With the commitment to meeting the health needs of its citizens by 2020, the Government of Rwanda, through the Ministry of Health, launched the Human Resources for Health (HRH) Program in August 2012. The HRH Program will build the healthcare education infrastructure and workforce necessary to create a high quality, sustainable healthcare system in Rwanda by addressing the country’s most challenging obstacles in high-quality healthcare:
- Critical shortage of skilled health workers;
- Poor quality of health worker education;
- Inadequate infrastructure and equipment in health facilities; and
- Inadequate management of health facilities.
The Rwanda Human Resources for Health (HRH) Program represents a new model for health education and the delivery of foreign aid.
Instead of small scale cooperative efforts between individual academic institutions involving exchanges of a few people, The Ministry of Health has partnered with a consortium of 23 top US Institutions of medicine, nursing, health management, and oral health. The US institutions have made a commitment that is unprecedented in global health. They are supplying full-time medical, nursing, health management and dentistry faculty who are paired with Rwandan faculty and students to ensure knowledge transfer and upgrading of clinical and didactic skills. By providing mentoring and formal instruction, according to the national plan, the HRH Program Faculty will improve the quality, skills, and capacity of the Rwandan health workforce so it is positioned to sustainably and comprehensively meet the country’s healthcare needs. The HRH Program will train over 550 medical specialists, upgrade the skills of over 5000 nurses and introduce formalized training in health management and dentistry.
The Ministry of Health receives the program funding directly from the U.S. Government, without the brokering of a third party. The Ministry of Health will allocate funds for the program, therefore erasing overhead typically lost to third party management and assuming all accountability. After 7 years, the Government of Rwanda will be positioned to sustain the improved health workforce on its own without foreign aid.
The Rwandan Faculty of Medicine is tasked with ensuring that the quality of graduating doctors and specialists will match that of developed countries. Through the Rwanda HRH Program, the Faculty of Medicine is increasing the skill level of trainees and broadening the physician workforce to include a dramatic increase in specialists and subspecialists. While a critical mass of general practitioners is necessary in the health system, the lack of specialists creates a concern about the quality of care available in public health facilities.
The Rwanda HRH Program focuses on the following programs– Internal Medicine, Pediatrics, Obstetrics and Gynecology (Ob/Gyn), Surgery, Anesthesiology, Emergency Medicine, Radiology, Pathology, Oncology and Psychiatry– to strengthen their curriculum and clinical training components, while increasing their capacity to absorb larger numbers of students. Rotating sub-specialists from the US in Internal Medicine, Pediatrics, Ob/Gyn, Surgery and Anesthesia provide modular teaching of critical subspecialties as part of specialists’ training.
The Rwanda HRH Program also helps to build the capacity of Rwanda instructors. To date, clinical mentors in Rwanda have received little to no training in education. While some have years of experience in clinical practice, they often do not provide optimal training for students in teaching hospitals. US mentors are paired with these clinicians to provide mentorship and build technical capacity. US mentors meet regularly one-on-one with their Rwandan partner to discuss the students under their tutelage and different teaching strategies.
Nursing and Midwifery
For nurses and midwives, the Rwanda HRH Program is heavily focused on raising the skill level of the workforce. It builds on the Ministry of Health’s effort to upgrade the skill level of existing A2 (secondary school) nurses and midwives, as well as dramatically increasing the production of new A1 (diploma) and A0 (Bachelor’s) level nurses and midwives. To do this, the Ministry of Health developed educational pathways for nurses and midwives to advance from A2 to A1 to A0 levels in an efficient sequence, raising the overall skill levels of the nursing and midwifery cadre in the country.
Through the HRH Program, the School of Public Health aims to introduce two new degree programs: a Master in Hospital and Healthcare Administration (MHA) and a Certificate of International Health Management (CIHM). The MHA program will combine classroom-based work in management and leadership, with supervised field work to apply and refine these skills. Over the course of the HRH Program, the SPH aims to graduate 75 new managers from the MHA program, surpassing the minimum requirement needed to ensure that at least one trained health manager is working at each of the district, provincial, and referral hospitals by 2019 and that at least one trained health manager is working in each district health office. In the early stages of the MHA program, graduates will be assisted in placement at leadership positions within the health system. This will help to maximize their impact and position them to implement new skills.
In addition to the health managers themselves, there is a need to build management capacity among the senior management teams at hospitals and district health units. The Certificate in International Health Management (CIHM) program will be established to meet the needs of this group. It will use a team-based approach that will be directly applicable to their organizations. These management teams will be enrolled as cohorts, including administrators, heads of clinical departments, chief nursing officers at the hospital level, officers in charge of health centers (chargés de santé), and their teams in the district offices. The CIHM will build similar skills as the MHA but will be geared toward experienced professionals. This will allow for a more intensive and shorter-term training program.