The need for continued growth of the health sector across Africa is well known and well documented. Rwanda is one African country that is harnessing collaborative resources in building a competent and knowledgeable healthcare workforce to improve the healthcare and wellness of its population (Ansoms & Rostagno, 2012). Following the wake of post-genocide in 1994, Rwanda has tackled head on, some of the health sector challenges succeeding to making such milestones as reducing maternal mortality ratios from 750/100,000 in 2005 to 210/100, 000 live birth in 2014 (Rwanda Annual Health Statistics, 2014). As part of the effort to build the healthcare workforce, the Human Resource for Health (HRH) program for Rwanda was birthed out of the government’s strategic plan intended to combat HIV back in 2002 (Binagwaho et al., 2013). The Rwanda ministry of health (MoH), working with its partner - the Clinton Access Initiative, established a unique seven year partnership with thirteen universities in the United States (US), six of which were schools of nursing (Mukamana, Uwizeye, & Sliney, 2015). The expectations for nursing were very clear and overall was aimed at restructuring nursing programs to equal accepted international level through curriculum development; and increasing the number of nursing and midwifery practitioners for both education and clinical practice areas. Further, the MoH identified a need to develop nursing leaders and educators at an advanced level that would carry on the growth and development of nursing achieved thus for purposes of sustainability chose to establish the first master’s program in nursing. This paper reports on the specific aspect of the need to develop nurse leaders and nurse educators that are expected to take the development of nursing workforce to a higher level in terms of quality and quantity required for future and optimum health of the population of Rwanda.
Purpose
The purpose of this presentation is to describe the development, and the extent of collaboration involved in the preparation, of the next generation of nurse educators and nurse leaders in Rwanda, highlight the challenges faced during the process and share experiences on how some of the challenges have been managed in Rwanda.
Methods
The Rwanda Ministry of Health (MoH) working with its partner the Clinton Health Access Initiative established a unique 7 year partnership with thirteen universities in the United States (US). The US institutions (USI) included Duke, Howard, New York, Chicago, Maryland and Texas Health Science center Universities. The USI recruited a pool of needed nursing experts and nurse academics from the US and other countries who would work directly with the Rwandan nursing faculty at the University of Rwanda (UR) through a ‘pairing’ or “twining’ mentorship model to achieve the consortium goals of development, skills transfer and sustainability.
There were 18 nurse academics recruited by the USI for the first Master’s in Nursing degree program based at UR. The USI initiated a joint development of the Masters in Nursing curriculum with the UR faculty for the eight (8) new specialty tracks in the Master’s program. The curriculum went through a rigorous approval process of the University and the country education system regulation. This culminated in the program starting late in October 2015, a month behind the UR normal academic calendar, with 120 students in the 8 specialty tracks.
The Education, Leadership, and Management (ELM) track is composed of 3 fulltime HRH foreign faculty (USI employed), 3 UR faculty and fourteen (14) students. The collaboration and twining relationship requires both faculty (HRH/Rwanda faculty) to work closely together so that the transfer of necessary skills takes place. Opportunities for transfer of skills prevailed at varied times including: the reviewing and development of undergraduate and graduate curriculums; development of modules and assessment of units; team teaching, sharing of information, text books, articles and all necessary resource; research initiation and research supervision, as well as advising toward professional development. The University of Rwanda (UR) structure requires a minimum of 240 credits (2400 notional hours) for a professional master’s degree such as nursing; with at least 100 credits for the dissertation. These would be distributed over four semesters or two years.
Output
It was expected that through a ‘pairing’ or “twining’ mentorship model the program would achieve the consortium goals of development, skills transfer and sustainability (Binagwaho et al., 2013). The team teaching model approach was mandated to maximize opportunities for skill transfer from foreign faculties to the Rwandan faculties. Supervision for research is shared so that both students and the national faculty have a sort of one to one supervision mentorship, with the student benefiting richly from both local and visiting faculty. The 14 students that enrolled for the ELM track are continuing in the program with no attrition. The students in the Master’s program are on campus three full days each week – Monday through Wednesday returning to serve in their pre-program jobs prior to the program from Thursday through the weekend. Students presented their theses proposals in October 2016 and have submitted these for review to the UR Institutional Review Board which meets quarterly. The University of Rwanda School of Nursing is set to be graduating its first cohort of the Masters of Nursing students in August of 2017.
Lessons learnt
A number of factors are impacting on the progress of the HRH development and particularly the ELM track. Among the challenges faced include the timing of the program, the program structure, the full time-part time nature of the program, the cultural context of Rwanda, grossly limited resources, the novelty of the program and the consolidation of the sustainability for the program. How the challenges were handled and further recommendations for the sustainability are given.
Conclusion
The Human Resource for Health work is ongoing in Rwanda and the fruits of capacity building for health professions are tangible. The opportunities for growth from this HRH endeavor should enable, and have already informed, other North and South global health collaborative initiatives for purposes of effectiveness and efficiency.
Significance to Nursing
The need for nurse leaders and nurse educators has been well documented and hailed by leading organizations such as World Health Organization (WHO) Collaborating Center for International Nursing Education as far back as 2004 (Woodring, 2004). The gap in the nursing workforce is not only highlighted by the pronounced shortage in nursing around the world, but also by the increased demand for population health nursing services that are required to meet the human right for health and wellness for all (Ugochukwu, Uys, Karani, Okoronkwo & Diop, 2013).
For African countries which have the lion’s share of the burden of disease, a competent, sufficient and capable nursing workforce is essential to participate in leading the achievement of the sustainable development goals. Nursing leaders and educators are necessary in Rwanda to guide healthcare provision for the Rwandan population by contributing to nursing research to guide evidence based care. In addition, nurse leaders and educators are essential for continued recruitment and retention of the much needed nursing workforce globally (Littlejohn, Campbell, Collins-McNeil & Khanyile, 2012).
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