Project brief: Training, Support and Access Model for Maternal Newborn and Child Health in Rwanda (TSAM): Cross Cutting Themes (CCT)

The Project

The Training, Support, & Access Model (TSAM) for Maternal, Newborn and Child Health (MNCH) in Rwanda is a 4-year international development partnership project with funding provided to the University of Western Ontario (Western) by Global Affairs Canada (GAC) at the Government of Canada. The main mission of the TSAM project is to improve maternal, newborn and child health (MNCH) in Rwanda by working with local partners to improve health service access and delivery. The project is regulated by a Contribution Agreement (CA) between Western University and GAC.


The TSAM project has three (3) primary goals:

  • To work with health practitioners and health workers in Rwanda to practice safe, evidence-based, gender sensitive, culturally appropriate and inter-professional emergency and life-saving interventions for MNCH care.
  • To improve specialized care for mothers and children provided by nurses, midwives and physicians, and reinforce MNCH district training and mentoring.
  • To advise the partners and the Ministries of Health and Education, as well other organizations with a vested interest in MNCH care, on the results of the TSAM project in order to align strategic plans and policies with gender sensitive MNCH service delivery.


The TSAM project partners in Rwanda include:

  • Rwanda Medical and Dental Council (RMDC); College of Medicine & Health Sciences (CMHS) at the University of Rwanda (UR); Nursing Council of Nursing and (NCNM)


The TSAM collaborating organizations in Rwanda include:

  • Rwandan Society of obstetrics and Gynecology (RSOG); Rwandan Pediatric Association (RPA); Rwandan Association of Midwives (RAM); Rwanda Association of Anesthesiologists (RPA)


Cross Cutting Themes (CCT) in TSAM Programs

  • Background:
    • In Rwandan there is a little consideration of factors such as gender and gender-based violence, culture, environment, mental health, ethics and interprofessional collaboration which could influence health care delivery.
    • A goal of TSAM is to contribute to the reduction of morbidity and mortality of mothers and newborns by integrating CCTs in MNCH training and mentoring.
    • This CCT program will increase the capacity of health care providers (HCPs) in 5 areas, including gender, ethics, interprofessional collaboration (IPC), maternal mental health (MMH) and gender based violence (GBV).
    • A TSAM innovation is to integrate the CCTs into the project’s main components, including district hospital mentorship, health center mentorship, community health workers training and mentoring, preservice programs in nursing and midwifery schools and in the medical interns training.
    • CCT integration phases have been established to help in understanding of how CCT concepts would be learned, owned and sustained by the MOH and other institutions involved in MNCH mentoring and training.


  • Current Status

            CCT Plan and Master Trainers:

  • Since April 2016, TSAM has had multiple meetings in Canada & Rwanda to develop the implementation plan.
  • Training of 48 Master Trainers in all CCT themes has been completed.
  • Twenty CCT Master Trainers (gender, ethics and IPC) received a Certificate of Recognition.
  • Research on validation of the MMH screening tool has been completed and presented to policy makers for possible expansion to the whole country.


District Hospitals and Health Centers:

  • Thirty six national mentors and 45 district hospital based mentors for both the Northern and Southern provinces in the TSAM catchment areas have been trained on CCT, including gender, ethics, IPC, MMH and GBV.
  • Integration of CCT concepts during CPD mentorship visits at the district hospital level and health center level is being implemented in the Northern and Southern provinces.
  • GBV specific trainings for 36 national mentors have been completed.
  • Workshops completed to provide GBV awareness training for 173 HCPs in the 5 Northern hospitals (Byumba, Kinihira, Nemba, Ruli and Rutongo).
  • Mentorship orientation on maternal mental health provided to HCPs from Northern Province DHs and HCs.


Nursing and Midwifery Schools and Medical Interns

  • ToT completed for 12 nursing and midwifery faculty.
  • CCT training manual for preservice is being finalized.
  • Validation of the training manual is completed.
  • CCT workshop for 48 faculty members has been conducted.
  • Twenty five HCPs from TSAM catchment hospitals for pediatric nursing course have been exposed to CCT integration.
  • CCT concepts have been taught to the 2017, 2018 and 2019 cohorts of medical interns.


Community Health

  • Training on all 5 CCT concepts provided to 318 ToT on CBMH in all 5 DH catchment areas in the Northern province.
  • Training on all 5 CCT concepts provided to ToT on CBMH provided to 3 of the 5 DH catchment areas in the Southern province.


  • Next Steps
    • The integrated CCT training manual for in-service will be completed and used by partnership institutions.
    • CCT pre-service training manual made available to faculty members for easy use in teaching and academic activities.
    • Selected students from different departments will be trained on CCT concepts with emphasis on IPC.
    • Expand activities on GBV and FP with an inclusion of teen pregnancy.
    • Evaluation of in-service and pre-service CCT programs to be conducted.
    • CCT key messages will be developed and designed for Community Health Workers.



February 6, 2019



Professor David Cechetto

Director, TSAM for MNCH in Rwanda