Rwandan primary healthcare providers' perception of their capability in the diagnostic practice.

Ditte L Weber,Michael Schriver,Per Kallestrup,Vincent K Cubaka,Susanne Reventlow

doi:10.4102/phcfm.v12i1.2197

Abstract

BackgroundSkill-mix imbalance is a global concern for primary healthcare in low-income countries. In Rwanda, primary healthcare facilities (health centres, HCs) are predominantly led by nurses. They have to diagnose a multitude of health complaints. Whether they feel capable of undertaking this responsibility has yet to be explored.AimThis study explored how healthcare providers (HPs) at Rwandan HCs perceived their capability in the diagnostic practice.SettingRural and urban HCs in Muhanga district, Rwanda.MethodQualitative, semi-structured interviews with nurses and clinical officers, and observations of consultations were made. Findings were analysed thematically.ResultsRwandan HPs were confident in their competences to perform diagnostic procedures although nurses felt that the responsibilities lay beyond their professional training. Clinical officers believed that their professional training prepared them to function competently and autonomously in the diagnostic practice, although all HPs experienced a high dependency on medical history taking, physical examination and laboratory tests for reaching a diagnosis. Resource constraints (time, rooms and laboratory tests) were seen as a barrier to perform diagnostic tasks optimally, and HPs experienced in-service training and supervision as insufficient. They increased their diagnostic competences through work experience, self-learning and supportive peer collaboration.ConclusionClinical officers perceived themselves as capable in the diagnostic practice. Nurses may compensate for insufficient school training through in-service learning opportunities and feel capable in the diagnostic practice. Formative mentorship schemes and tailored education may prove valuable, but further research on how to improve HPs’ diagnostic capability in Rwanda’s primary healthcare sector is needed.

Highlights

A health system’s ability to provide quality healthcare services depends on an adequate ‘skillmix’ of healthcare providers (HPs)
Task delegation is commonly done in primary healthcare (PHC) in low-income countries (LICs) where nurses and other HPs deliver services that fall outside the scope of their routine training, and carry out tasks that would have ideally been performed by physicians.[1,2]
While clinical officers (COs) and nurses generally perceived themselves as competent in the diagnostic practice, findings indicate that other components influence their overall perceived capability to carry out procedures that are important for reaching a diagnosis, namely, dependency on diagnostic tools, educational background, match between work function and educational background, resource constraints at health centres (HCs), inservice learning opportunities and supportive work relations

Summary

Introduction

A health system’s ability to provide quality healthcare services depends on an adequate ‘skillmix’ of healthcare providers (HPs). This implies that there is a sufficient number of HPs, who are competent to carry out tasks that match the healthcare needs of the population.[1,2]. In Rwanda, primary healthcare facilities (health centres, HCs) are predominantly led by nurses They have to diagnose a multitude of health complaints. Whether they feel capable of undertaking this responsibility has yet to be explored

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Conclusion