Developing and implementing a model of equitable distribution of mentorship in districts with spatial inequities and maldistribution of human resources for maternal and newborn care in Rwanda

Anaclet Ngabonzima,Celestin Hategeka,Gisele Mukunde,Isaac Luginaah,Daniel Kpienbaareh,Cynthia Kenyon,David F Cechetto

doi:10.1186/s12913-021-06764-y

Anaclet Ngabonzima, Celestin Hategeka + Show 5 more

Open Access

https://doi.org/10.1186/s12913-021-06764-y

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Abstract

BackgroundThe shortage of health care providers (HCPs) and inequity in their distribution along with the lack of sufficient and equal professional development opportunities in low-income countries contribute to the high mortality and morbidity of women and newborns. Strengthening skills and building the capacity of all HCPs involved in Maternal and Newborn Health (MNH) is essential to ensuring that mothers and newborns receive the required care in the period around birth. The Training, Support, and Access Model (TSAM) project identified onsite mentorship at primary care Health Centers (HCs) as an approach that could help reduce mortality and morbidity through capacity building of HCPs in Rwanda. This paper presents the results and lessons learnt through the design and implementation of a mentorship model and highlights some implications for future research.MethodsThe design phase started with an assessment of the status of training in HCs to inform the selection of Hospital-Based Mentors (HBMs). These HBMs took different courses to become mentors. A clear process was established for engaging all stakeholders and to ensure ownership of the model. Then the HBMs conducted monthly visits to all 68 TSAM assigned HCs for 18 months and were extended later in 43 HCs of South. Upon completion of 6 visits, mentees were requested to assist their peers who are not participating in the mentoring programme through a process of peer mentoring to ensure sustainability after the project ends.ResultsThe onsite mentorship in HCs by the HBMs led to equal training of HCPs across all HCs regardless of the location of the HC. Research on this mentorship showed that the training improved the knowledge and self-efficacy of HCPs in managing postpartum haemorrhage (PPH) and newborn resuscitation. The lessons learned include that well trained midwives can conduct successful mentorships at lower levels in the healthcare system. The key challenge was the inconsistency of mentees due to a shortage of HCPs at the HC level.ConclusionsThe initiation of onsite mentorship in HCs by HBMs with the support of the district health leaders resulted in consistent and equal mentoring at all HCs including those located in remote areas.

Highlights

IntroductionApproximately 2.5 million newborns died in 2018, most of which were in Low-and Middle-Income Countries (LMICs) where newborns are nine times more likely to die in the first month of life compared to babies born in highincome countries [2]
We believe that the model we developed based on making use of the midwives from District Hospitals (DHs) that were given extensive mentoring by an interprofessional group of experts from tertiary hospitals, to provide mentoring at the health centers in their hospital catchment area has not been used elsewhere in resourcepoor countries [15]
We encouraged that once a mentee attended at least 6 visits, s/he starts mentoring her/his colleagues who have not been able to be part of the programme to ensure the knowledge and skills reach all staff of the Health center (HC)

Summary

Introduction

Approximately 2.5 million newborns died in 2018, most of which were in Low-and Middle-Income Countries (LMICs) where newborns are nine times more likely to die in the first month of life compared to babies born in highincome countries [2]. The shortage of health care providers (HCPs) and inequity in their distribution along with the lack of sufficient and equal professional development opportunities in low-income countries contribute to the high mortality and morbidity of women and newborns. Strengthening skills and building the capacity of all HCPs involved in Maternal and Newborn Health (MNH) is essential to ensuring that mothers and newborns receive the required care in the period around birth. The Training, Support, and Access Model (TSAM) project identified onsite mentorship at primary care Health Centers (HCs) as an approach that could help reduce mortality and morbidity through capacity building of HCPs in Rwanda. This paper presents the results and lessons learnt through the design and implementation of a mentorship model and highlights some implications for future research

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