\u201c\u2026 the way we welcome them is how we will lead them to love family planning.\u201d: family planning providers in Rwanda foster compassionate relationships with clients despite workplace challenges

Hilary Schwandt ,Innocent Manzi,Haley Morris,Lyse Uwera,Madeleine Zeiler,Ilia King,Claudette Imbabazi,Chimene Ntakarutimana,Abigail Miller ,Ana María Trejos Herrera ,Uwase Musekura,Lyn Mezier,Julia Corey,Jessica Linus,Divine Mutuyimana,Ethan Hudler,Madelyn Merritt,Gi’anna Sterling-Donaldson ,Dieudonne Musemakweli,Angel Boulware,Nirali Patel ,Chantal Umutoni,Adriana Scanteianu,Biganette-Evidente Shemeza,Seth Feinberg

doi:10.1186/s12913-021-06282-x

Abstract

BackgroundRwanda has markedly increased the nation’s contraceptive use in a short period of time, tripling contraceptive prevalence in just 5 years between 2005 and 2010. An integral aspect of family planning programs is the interactions between family planning providers and clients. This study aims to understand the client-provider relationship in the Rwandan family planning program and to also examine barriers to those relationships.MethodsThis qualitative study in Rwanda utilized convenience sampling to include eight focus group discussions with family planning providers, both family planning nurses and community health workers, as well as in-depth interviews with 32 experienced modern contraceptive users. Study participants were drawn from the two districts in Rwanda with the highest and lowest modern contraceptive rates, Musanze and Nyamasheke, respectively Data analysis was guided by the thematic content approach, Atlas.ti 8 was utilized for coding the transcripts and collating the coding results, and Microsoft Excel for analyzing the data within code.ResultsData analysis revealed that, despite workplace related challenges – including inadequate staffing, training, and resources, relationships between providers and clients are strong. Family planning providers work hard to understand, learn from, and support clients in their initiation and sustained use of contraceptives.ConclusionGiven the existing context of purposeful efforts on the part of family planning providers to build relationships with their clients, if the current level of government support for family planning service provision is enhanced, Rwanda will likely sustain many current users of contraception and engage even more Rwandans in contraceptive services in the future.

Highlights

Rwanda has markedly increased the nation’s contraceptive use in a short period of time, tripling contraceptive prevalence in just 5 years between 2005 and 2010
Rwanda is a stand-out in terms of family planning program success [16, 17]. Amidst this backdrop of rapid increase in contraceptive use in Rwanda, this study aims to explore the potential role of one contribution among many to the rapid increase in contraceptive use in Rwanda – the interpersonal relationships between family planning providers and clients, and any workplace challenges that may negatively impact provider’s ability to foster those relationships
Qualitative data were collected via focus group discussions (FGD) and in-depth interviews (IDI) in the Musanze and Nyamasheke districts of Rwanda (the areas of the country with the highest (67%) and lowest (34%) rates of modern contraceptive prevalence rates, respectively [15])

Summary

Introduction

Rwanda has markedly increased the nation’s contraceptive use in a short period of time, tripling contraceptive prevalence in just 5 years between 2005 and 2010. An integral aspect of family planning programs is the interactions between family planning providers and clients. This study aims to understand the client-provider relationship in the Rwandan family planning program and to examine barriers to those relationships. A crucial maternal health service, contributes to reductions in maternal, infant, and childhood mortality via prevention of unwanted pregnancies and a reduction in births [2]. The impact of family planning is larger than the individual, as family planning use aids families, local communities, and entire nations in achieving better health outcomes [3]. An integral aspect of a strong health system are the people who provide the services. Health providers everywhere face challenges – but those in developing nations often face more substantial barriers to health service provision than providers from developed nations. Health providers from developing nations commonly note challenges with inadequate staffing, training, and supplies [5,6,7,8]

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