Clinical mentorship to improve pediatric quality of care at the health centers in rural Rwanda: A qualitative study of perceptions and acceptability of health care workers

Anatole Manzi*, Hema Magge, Bethany L. Hedt-Gauthier, Annie P. Michaelis, Felix R. Cyamatare, Laetitia Nyirazinyoye, Lisa R. Hirschhorn, Joseph Ntaganira

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

56 Scopus citations

Abstract

Background: Despite evidence supporting Integrated Management of Childhood Illness (IMCI) as a strategy to improve pediatric care in countries with high child mortality, its implementation faces challenges related to lack of or poor post-didactic training supervision and gaps in necessary supporting systems. These constraints lead to health care workers' inability to consistently translate IMCI knowledge and skills into practice. A program providing mentoring and enhanced supervision at health centers (MESH), focusing on clinical and systems improvement was implemented in rural Rwanda as a strategy to address these issues, with the ultimate goal of improving the quality of pediatric care at rural health centers. We explored perceptions of MESH from the perspective of IMCI clinical mentors, mentees, and district clinical leadership. Methods. We conducted focus group discussions with 40 health care workers from 21 MESH-supported health centers. Two FGDs in each district were carried out, including one for nurses and one for director of health centers. District medical directors and clinical mentors had individual in-depth interviews. We performed a hermeneutic analysis using Atlas.ti v5.2. Results: Study participants highlighted program components in five key areas that contributed to acceptability and impact, including: 1) Interactive, collaborative capacity-building, 2) active listening and relationships, 3) supporting not policing, 4) systems improvement, and 5) real-time feedback. Staff turn-over, stock-outs, and other facility/systems gaps were identified as barriers to MESH and IMCI implementation. Conclusion: Health care workers reported high acceptance and positive perceptions of the MESH model as an effective strategy to build their capacity, bridge the gap between knowledge and practice in pediatric care, and address facility and systems issues. This approach also improved relationships between the district supervisory team and health center-based care providers. Despite some challenges, many perceived a strong benefit on clinical performance and outcomes. This study can inform program implementers and policy makers of key components needed for developing similar health facility-based mentorship interventions and potential barriers and resistance which can be proactively addressed to ensure success.

Original languageEnglish (US)
Article number275
JournalBMC health services research
Volume14
Issue number1
DOIs
StatePublished - Jun 20 2014

Funding

This study was supported by funds from the African Health Initiative of the Doris Duke Charitable Foundation. This study was conducted in Kirehe and Southern Kayonza districts, two rural districts in Rwanda supported by PIH and covered by the MESH program. There are 13 HCs to support 344,157 people in Kirehe and 8 supporting 194,248 in Southern Kayonza. The median distance between the district hospital and HCs is 23 km and 21 km in each district respectively and the mean distance from rural households to the nearest HC is approximately 3.5 km. Each HC has ten nurses on average, with one to three nurses trained in clinical IMCI. HC directors are all nurses by training. Their activities include management of human resources, infrastructure, and finance with limited clinical time. No HC director was an IMCI provider during the study.

Keywords

  • Acceptability
  • Clinical mentorship
  • Health centers
  • IMCI
  • Pediatrics
  • Perceptions
  • Quality improvement
  • Rwanda

ASJC Scopus subject areas

  • Health Policy

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