Gender is a Human Rights Issue.
Innocent became involved with TSAM because of the Centre for Gender Studies at the University of Rwanda where he teaches. As he describes, “I happened to be the lecturer of one of the staff members of TSAM - Francine Ingabire. Francine was my student, not only in class but also I was the supervisor of her master’s dissertation. She is in charge of Cross Cutting Themes at TSAM which includes gender, ethics and interprofessional collaboration. When she was putting together a committee on the issue of gender she thought of this centre where she did her studies. She called me, she consulted me and I advised her to come and see the director of the centre for gender studies. And it was the director of the centre who appointed me to be a part of this project.”
At the center for gender studies Innocent and his colleagues support the University of Rwanda and other institutions on how to mainstream gender in different programs. He credits TSAM for creating room for them to learn how they can help people to mainstream gender in their programs. It has created an opportunity to consider gender in their work in the community, especially the work related to maternal, newborn and child health. “Working with TSAM has strengthened me and others in my team. I have seen some team members who could not initially explain anything about gender but now are able to stand before people, university students, lecturers, medical doctors and explain what gender is and help them think about how to integrate it in what they are doing. So it’s an opportunity for capacity building. Also it is an opportunity for change, even in the community. This is because, I have heard some people saying that what you are doing in CCT is changing the way people are working in the hospitals and the community. Changes are especially being witnessed when working with people and remaining mindful during decision making, so that these decisions do not harm some people while privileging others. The issue of gender is a human rights issue.”
“I believe this is a wonderful project because of the way it has targeted people. It works with people who are in their internships, people who are already in-service in hospitals and also those who are teaching in nursing and midwifery schools. These are the people who are working in the community, who will stay in the community and have relationships with the community. If we succeed to change their way of thinking and doing they are going to positively impact their community.”
Change their mindset and their lives change as well.
Esperance was part of the first MNCH project in Rwanda; participating in training as early as 2009. It was the training in Cross Cutting Themes of Gender, Ethics and Interprofessional Collaboration (IPC) that made her decide to continue her involvement with TSAM. In particular, IPC was a new are of learning for her and peaked her interest as she realized there was a big gap in this area of the health profession. She received training from TSAM to be a master trainer and is now the leader of the IPC team.
Esperance has found that people are very willing to learn more about IPC. “Whenever we do a training course there is a desire to know more. They always say, “Oh we didn’t know, we thought we knew.” Attitudes are changing. Community leaders now understand what IPC, Gender and Ethics are and how they impact the healthcare system. It’s changing their mentality is passing down through the channels from mentors, to hospitals, district hospitals, healthcare centres and to the communities of Rwanda. The training has also been implemented in the University of Rwanda which Esperance describes as a, “big opportunity for us. Whereby these students will graduate with the full training package, reducing the gap. If the students graduate already knowing what IPC , gender and ethics are and how to implement them the standard of practice and quality of care for patients will be that much better.”
Improving care is a big part of the reason Esperance chose her career path. Esperance wanted to be advocate for children who are vulnerable, which drew her to paediatric nursing. Similarly becoming involved with MNCH is important to her as a paediatric nurse due to the high mortality rate in Rwanda. Esperance explains that the “reduction of maternal and child mortality rates will leads to the economic growth of Rwanda.” Likewise she hopes the project will help to develop empowered Rwandans. “That it will change Rwandans’ lives especially children, pregnant mothers and their families as mindsets change. Change their mindset and their lives change as well.”
Changing Attitudes in the community.
Immanuel Kayumba serves as a part of the Community Health action team with TSAM. Emmanuel, a local himself to Gicumbi, has been working in the Gicumbi district health sector since 2010 and assisted with the first MNCH project with Western in Rwanda. It’s focus on MNCH drew him to the project as MNCH is an area that is of personal interest and also directly aligns with his job to promote the health services in the district. Emmanuel works to mobilize families to make use of and understand the benefits to district health centers. In particular, he responds to the national policies by encouraging families to access antenatal care, delivery services and postnatal care health. “This includes the promotion of the family, the well-being of the family, especially the mother and the newborn.”
Emmanuel appreciates the multi-disciplined approach to MNCH that TSAM promotes. He describes how community health workers are the health professionals who are closest and have the most access to the family unit. “They are the most important structure to reach the family so that all mothers or pregnant women are mobilized to go visit the health centre.”
Already Emmanuel has seen positive outcomes in his district. The number of non-assisted deliveries has steadily decreased since 2012. In 2012 there were 427 deliveries out of health facilities and in 2016 there were 151 and in the first 11 months of 2016 there were only 88. Deliveries in health facilities are at a rate of 99.1% which he attributes in part to the collaboration between TSAM the district health centers and the Ministry of Health.
This collaboration has helped change attitudes in the community. When an expectant mother visits the health care center she is met by a CHW in charge of maternal health, who registers the mother and later visits the family and reminds them of the next appointment for antenatal care. This makes the mother more likely to participate in antenatal care which in turn increases the likelihood that she will deliver in the clinic as she is aware of the benefits. From a community health perspective he have seen that change in MNCH begins with the family.
One of the ways he has been working to implement change with the project is to build a strong foundation among the community, and among CHW’s so that they will work together to improve themselves and the local community. His team is planning for mentorship, which will help build the capacity of CHW’s. The mentorship is organized into two approaches, vertical and horizontal. The vertical mentorship is done by the MOH, RBC and health facilities to CHW’s, while the horizontal mentorship will build capacity through peer mentorship. In designing peer mentorship they were specifically thinking about the aftermath of the project, ensuring that they would have the structures in place to continue this positive trend. Emmanuel’s goal is to support new CHW’s who will be beginning their career after the project is over. Thus, the two pronged mentorship model.
Good success and strong collaboration has already been observed between the project and district in a way that facilitates these positive successes. But Emmanuel expects to reach better still. “I wish to reduce all problems that could lead to the death of the mother and the child and further empower the districts.”
Health care is in my blood.
Gasana Umwiza Rose
Rose is an electronic engineer and has a master’s degree in business administration. She was drawn to engineering due to her love for mathematics, which is certainly a big part of her role with TSAM as the Monitoring and Evaluation Officer. Though Rose comes from an engineering background she describes health care as being in the blood. “I am from a family of doctors, my mom is a medical doctor, an Ob-Gyn, my dad was a professor of biology and chemistry, and my husband is a medical doctor.”
Initially Rose was interested in becoming involved with TSAM because of its strong basis in education, as it is linked to the University of Rwanda. She was interested in gaining a new, more academic perspective of the health field particularly in MNCH. Rose describes the rooting of the project within academia as being a major asset, “As an monitoring and evaluation specialist from all the projects I did previously - I was a junior staff - then, it was more collecting data. Simple analysis, but the added value with TSAM is the research part. From the data we collect, we turn it into practical material or a research finding.”
Rose is also passionate about seeing mothers and children receiving the proper care, and nutrition, especially as they are a vulnerable sector of society. “Women and kids are the most vulnerable - so receiving the proper care and being part of a team that would put up a solution for them to be well - I am really really proud of.”
When asked about the outcomes of the project Rose describes the work that is being done with mentorship. “Helping people in the field to do real things and not just theory, not only trainings and talks, but being in the hospital doing it, saving lives. That’s really something.” Her favourite story from the mentorship team involves a woman who was suffering from a postpartum hemorrhage. The mentorship team was at the district hospital and was preparing to go home when they heard about the incoming patient. They stayed, waited for the patient to arrive from a health centre. They began to treat her in the district hospital but decided to transfer her to a referral hospital. Because of their timely intervention she survived and the mentee doctors benefited from the hands on training under the careful supervision of their mentors.
Rose discusses the future of the project expressing that she hopes it will continue to implement the strategies here in Rwanda and will then be able to make the model available country wide.