CPD Policy Briefs

 

 


Project Brief – Training, Support and Access Model for Maternal Newborn and Child Health in Rwanda (TSAM): CPD Mentorship in Districts

 

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)

 

Mentorship in District Hospitals and Health Centers

  • Background
    • Clinical mentorship in 10 DHs is a priority activity as per the MoU with the MoH.
    • The mentorship program is to build the capacity of health care providers in delivering high quality of care to women and children to reduce morbidity and mortality.
    • The TSAM mentorship model is built on an inter-professional collaboration approach with a team of 5 mentors working together in 3 areas of competency: Maternity services to include a gynecologist/obstetrician and a midwife; Pediatrics services to include a pediatrician and a pediatric nurse and  Anesthesia to include an anesthesiologist physician or a non-physician anesthetist.
    • The TSAM mentorship in the HCs is based on enhancing perinatal care as determined by the content of the EmONC program. The mentors are midwives from the 10 DHs.

 

  • Current Status

Mentoring at District Hospitals

  • Mentorship model development completed in February 2017
  • Mentorship tools reviewed and Cross Cutting Themes (CCT; gender, ethics, inter-professional collaboration, maternal mental health & gender based violence) incorporated
  • Worked with professional associations to identify potential mentors for each area of competency
  • Conduction of the refresher course of potential mentors in their area of competency
  • Completed training on mentorship approach for 30 mentors to conduct mentorship in Byumba, Nemba, Ruli, Rutongo and Kinihira; hospital directors, clinical directors and directors of nursing from the above hospitals were included for the purpose of understanding and ownership
  • Conducted an initial field visit after training of mentors
  • Conducted mentorship field visits in five hospitals of the Northern Province for 3 consecutive days. There were 9 visits by the end 2018 providing benefit to 72 mentees in total.
  • Training on mentoring provided to 30 mentors for the Southern Province and it included hospital directors, clinical directors and directors of nursing from Kabgayi, Ruhango, Gitwe, Kibirizi and Gakoma
  • Conducted an initial field visit in the 5 Southern DHs for first contact and initial assessment by mentors
  • Conducted mentorship field visits in five hospitals of the Southern Province with six for 3 consecutive days. There were 6 visits by the end 2018 providing benefit to 65 mentees in total.

 

Maternal Death Surveillance Response and Continuous Quality Improvement

  • Completion of the training of mentors and 3 staff from each of the 10 hospitals on Maternal Death Surveillance Response (MDSR) and Continuous Quality Improvement (CQI). In total, 90 participants benefited from the training.
  • Completion of the training on MDSR with the focus on CQI for hospital management teams. The training brought together Director Generals, Directors of Nursing, Clinical Directors and Directors of Finance and Administration for all TSAM assigned hospitals. In total, 39 participants attended this training from the 10 hospitals.

 

Mentoring at Health Centers

  • Northern Province:
    • Rapid assessment of available trained staff on EmONC in health facilities
    • Selection of potential midwives to be trained as hospital-based mentors (HBMs)
    • Completion of EmONC refresher training for selected HBMs
    • Training on mentoring, including 5 cross cutting themes for HBMs
    • Induction meetings held for each hospital to ensure ownership of the approach by both hospitals and health centers. Attendance included heads of each health center and the head of maternity from each health center and hospital teams.
    • Hospital based mentors (HBMs) have made 4 mentorship visits for the 68 HCs of the 5 Northern DHs. Services mentored included labor ward, antenatal and postnatal care. Around 100 mentees from 68 health centers are benefiting from this mentorship giving a ratio of mentor/mentee of 1:4.

 

  • Southern Province:
    • Rapid assessment of available trained staff on EmONC in health facilities
    • Selection of potential midwives to be trained as HBMs
    • Completion of EmONC refresher training for selected HBMs
    • Training on mentoring, including 5 cross cutting themes for HBMs

 

Action Team

  • Action Team (representatives of partners and collaborative institutions) meet regularly to discuss & evaluate field visits result & review field reports

 

  • Impact
    • Based on data provided by hospitals for some indicator there were some positive trends
    • For example, maternal death due to PPH appears to be decreasing and trends are showing that neonatal deaths are being reduced considerably in hospitals
    • There also appears to be a link between consistency of mentees and positive trends

 

  • Next Steps
    • Continue mentorship visits at the district hospital level in Northern and Southern provinces.
    • Continue mentorship visits by HBMs in the Northern & Southern to the HCs.
    • Conduct the validation of the mentees in DHs after completion of the six visits.
    • Identify and train Master Mentorship Trainers for sustainability of the approach.
    • Develop simulation training materials and train Central Mentors on use of simulation in mentoring.
    • Complete a survey of administrators, mentors, and mentees for QI purpose and conduct an evaluation meeting of mentorship in the Northern and Southern Provinces.
    • Ensure strong M&E using the indicators determined in the PMF and document near misses saved through the mentorship
    • Induction meetings for each hospital in the Southern Province to ensure the ownership of the approach by both hospitals and health centers.
    • Conduction of regular consultation meetings between TSAM, MoH and stakeholders to provide updates on the development of a sustainable clinical mentorship model

 

 

Date: 

February 6, 2019

 

Contact:

Professor David Cechetto

Director, TSAM for MNCH in Rwanda

cechetto@uwo.ca