ArticleWorkforce and Collaboration: International PerspectiveNurse mentorship to improve the quality of health care delivery in rural Rwanda
Section snippets
Background on HCs in Rwanda
In Rwanda, HCs provide a range of outpatient preventative and curative services, as well as more limited in-patient care, including uncomplicated deliveries. Each MESH-supported HC covers an average population varying between about 20,000 (Southern Kayonza district) and 24,900 (Kirehe district) and encompasses an average area of 48 km2 in both districts. There are eight HCs in Southern Kayonza District and 13 in Kirehe District (see Figure 1). The mean distance between the district hospital and
Program Progress
Program implementation began in November 2010, with program initiation at four HCs at a time, achieving full-district coverage within five months. During initial visits, mentors conducted baseline assessments of service delivery through case observation and facility evaluation. Mentoring visits started approximately one month after baseline assessments.
Discussion
We have encountered a number of challenges in our early stages of program implementation. Frequent turnover of HC nurses was a challenge to the MESH program, as it resulted in the loss of trained and mentored nurses. Turnover of HC staff is a problem across the country and is related to a number of reasons, including individual nurse decisions to transfer from rural to urban areas, seek positions with higher salaries, or pursue further formal education opportunities. This loss of trained staff
Conclusion
Despite these challenges, the MESH program has helped to bridge the gap between traditional didactic training and clinical practice using locally trained nurse mentors to start to improve the quality of care delivered at rural HCs in Rwanda. Through ongoing, direct observation of nurse practices and HC operations, nurse-mentors can effectively identify and intervene in quality of care issues, reinforce didactic nurse training, and facilitate systems-level improvements. MESH’s integration within
Acknowledgments
We thank the MESH mentors, technical advisors, and the M & E team for their dedication to improving care at HCs in Kirehe and Southern Kayonza districts and Dr. Corrado Cancedda for his vision and leadership in training. We are grateful to Fabien Munyaneza for providing the map in Figure 1 and to Catherine Mezzacappa for her statistical support. This work could not have been accomplished without the ongoing support of the district hospital supervision teams, PIH, and the Rwandan MOH.
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The Mentoring and Enhanced Supervision at Health Centers (MESH) program is funded in part by the Doris Duke Charitable Foundation Population Health Implementation and Training Partnership.