Rwanda: How Rwanda Plans to Build a Mass of Healthcare Workforce

8 February 2022
interview

Besides achieving Universal Healthcare Coverage for all citizens, Rwanda has an ambitious target of becoming a medical tourism hub where people from various parts of the continent and the world can access advanced healthcare services and training.

In line with this, the country is undertaking several efforts to develop its healthcare human resources, as well as establishing more infrastructure and bringing in the required equipment to facilitate training of the medics and treatment of the patients.

In 2020, the Government of Rwanda established the Human Resource for Health (HRH) Secretariat, an institution whose mission is to build health education infrastructure and capacity of the health workforce necessary for creating a high-quality and sustainable healthcare system.

To get more insights, The New Times' Hudson Kuteesa sat down with Dr. Patrick Ndimubanzi, the Executive Secretary of the HRH Secretariat, to understand the mission and ambitions of the new institution.

Excerpts:

First off, tell us about the HRH Secretariat and its mandate.

The HRS Secretariat was established in February 2020 as a resolution of the Leadership Retreat that took place in the same month and it was given the following responsibilities:

To oversee the health professional education and training in public and private institutions to ensure quality, build the capacity of higher learning public institutions providing education for healthcare professionals and clinical teaching sites in order to sustain high quality education and advocate for adequate infrastructure and equipment for quality health professional education.

Other roles include coordinating faculty recruitment and management, put in place strategies to attract student's enrollment in health profession education, coordinate the teaching sites expansion and coordinate academic partnership in health sector at national, regional and international level.

We are also charged with providing support in teaching hospital reforms, ensure the quality of health professional teaching, provide support in improvement of health professional skills through continuous professional development programs in the public and private health sectors and support training and sustain the role of health managers into the public sector health system.

This is a huge mandate and one would guess that you are handling each of these things at a time...

We are almost doing everything simultaneously. The oversight has already happened, where we work very closely with the teaching institutions both public and private to ensure we are aligned on the vision of health professional education.

One of the first things we did during this short time was to establish standards for health professional training as a guide for higher learning institutions and teaching hospitals. We have also developed standards for "second level teaching hospitals."

These are hospitals planned to be upgraded in phases to supplement the current four teaching hospitals; CHUB, CHUK, Rwanda Military Hospital, and King Faisal Hospital in training more health professionals.

We have also established different partnerships with various universities in the world such as the University of Strasbourg in France, the French Cancer Institute, the Belgian Research Academy and High Learning Institution, to name a few, and we work with them to have skill exchanges with Rwandan professionals in different fields such as Cardiology, Cancer Care, Minimally Invasive Surgery, etc.

Those are just a few examples of the partnerships we have either signed or revived.

We are very soon starting a number of new sub-specialty training programmes including but not limited to nephrology, pediatric surgery, cardiology, gynecological oncology and gastroenterology.

Moreover, we are planning to start a Master's programme in midwifery this year and the main goal of this is to be able to train the next generation of trainers who will sustain these programmes and services in Rwanda.

Tell us more about the second level teaching hospitals that are in the offing...

They will be upgraded so as to accommodate training. For instance, Kibungo Hospital which is already a referral hospital will need additional staff and different departments such as gynecology so that general practitioners can rotate there as part of their residence training.

What reforms are going to be undertaken in the main teaching hospitals?

We are looking at having all health professionals in teaching hospitals contribute to teaching and training. For instance, if you are a medical doctor working in Pediatrics at CHUK, you should be teaching students by the simple virtue that you are working in a teaching hospital even if you are not hired by the university.

In this way, a methodology to establish linkage between the teaching hospital and the university has to be followed.

This is a very good model where each hospital is not only carrying out clinical care but also teaching and research. Therefore, this strengthens the sense of duty to pass on knowledge and skills to the next generation of practitioners and trainers.

The country has been trying to address the problem of inadequate doctors and specialists. Where are we now?

This is not a problem specific to Rwanda. Preparing the workforce to be able to work towards the attainment of the health needs of the population is a challenge everywhere.

During the Covid-19 pandemic, there is no single country that has not faced challenges in terms of identification of cases and their management due to health workforce shortage.

I want to highlight the remarkable progress that has been made over the last ten years or even before. In 2010/11, we had 1 doctor per 16000 people whereas now we have 1 doctor per 8000 people.

We have also been able to double our nurse population from over 6000 to close to 11000 now, and for midwives we have had an increase of 60 percent - going from 600 to 1500 now.

There is no single method to assess if you have sufficient or insufficient health workers across the world. It is not just a matter of the numbers; but also the quality and we are looking at both. If you try to increase the numbers too fast, you may compromise quality.

As much as we want to increase the quantity, we also want to increase the quality side by side to be able to provide widely accessible quality advanced healthcare.

Currently, Rwandans go abroad to seek care mainly for: kidney diseases, heart diseases and cancers and we want to alleviate that burden by introducing in-country training programs in those fields and ultimately those services.

What is being done to address the problem of brain drain in the health sector?

Health workforce migration is a global challenge; it happens more in some places than others. I don't think it is as dramatic here, but it still needs to be addressed.

In Rwanda, one of the main things we are doing is actually bringing the training in the country so that people can be trained from here. This is because if you send them to be trained abroad, there is a risk that they may not come back, especially if they go and train for many years, for example 7 to 10 years.

It is also extremely important to provide some retention strategies that we have already started to work on with the Ministry of Health, and these strategies are not just financial.

We have already started putting all the health workers in what we call the 'mutual aid group of the health professionals' who work in the public sector, and this is going to evolve into a SACCO, so that people have access to financing.

Additionally, career progression is of paramount importance. If you do not have opportunities to grow as a professional, it becomes a challenge to stay motivated. Hence, medical professionals' career progression happens in form of a grading system. For instance, a general practitioner can start by being a junior medical officer, then a medical officer, a senior medical officer, and then a chief medical officer over time.

It is similar for the specialists where they start as junior consultants, then become consultants, senior consultants, and then chief consultants.

This progression is often informed by the years someone has spent working but also the work they have done during that time, the research papers they have published, how many students they have trained, among other criteria.

Continuous professional education is also important for retaining health professionals. Professionals need to continue upskilling themselves to improve their levels so as to really help the patients.

The training infrastructure and the equipment is important, and we have been working on it. More hospitals are built and equipped every year.

Management and appreciation that the health workers get is also important for retaining them. When they are appreciated for the work they do, they tend to stay and do more. There is not a single way of looking at it, since there are multiple parameters to retention.

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