In order to make a lasting impact on Rwanda’s health outcomes, we are investing in the people that deliver health care. Through formal degree-granting educational programs, in-service training, and targeted mentorship, we are building the capacity of Rwanda’s health workforce. PIH/IMB offers certificate programs for nurses, physicians, and other healthcare professionals in specialty areas such as oncology and neonatology. Through these programs, health care professionals gain much-needed skills and, as a result, health outcomes improve. We host scholars from around the world and residents from Brigham and Women’s Hospital’s Division of Global Health Equity in Boston. To provide the best possible education, we partner with many medical institutions, including the University of Rwanda, Human Resources for Health, and the University of Global Health Equity.
MENTORSHIP for Quality Improvement
Our mentors work with practicing health professionals in the districts we support to strengthen their skills in critical areas. We train nurses and physicians at health centers and district hospitals in HIV and TB treatment, maternal health care, child health care, mental health care, and noncommunicable disease management. Our mentors provide routine follow-up training and mentorship to ensure the knowledge learned is being put into practice. Mentors check in with the staff to identify issues, such as missing equipment or infrastructure improvements, and work with the local government to address those problems. We are beginning a new program to provide health professionals with training and mentorship in non-clinical areas such as finances, leadership, and clinic management.
Mentors work to improve the quality of care delivered by identifying key indicators not being met and then developing projects targeted at those specific outcomes. Mentors monitor indicators such as average length of stay for patients with malaria and infection rate for cesarean section surgeries. If they notice that a particular health center or hospital is not meeting the standard, they will work to find the root cause. Then they will work with the staff to develop or improve the related protocols and train all the staff on these improvements. Mentors measure and evaluate results of quality improvement projects, and departments that perform the best are awarded. Through this model of mentorship, health professionals working at all levels gain skills, and health systems are improved, resulting in higher quality care for those who need it most.
Social and Community Medicine
We support Rwanda’s goal to produce socially responsible health care professionals who adopt a patient-centered and community-oriented approach to delivering care. Through partnerships with academic institutions such as the University of Rwanda, we teach the values of social and community medicine to current and future health care providers.
Presently, every future Rwandan medical doctor visits PIH-supported Rwinkwavu District Hospital to participate in social and community medicine education. First-year medical students learn the basic elements of medical care at the community level. This course forms the foundation of the principles of social and community medicine, which will be further developed as they continue their education. Fifth year medical students complete a one month rotation at Rwinkwavu District Hospital, which allows students to step out of the classroom and into communities. It provides opportunities for hands-on learning at the health centers and district hospital. The training emphasizes reflection and peer-based learning to build upon their formal education.
We have successfully advocated for the need of early exposure to social and community medicine. In the newly revised curriculum, teaching time focused on social and community medicine will begin in the first year of medical school and continue in every subsequent year.
A key strategic objective at PIH is to provide essential knowledge, skills, and attitudes for frontline health workers to tackle global health priorities. To do so, we are developing new educational curricula that will guide improvements in service delivery. Curricula based upon already existing material such as WHO guidelines must be adapted and translated to fit the Rwandan context. For example, we have created a Rwanda-specific version for the WHO Problem Management Plus Mental Health curriculum, which is a new psychotherapy intervention to be integrated into the routine mental health care package at health centers. Some of the situations depicted in the original curriculum do not reflect life in Rwanda, and therefore relevant cases and pictures were substituted. Additionally, it’s important to present materials in the native language of recipients.
All training and educational programs we develop undergo rigorous screening to ensure the material is scientifically sound and the delivery format is learner friendly. Our Medical Intern Induction curriculum prepares medical graduates for their professional duties through hands-on experience and mentorship. Due to shortage of personnel, Rwandan medical graduates must also be mentally prepared to assume a leadership role early on. Therefore this curriculum is designed to be informative regarding protocol and process issues, and to provide practical training in procedural, clinical, and surgical areas. The curricula we develop are shared with our partners and the greater global health community and are used in national training in Rwanda and other countries.
University of Global Health Equity
University of Global Health Equity (UGHE) is a new kind of university focused on the delivery of health care to those who need it most. Building on Partners In Health’s three decades of delivery experience, and leveraging the unique expertise of Rwanda’s health sector, UGHE is training the next generation of global health leaders from Africa and beyond.
In many parts of the world, the traditional scope of health education does not suffice. The implementation needs are vast and deep and the challenges complex and messy. Addressing them requires experienced understanding of the cultural, social, and economic conditions in which patients live, a detailed knowledge of the biological basis of disease, and practical skills for program management and evaluation. Furthermore, it requires an interdisciplinary focus on One Health—a framework that incorporates human and animal medicine with environmental science to improve health outcomes.
University of Global Health Equity is our antidote to this gap in higher education. As the world’s first delivery-focused university, UGHE stands alone both in its focus on equity and its proximity to health systems that face the very challenges that students will grapple with in the classroom. UGHE graduates will be policymakers, doctors, scientists, and systems builders, who will lead health delivery for generations to come.