The impact of nursing education programs on healthcare delivery in low and middle-income countries (LMICs): A mixed systematic review

Introduction: Nursing is a cornerstone of global healthcare delivery, particularly in low- and middle-income countries (LMICs) where nurses are essential to addressing the needs of underserved populations. While nursing education is intended to strengthen clinical effectiveness, the systemic impact of these programs on healthcare delivery in resource-limited settings remains insufficiently synthesized. This study focuses on the role of nursing educational programs in LMIC. Objective To synthesize existing evidence on the impact of nursing education programs for improving healthcare delivery and patient outcomes in LMICs. Methods A mixed-methods systematic review was conducted following the Joana Briggs Institute methodology. Eligibility criteria were pre-defined and registered in PROSPERO. Article were included if they (1) were related to nursing education programs in LMICs, and (2) focus on the impact of nursing education programs. A comprehensive search was performed through PubMed, Scopus, Web of Science, CINAHL, ERIC, BVS, and Embase. Quantitative and qualitative data were extracted and synthesized using a convergent integrated approach. Findings were categorized and pooled based on thematic similarity to produce an integrated evidence base. Results From the 630 identified study, 46 were included, with findings mapped across the four levels of Kirkpatrick’s Evaluation Model. The evidence demonstrated high levels of participant satisfaction and engagement (Level 1), significant acquisition and retention of both theoretical knowledge and practical clinical skills (Level 2), and successful transfer of learning into clinical practice (Level 3). These behavioral changes directly resulted in enhanced patient outcomes and strengthened health system performance (Level 4), including improved diagnostic accuracy and reduced clinical errors. Conclusion Nursing education programs in LMICs are effective catalysts for improving healthcare delivery. This review provides an integrative framework demonstrating that structured educational interventions not only enhance individual nursing competences but also drive systemic improvements in patient care and institutional capacity. Trial registration PROSPERO CRD42025646172