Executive Summary MNCH in Rwanda Western University

Transcription

1 Executive Summary MNCH in Rwanda Western University For approximately 15 years, Western University has been working in the health sector in Rwanda in partnership with the Kigali Health Institute, the Faculty of Medicine at the National University of Rwanda, and the Ministries of Health and Education on capacity building projects, program review, needs assessments, and a health care quality assessment. Western team members have also served on national committees for health professional education and partnered with the national nursing program to develop a Bachelors of Science in Nursing and a Bachelors of Nursing Education program that was completed in March The Maternal, Newborn and Child Health in Rwanda project (MNCHR), was one of the 28 initiatives funded under the Muskoka Initiative Partnership Program. Project content focuses on one of the three core priorities under this program: strengthening health systems. MNCHR project is a collaboration between the University of Western Ontario (Western), the Kigali Health Institute (KHI) and the National University of Rwanda (NUR). MNCHR also works under the general guidance of the Ministries of Education and Health (MOE and MOH). Additional partners include the Medical Council, the Nursing and Midwifery Council, and the Obstetrical and Gynaecological and Paediatric Professional Societies of Rwanda. During the first half of the project the programs of KHI and NUR as well as other institutions of higher education were folded into one organization, the University of Rwanda (UR). The primary partners from the nursing and midwifery programs at KHI and the faculty of medicine were included in the College of Medicine and Health Sciences (CMHS) at UR. Nevertheless, as a result of the strong relationship Western has with the administration and faculty members at our partner institutions, and with the support of the MOE and MOH, the transition to the new partnership arrangement was seamless. Although there were new individuals appointed to the positions of Principal of CMHS and Rector of UR, all of the other key team members remained in the new organization. The deans of nursing and medicine and heads of departments were individuals with a long history of partnering with Western. The Ministry of Health (MOH) for Rwanda has established 5 general priorities for MCH. A representative of the MOH serves on the project s advisory committee to ensure that there is alignment with policy. Of the 5 priorities of the MOH for MCH, our project directly addresses 4, including (i) health professional education through the faculty of medicine and nursing and the regional nursing schools, which include midwifery; (ii) reduction in maternal and child mortality; (iii) increased quality of service; (iv) antenatal care and emergency procedures in obstetrics and neonatal care, including management of the third stage of labour. The Rwandan partners requested the Canadian team to collaborate with them in capacity-building activities to address some gaps in MNCH. There are 3 primary goals of the MNCHR project: A/ development of continuing professional development (CPD) capacity in MNCH; B/ strengthening midwifery and paediatric nursing and C/ working closely with our partners and the relevant council and ministries to provide feedback on the program to assist in the development of policy.

2 Summary of MNCHR Program Results During the course of the project, more was accomplished in the areas of CPD and strengthening of programs than was originally planned. Part of this was due to the requests received from the MOE and MOH to expand the scope of the training. An example of this is the MOH s request for the project to undertake CPD training in all 9 hospitals in the Eastern Province and not just 3 of them as originally planned. A second example is the request received from the MOE to expand the training to the regional nursing and midwifery schools in addition to the training at KHI. A second reason that the project accomplished more than the initial objectives is the very strong relationship between Western and the Rwandan partners. This enabled the teams to get started quickly implementing the activities due to the fact that the Rwandan partners had set the priorities and selection of approaches during the writing of the proposal. A/ Strengthening Midwifery and Paediatric Nursing This project component was broken down into three objectives: faculty development; certification in specialty advanced paediatrics and neonatology; and development of new programs and highly qualified personnel in MNCH. For the enhancement of the BScN curriculum the project teams worked together via face-to-face meetings in addition to correspondence over , revising the curriculum to reflect a new competency-based format. The teams were successful in delivering the planning working sessions related to nursing and midwifery care. Multiple meetings were held in Canada and Rwanda with nursing and midwifery faculty to collaboratively develop evaluation tools for both the BScN and degree midwifery program. The largest of these meetings was a workshop held in Rwanda in 2013, where 40 faculty members participated in developing clinical evaluation tools. One of the key components that contributed to the enhancement of the programs in nursing, particularly paediatric nursing, and midwifery at CMHS, was the increase in the numbers of teachers with advanced degrees, including masters (5) and PhDs (2). The return of these teachers greatly increase the capacity of the nursing and midwifery programs to deliver quality training at the bachelors level, which in turn, provides leadership level practitioners to deliver quality care at the district hospitals and the health centres. The midwifery program at KHI was launched in October 2013, with 30 students in the first intake of the program and another 30 students in After the program launch, the focus was on ongoing curriculum development and faculty development. One large workshop was held in Rwanda where participants worked on curriculum and pedagogy, including relevant gender concepts. In December 2013, one faculty member, Olive Bazirete, from the midwifery program at KHI returned after completing her Masters degree in South Africa, as part of the MNCHR Project. She resumed her role as a faculty member, and is using her newly developed skills and expertise to work on curriculum and faculty development. There is also one member of the midwifery faculty at KHI, Pauline Uwajeneza, who pursued graduate studies with the MNCHR project at Western University, focusing on nursing education (highlighted in section B). Upon completion of her master s degree, she has returned to CMHS to resume teaching. The teams did considerable work in 2012 and 2013 to finish the paediatric nursing curriculum through both face-to-face meetings and teleconferencing. The team members focused on developing the paediatric nursing curriculum and identified the priorities from each sector represented. In addition, a needs assessment was conducted in the field of

3 paediatric nursing to ensure all needs and priorities were present in the curriculum. Although CMHS decided to prioritize a masters program in paediatric nursing and not an advanced post graduate diploma, the curriculum developed was available for the course work involved in the masters program. Professional development also included graduate education, one of the major components of the project to strengthen the nursing and midwifery programs at CMHS. The research of some of these graduate students was also directly used to provide program evaluation, thereby permitting a double benefit of institutional program strengthening and project evaluation. There were 4 teachers from the former KHI who enrolled in master s programs in neonatal medicine or maternal mental health in Africa. With their new skills and increased professional capacity, these 4 teachers are already playing a critical role in the development and enhancement of the nursing and midwifery curriculum. The impact of their education on their professional development is already being realized with additional responsibilities and opportunities being offered that wouldn t have been possible without their master s qualifications. There are 3 additional teachers from the former KHI undertaking advanced degrees, masters and PhD, at Western and they will make a considerable contribution to the leadership and quality of programming in the nursing and midwifery programs at CMHS. One of these successfully defended her master s thesis and returned to teach at the end of April The other 2 teachers are completing PhD programs at Western and have received scholarships to complete their programs after the end of the project term. There are 2 other graduate students from Rwanda. One was selected directly by the project and another from the Faculty of Medicine at the University of Rwanda. The student from the project undertook a master s degree in health geography at Western. The student from medicine is completing a master s degree in public health at the University of British Columbia. B/ CPD Results In total, there were 88 expert trainers for all of the modules either trained or having received a refresher course. In addition, almost all of the expert trainers received training in interprofessional collaboration, ethics, and gender issues. This training of trainers took place from December 4, 2012 to May 24, Subsequently, these expert trainers provided MNCH training in the Eastern Province for a total of 317 health professionals. This represents a considerable amount of hard work and commitment by the Rwandan teams responsible for each of these trainings and it surpasses the amount of training we anticipated would take place when the project began. There were 5 phases to the development and training of the CPD for the Eastern Province. The first phase was module selection and planning. Some excellent modules were already being taught in Rwanda and other organizations such as the WHO had modules available. For this reason, the project teams selected several training modules with proven track records to develop a comprehensive training program to achieve the maximum impact on MNCH in the Eastern Province. The modules used were ALSO (Advanced Life Support in Obstetrics); ETAT (Emergency, Triage, Assessment and Treatment); HBB (Helping Babies Breathe); SAFE (Safer Anaesthesia from Education) Obstetric Anaesthesia; and MMH (Maternal mental health). The second phase involved training sessions in teaching a clinical skill as well as and inter-professional collaboration, ethics and gender issues. This training was primarily

4 provided to the expert trainers as well as teachers from nursing, midwifery and medicine. In addition, a team of cross cutting theme (CCT) experts was trained to provide continuing expertise in inter-professional collaboration, gender issues, and ethics. This CCT team took the training to the largest hospital in the Eastern Province and provided 2 days of workshops to 30 health professionals working in MNCH. The third phase was training and refresher courses for expert trainers in the selected CPD modules (i.e. Training of Trainers, TOT). It involved the training of expert trainers who delivered the content to the health practitioners. In total there were 88 expert trainers for all of the modules either trained or receiving a refresher course. This took place December 4-6, 2012 for MMH; February 24-26, 2013 for the ALSO and ETAT refresher courses; May for the HBB refresher course; and January for the SAFE Obstetrical anaesthesia course. The fourth phase of the CPD program was training in the CPD modules for the health professionals in the Eastern Province by the expert trainers. From June to December 2013, there was a series of workshops in which the expert trainers took the modules and trained health practitioners in the Eastern Province. Most of these workshops were held in Rwamagana. In total, for all 5 modules there were 317 health professionals trained. Almost all were from district hospitals in the Eastern Province although a few individuals from other provinces requested permission to participate. Those trained in the 5 modules were as follow: ALSO (81), ETAT (69), HBB (83), MMH (55) and SAFE (29). In addition many these were also trained in inter-professional collaboration. The final phase was the evaluation of the impact of the CPD. The MNCHR project provided training in both theory and practice. In the final stage of the project the focus was shifted to program evaluation to determine the impact of the CPD training. The research conducted by Rwandan graduate students evaluated the knowledge transferred during the training sessions as well as the impact on clinical practice. In addition, the research looked at whether enhanced knowledge and change in practice impacted the patient experience and perception of MNCH care. Finally, the evaluation considered whether better care and reduced barriers to the care would eventually impact clinical outcomes. Rwandan students enrolled in graduate programs at Western University and the University of British Columbia did the program evaluation research. The students and their research were supervised by a project team member from their respective universities in Canada as well as from the University of Rwanda and the Ministry of Health in Rwanda. C/ Policy Development This project component had two objectives: project alignment and implementation support. The project teams were able to work closely with government officials at the Ministries of Health and Education in Rwanda and administration at the University of Rwanda and in the Hospitals in the Eastern Province. Before the team drafted any project plans they were discussed with the Rwandan ministry and administrative representatives to ensure they were in line with their strategic objectives and to obtain their input on the most effective way to implement our activities. This communication was ongoing as plans were executed to obtain feedback and input during implementation. In addition, the project had a member of the management team in Rwanda attend the Technical Working Group for MCH meetings at the Ministry of Health on a regular basis.

5 This provided an opportunity to update the MOH along with other organizations in Rwanda working in MNCH about the project activities and plans, to explore opportunities for harmonization or complementary planning, and to ensure that the project was moving in the same direction as the MOH. This regular communication with the ministries and the partner organizations was particularly important as we were finishing up project activities and working together to determine the way forward to ensure that these activities and programs would be able to continue. In November 2014 and January 2015, the Canadian Project Director met with team members and stakeholders in Rwanda to discuss next steps for the CPD program and Nursing and Midwifery programs at UR after the project is complete. A plan was developed for the next phase of this work and the team has applied for funding to facilitate the plan to build on and expand the work done on MNCHR. An objective of this component of the project was to share information from the MNCHR project in Rwanda, Canada and elsewhere in Africa. Information on the Project was shared regularly with the government and institutional partners in Rwanda, as outlined above. The project work and accomplishments were presented at multiple conferences in Canada, South Africa and Uganda. There are plans in place to present the findings from the graduate student research in Canada in The results from the program evaluation will be published in peer-reviewed journals in D/ Complementary Results The project activities provided an opportunity to complete several other complementary objectives not directly included in the specific objectives of the results summarized above. These included: (i) assisting the National Nursing and Midwifery Council in Rwanda to develop a national plan for CPD for their respective disciplines. (ii) Project team members attending international conferences to upgrade their skills and present results from the project activities. (iii) Providing training tools for the CPD modules. The participants in the modules were provided books and manuals. These were also distributed to the districts hospitals to be used for future training opportunities. (iv) Ongoing use of materials: e.g., the ALSO course had posters with different topics. Multiple copies of these posters were made and distributed to the 9 hospitals. In addition, mannequins for ALSO and HBB training were purchased that were used in the project training and will also be available for future training sessions. (v) Use of a screening tool developed by the Mental Health team will assist health professionals to detect depression among mothers and children and promote the quality of holistic health care in the district hospitals. (vi) Giving pre-service ETAT course training to medical school students. (vii) All of the training modules were taught with the cross cutting theme of gender integration. A gender analysis of the project was undertaken in 2013 and a report generated. This report is being used to guide the project training as well as ensuring gender concepts are integrated into the curriculum for the training. (viii) MNCHR organized various management forums of health professionals in Rwanda and in Canada to enhance the collaboration and teamwork among the Rwandan and Canadian team members as well as hospital administrators and ministry representatives. These meetings have achieved better decision making towards improving MNCH. In summary, the MNCHR project was able to not only meet the objectives of the original proposal, but to surpass them in most of the project components. This was particularly true in the CPD training that was approximately 3 times the amount initially anticipated. Similarly, the strengthening of nursing/midwifery programs was extended from the central program at KHI to include the regional schools. Finally, the project was able to

6 support, though strategic leveraging, many more individuals than originally planned in graduate programs for the purpose of program evaluation as well as capacity-building as they returned to their institutions to teach and develop curriculum.