Developing and implementing a model of equitable distribution of mentorship in districts with spatial inequities and maldistribution of human resources for maternal and newborn care in Rwanda

Abstract

Background The shortage of health care providers (HCPs) and inequity in their distribution along with the lack of sufficient and equal professional development opportunities in low-income countries contribute to the high mortality and morbidity of women and newborns. Strengthening skills and building the capacity of all HCPs involved in Maternal and Newborn Health (MNH) is essential to ensuring that mothers and newborns receive the required care in the period around birth. The Training, Support, and Access Model (TSAM) project identified onsite mentorship at primary care Health Centers (HCs) as an approach that could help reduce mortality and morbidity through capacity building of HCPs in Rwanda. This paper presents the results and lessons learnt through the design and implementation of a mentorship model and highlights some implications for future research. Methods The design phase started with an assessment of the status of training in HCs to inform the selection of Hospital-Based Mentors (HBMs). These HBMs took different courses to become mentors. A clear process was established for engaging all stakeholders and to ensure ownership of the model. Then the HBMs conducted monthly visits to all 68 TSAM assigned HCs for 18 months and were extended later in 43 HCs of South. Upon completion of 6 visits, mentees were requested to assist their peers who are not participating in the mentoring programme through a process of peer mentoring to ensure sustainability after the project ends. Results The onsite mentorship in HCs by the HBMs led to equal training of HCPs across all HCs regardless of the location of the HC. Research on this mentorship showed that the training improved the knowledge and self-efficacy of HCPs in managing postpartum haemorrhage (PPH) and newborn resuscitation. The lessons learned include that well trained midwives can conduct successful mentorships at lower levels in the healthcare system. The key challenge was the inconsistency of mentees due to a shortage of HCPs at the HC level. Conclusions The initiation of onsite mentorship in HCs by HBMs with the support of the district health leaders resulted in consistent and equal mentoring at all HCs including those located in remote areas.

Knowledge of pregnancy complications and utilization of antenatal care services in Rwanda

“…Moreover, utilization of maternal health services and choice of place of delivery are influenced by a complex web of factors, including health insurance coverage and quality of maternal health care, which are not part of the current study because of data limitations. In fact, studies by Ngabonzima et al 56 . emphasized that even knowledge of these complications by health care professional contribute significantly toward reducing newborn deaths in Rwanda, further highlighting the relevance of understanding women's comprehension of pregnancy complications.…”

“…As Rwanda and the developing world, in general, make efforts to achieve the SDGs, a more proactive approach to educating both pregnant women and prospective mothers on pregnancy complications is crucial. In the Rwandan context, programs such as Maternal and Child Health (MCH), Training Support and Access Model (TSAM), the Mentoring and Enhanced Supervision at Health Centres (MESH), which aim to enhance maternal health, could be mainstreamed into health policies to build the capacity of women and increase coverage to all rural areas through mentorship programs 56 …”

“…In fact, studies by Ngabonzima et al 56 emphasized that even knowledge of these complications by health care professional contribute significantly toward reducing newborn deaths in Rwanda, further highlighting the relevance of understanding women's comprehension of pregnancy complications. That notwithstanding, the findings are generally intuitive and consistent with the literature and provide relevant policy pointers for improving maternal health policy in Rwanda and the Global South in general.…”

“…In the Rwandan context, programs such as Maternal and Child Health (MCH), Training Support and Access Model (TSAM), the Mentoring and Enhanced Supervision at Health Centres (MESH), which aim to enhance maternal health, could be mainstreamed into health policies to build the capacity of women and increase coverage to all rural areas through mentorship programs. 56 A crucial challenge militating against effective sensitization of people on health issues in SSA is language limitation. While health information is mostly presented in English, most of the population is not literate.…”

Acceptability of decentralizing childhood tuberculosis diagnosis in low-income countries with high tuberculosis incidence: Experiences and perceptions from health care workers in Sub-Saharan Africa and South-East Asia

“…Support supervision, clinical mentoring, and problem solving from experts were reported as contributing to HCWs confidence and self-efficacy in adopting these new diagnosis services, and overcoming initial challenges. Investments in supportive systems for HCWs will be key to the successful implementation of diagnosis of tuberculosis at decentralized levels of care [ 31 ].…”