3-year bachelor programs for nursing. In Sri Lanka the primary difference is the existence of 3 year programs without diploma programs. Currently, in Sri Lanka, all nursing programs are in the native language, which raises more barriers to foreigners including expatriates interested in seeking employment within the country. This is not the case in Saudi Arabia.

Post Graduate (Masters) Education
Post graduate education can help enhance a nursing student’s understanding of the medical practice. In Saudi Arabia, masters or graduate education is limited to privately sponsored programs. This is not the case in Sri Lanka, where more post-graduate nursing education programs are available via State institutions. Post graduate educational requirements in Sri Lanka and in Saudi Arabia are provided in this section.

Saudi Arabia. In Saudi Arabia, private centers offer post graduate education to students of nursing (Almaki, Fitzgerald & Clark, 2011). This advanced training is limited to private rather than public institutions, which may reduce the number of applicants to graduate nursing courses. According to Almaki, Fitzgerald & Clark (2011), many expatriates stay in Saudi Arabia long enough to complete their education and long enough to gain experience before departing, increasing the need for local nurses.

Sri Lanka. In Sri Lanka, graduate-level training is available via a post-basic nursing program first established in 1960 (Jayasekara & McCuthceon, 2006). This program offers 18 additional months of training, 6 of which offer a midwifery course for women, and psychiatric training for males interested in post graduate education (Jayasekara & McCuthceon, 2006). Sri Lanka offers a comprehensive post graduate program where both males and females have an opportunity to specialize in an area of practice.

Comparison of countries. In comparing and contrasting the two, post-graduate education is more readily available in Sri Lanka, where graduate training is available for 18 months, with clinical training following. In Saudi Arabia, post-graduate training is provided but limited. This limitation is to private entities, which are the only entities that currently offer this level of training. The rigor of education in Sri Lanka appears more evident, partly due to the availability of education.

Conclusion: Reflections on Nursing Education
There are some interesting aspects of nursing education revealed through this analysis. It was surprising to learn that nurses can practice similarly in Saudi Arabia and in Sri Lanka, with 2 to 3 years of training. However, it does appear that this level of training is more basic than 4-year bachelor programs in the United States. Perhaps this is why there is such a shortage of qualified nurses currently in Saudi Arabia especially. It was also surprising and interesting to learn of the nursing associations abroad, including the Division of Nursing under the Minister of Health in Saudi Arabia. Sri Lanka has long had an organized health system supporting the advancement and preservation of nursing. This is similar to the American Nursing Association in the U.S., which provides representation and support for nurses in the States (ANA, 2016). In all regions, there are nursing shortages, which is a theme common to the U.S. and the countries surveyed.

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