Strengthening Human Resources for Health to Achieve Epidemic Control: A Case Study of Democratic Republic of the Congo

Thurman, Paul W.; Michaels-Strasser, Susan; Lukusa, Luc Ferdinand Kamanga; Ngulefac, John; Lukeni, Beatrice; Matumaini, Serge; Assukulu, Noe; Parmley, Lauren; Zidana-Ndovi, Sungani; Malele, Faustin

doi:10.21203/rs.3.rs-41976/v1

Cited by 2 publications

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References 11 publications

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“…In 2019 with support from HRSA, ICAP launched a telementoring program in DRC to help address some of disparities and lack of knowledge transfer from urban to rural settings [34]. While successfully launched and currently being scaled up to, telementoring does not address insufficient supply of health care workers in rural areas able to drive health promotion, disease prevention and treatment.…”

Section: The Need To Expose and Engage Nursing Students In Rural Healthcarementioning

confidence: 99%

Increasing nursing student interest in rural healthcare: lessons from a rural rotation program in Democratic Republic of the Congo

et al. 2021

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Background Many challenges exist in providing equitable access to rural healthcare in the Democratic Republic of the Congo (DRC). WHO recommends student exposure to rural clinical rotations to promote interest in rural healthcare. Challenges to rural engagement include lack of adequate infrastructure and staff to lead rural education. This case report highlights key steps in developing a rural rotation program for DRC nursing students. Case presentation To implement a rural rotation (RR) program, ICAP at Columbia University (ICAP) consulted with students, the Ministries of Health (MoH) and Education (MoE), and nursing schools to pilot and expand a rural rotation program. Nursing schools agreed to place students in rural clinics and communities. Key stakeholders collaborated to assess and select rural sites based on availability of nursing mentors, educational resources, security, accessibility, and patient volume. To support this, 85 preceptors from 55 target schools and 30 rural health facilities were trained of which 30 were selected to be “master trainers”. These master trainers led the remaining 55 preceptors implementing the rural rotation program. We worked with rural facilities to engage community leaders and secure accommodation for students. A total of 583 students from five Lubumbashi schools and two rural schools outside Kinshasa participated across 16 rural sites (298 students in 2018–2019 school year and 285 in 2019–2020). Feedback from 274 students and 25 preceptors and nursing school leaders was positive with many students actively seeking rural assignments upon graduation. For example, 97% agreed or strongly agreed that their RR programs had strengthened their educational experience. Key challenges, however, were long-term financial support (35%) for rural rotations, adequate student housing (30%) and advocacy for expanding the rural workforce. Conclusions With nearly 600 participants, this project showed that a RR program is feasible and acceptable in resource-limited settings yet availability of ample student accommodation and increasing availability of rural jobs remain health system challenges. Using a multipronged approach to rural health investment as outlined by WHO over two decades ago remains essential. Attracting future nurses to rural health is necessary but not sufficient to achieve equitable health workforce distribution.

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Section: The Need To Expose and Engage Nursing Students In Rural Healthcarementioning

confidence: 99%

Increasing nursing student interest in rural healthcare: lessons from a rural rotation program in Democratic Republic of the Congo

et al. 2021

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show abstract

“…In 2019 with support from HRSA, ICAP launched a telementoring program in DRC to help address some of the disparities and lack of knowledge transfer from urban to rural settings [29]. While successfully launched and currently being scaled up to assist and build capacity of rural clinicians, telementoring does not address insu cient supply of health care workers in rural areas.…”

Section: Icap and Hrsa Engagement In Nursing In Drcmentioning

confidence: 99%

Increasing Nursing Student Interest in Rural Healthcare: Lessons From a Rural Rotation Program in Democratic Republic of the Congo

Michaels-Strasser

Thurman

Kasongo

et al. 2020

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BackgroundMany challenges exist in providing equitable access to healthcare in the Democratic Republic of the Congo (DRC) including resource disparities between rural and urban areas coupled with a majority rural population. One of the most promising ways to close the gap between rural and urban healthcare access and quality is through the support of human resources for health (HRH), especially nurses, in rural health settings. Current barriers including lack of nursing students from rural communities, insufficient infrastructure, and absence of programs for rural practice exposure, have allowed disparities between rural and urban healthcare to persist. MethodsTo implement a rural rotation (RR) program for nursing students in DRC, whereby students are immersed in a rural clinical and community placement for an extended period of time, ICAP at Columbia University (ICAP), with funding and support from the United States Health Resources Service Administration (HRSA), consulted with stakeholders in DRC including students, the Ministry of Health (MoH), the Ministry of Education (MoE), and nursing schools and associations to improve health workforce education including understanding the disparities and realities of rural health care. Following this, schools of nursing in the Lubumbashi area agreed to add nursing students into rural workforce settings, including time in clinical as well as community health on a rotational basis. ICAP then worked with the MoH and MoE to select rural sites that could adequately support rotating nursing students and develop expectations for the RR program. Assessments of the selected rural sites were conducted, and the availability of nursing mentors, teaching materials, security, and accessibility, as well as patient volumes, were identified. Building on prior work to strengthen preceptors, a training of trainers approach was used. Out of a cohort of 85 trained preceptors from across 55 target schools and 30 rural health facilities, 30 were selected to be “master trainers” based on their experience in training others, their performance in initial preceptor training, and willingness to contribute more to overall success of the RR program. These master trainers educated the remaining 55 preceptors in rural practice. Concurrent with the training, ICAP, along with the MoH and MoE, worked with communities around the rural health facilities to secure accommodations for nursing students and to engage them with community leaders for purposes of future health promotion and clinic collaboration.ResultsAll five target schools from the Lubumbashi area that were selected for the project chose to participate. Kinshasa was not targeted for the project but did have two schools in rural areas outside the urban center interested and willing to accept students on rotations. Over the life of the project, 583 students successfully participated in the program and completed rural rotations as planned. Sixteen rural sites and 298 students participated in the rotational program during the 2018-2019 school year. For the 2019-2020 school year (through March), 285 students participated.Post-rotation feedback RECEIVED FROM 274 students, as well as from over 25 preceptors, and nursing school leaders, has been very positive and has resulted in more nursing students seeking rural assignments upon completion of their studies. Ninety-three percent of students surveyed, for example, indicated that they agreed or strongly agreed that they would recommend participation in RR programs to their classmates. Ninety-seven percent agreed or strongly agreed that their RR program had strengthened their education experience and increased their willingness to serve in rural areas in the future. The most significant challenges, however, were financial support (35%) and housing (30%).ConclusionsWith nearly 600 successful participants, this project showed that a RR program is both feasible and acceptable for nursing students, faculty, and rural clinic staff in resource-limited settings. Student exposure to rural practice is critical to increasing interest (and therefore downstream HRH staffing) in rural area healthcare. ICAP, HRSA, and DRC ministry leadership believe these early successes are indicative of both the opportunity available and value-added of such a RR program. Going forward, HRSA, ICAP and key stakeholders will continue to collaborate to sustain this project and advocate for employment and placement of student nurses who expressed interest, into rural employment following graduation. In addition, expanding such programs to other majority rural areas of sub-Saharan Africa seems both feasible and affordable with the right up-front collaborations and program design with key stakeholders.

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Strengthening Human Resources for Health to Achieve Epidemic Control: A Case Study of Democratic Republic of the Congo

Cited by 2 publications

References 11 publications

Increasing nursing student interest in rural healthcare: lessons from a rural rotation program in Democratic Republic of the Congo

Increasing nursing student interest in rural healthcare: lessons from a rural rotation program in Democratic Republic of the Congo

Increasing Nursing Student Interest in Rural Healthcare: Lessons From a Rural Rotation Program in Democratic Republic of the Congo

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