Nursing and Midwifery Policy Brief


Project Brief – Training, Support and Access Model for Maternal Newborn and Child Health in Rwanda (TSAM): Strengthening Pre-service Programs in Nursing and Midwifery


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 Society of Anesthesiologists (RSA)


Pre-service Programs in Nursing and Midwifery

  • Issue

An immediate outcome of the TSAM project is to enhance the capacity of pre-service program graduates to provide MNCH care. The corresponding output is that nursing and midwifery faculty are educated to enhance knowledge and technical skills for pre-service programs incorporating cross cutting themes.

Improvements in nursing and midwifery education are recognized as essential in increasing workforce numbers and enhancing the quality of health care and health systems. Rwanda, like other low-income countries in sub-Saharan Africa, still has a shortage of competent nurses and midwives to provide emergency MNCH care. The TSAM Project works in partnership with  the School of Nursing and Midwifery (SoNM) at the University of Rwanda (UR) and regional  private schools of nursing and midwifery, including Ruli Higher Institute of Health, Kibogora Polytechnic and Institute Superieur Pedagogique de Gitwe, as well as the NCNM and RAM to strengthen the quality of pre-service in pediatric  and neonatal nursing and midwifery with focus on MNCH.

  • Background
    • TSAM is a health sector project with a focus on health profession education
    • The primary objective is to establish a sustainable, cost-effective model of delivering training, provide mentoring, coaching and outreach for continuing professional development in emergency care and access in MNCH
    • TSAM supports the increase in the cadre of skilled attendants at delivery, with advanced training in emergency care for MNCH
    • TSAM also supports the strengthening of pre-service neonatal and pediatric nursing and midwifery programs
    • The goal is to ensure sustainability to local teaching institutions for the supply of well-trained nurses and midwives to continue the training and mentoring for MNCH into the future.


  • Current Status

Curriculum Harmonization

    • A harmonized and validated curriculum for pediatric nursing and midwifery education programs is being implemented in TSAM partners schools of nursing and midwifery, both public and private.
    • Harmonized clinical and evaluation tools and are being used in clinical teaching.


Pediatric CPD Program

    • A Canadian pediatric nursing course was adapted, contextualized and accredited by the NCNM as a professional CPD course is being delivered in collaboration between the SoNM and the TSAM project.
    • The first cohort of 14 students composed by faculty members from nursing and midwifery schools and in-service nurses from teaching and referral hospitals graduated from the pediatric nursing CPD program in October 2018.
    • Recruitment and Orientation workshop of 26 candidates for the second cohort composed of nurses from nursing and midwifery schools and teaching and referral hospitals and from 10 district hospitals supported by TSAM has been completed.
    • Second cohort completing the first module, Theory 1.


Other Trainings

    • Twenty four faculty members have been trained on Emergency Obstetric and Newborn Care (EmONC).
    • Thirty Eight  faculty members have been trained on family planning (FP).
    • Thirty nine faculty members have been trained on Helping Baby Survive (HBS) modules for Essential Newborn Care.


Perinatal CPD Program

    • A Canadian neonatal program was selected for the development of a CPD module for the faculty of the partner nursing and midwifery schools and the teaching hospitals.
    • The contextualization of the neonatal CPD course modules is ongoing to be followed by validation and submission to the NCNM for accreditation as a CPD course.


Masters of Science in Midwifery

    • The curriculum for a Master’s of Science in Midwifery at the SoNM at UR has been developed and is in the final stage for completion.


Capacity Building Scholarships

  • Graduate scholarships have been provided to teachers at UR and other regional nursing and midwifery schools: 7 master’s in nursing or health sciences at Western University; 3 master’s in nursing at Makerere University, 2 master’s in nursing at UR; 6 PhD’s in nursing or public health at UR; 4 PhDs at Western University


  • Lessons Learned
    • The TSAM project partnership model and coordination of different stakeholders is key in strengthening training in nursing and midwifery education programs.
    • Establishment of CPD programs such as the pediatric and neonatal courses contributes to the capacity for quality service delivery in MNCH for a low-income country like Rwanda.
    • Training of faculty members on transferable technical knowledge and skills in programs such as EmONC and Family Planning prepares competent nurses and midwives able to provide highly quality services in MNCH.
    • Combining health professionals from teaching institutions and from clinical settings is an effective good training approach to facilitate the exchange of theoretical and practical knowledge and skills for MNCH emergency health care.


  • Next Steps
    • Complete theoretical and clinical training for the second pediatric CPD cohort.
    • Complete contextualization, validation and accreditation of the neonatal nursing CPD program.
    • The first cohort of the neonatal CPD program complete both theoretical and clinical training and graduate.
    • Organize a symposium on pediatric and neonatal nursing.
    • Complete the development of the curriculum for the Master’s of Science in Midwifery and have the curriculum validated.
    • Identify gaps in MNCH practice based on litigation cases and provide training to address those gaps.




February 6, 2019



Professor David Cechetto

Director, TSAM for MNCH in Rwanda