Mentors’ perspectives on strengths and weaknesses of a novel clinical mentorship programme in Rwanda: A qualitative study

BMJ Open, Volume 11, No. 3, Year 2021

Ukuhunyushwa

Objectives To identify mentors’ perspectives on strengths and weaknesses of the Training, Support and Access Model for Maternal, Newborn and Child Health (TSAM-MNCH) clinical mentorship programme in Rwandan district hospitals. Understanding the perspectives of mentors involved in this programme can aid in the improvement of its implementation. Design The study used a qualitative approach with in-depth interviews. Setting Mentors of TSAM-MNCH clinical mentorship programme mentoring health professionals at district hospitals of Rwanda. Participants 14 TSAM mentors who had at least completed six mentorship visits on a regular basis in three selected district hospitals. Results Mentors’ accounts demonstrated an appreciation of the two mentoring structures which are interprofessional collaboration and training. These structures are highlighted as the strengths of the mentoring programme and they play a significant role in the successful implementation of the mentorship model. Inconsistency of mentoring activities and lack of resources emerged as major weaknesses of the clinical mentorship programme which could hinder the effectiveness of the mentoring scheme. Conclusion The findings of this study highlight the strengths and weaknesses perceived by mentors of the TSAM-MNCH clinical mentorship programme, providing insights that can be used to improve its implementation. The study represents unique TSAM-MNCH structural settings, but its findings shed light on Rwandan health system issues that need to be further addressed to ensure better quality of care for mothers, newborns and children. The health system in Rwanda is dominated by publicly funded healthcare facilities that include health centres, dispensaries, district hospitals, national referral hospitals and university teaching hospitals.16 Compared with the health centres, district hospitals offer services with a higher level of complexity and expertise including surgeries and complex inpatient care such as the management of high-risk cases of mothers and children that have been referred from health centres.19 Rwanda has 42 district hospitals that serve as first-line referral hospitals and receive referrals from peripheral health facilities.20 District hospitals are generally staffed by nurses, midwives and generalist physicians with basic medical training.16 Despite the limited number of specialists and resources, district hospitals are fundamental to primary care, especially in remote areas.16 The mentorship activities were conducted in neonatal, maternity and paediatric wards in the district hospitals. Through consultations with different key actors, the mentoring model was developed in early 2017. The potential mentors to be part of this mentorship model were identified and selected among experienced healthcare providers permanently working in university (tertiary) referral hospitals. Consequently, mentors had to travel to take part in mentorship activities at the district hospitals where their mentees are based. Mentors were selected by TSAM-MNCH from different professional associations in their areas of competency. The selection was based on mentors’ medical expertise, competency and willingness to transfer skills. The programme was built on interprofessional collaboration which required mentors to work in a team. Each mentoring team had five health professionals consisting of a gynaecologist/obstetrician, a paediatrician, an anaesthetist, a midwife and a paediatric nurse. This was the first mentorship model to include anaesthesia providers recognising their crucial role in the reduction of maternal, newborn and child morbidity and mortality. Each mentor was assigned two to three mentees and each mentorship visit lasted 3 consecutive days, once in 2 months. Five hospitals in the Northern Province benefited from 15 mentorship visits, while the five hospitals in the Southern Province had 13 visits each. The selected mentors received refresher courses in specific skills in their specialty and a training course on mentoring. This course on mentoring included cross-cutting themes focusing on interprofessional collaboration, gender and ethics. In addition, mentors benefited from additional training including simulation and debriefing and quality improvement. The district hospital management team was involved in the development and implementation of the mentorship model to ensure ownership of the model. This was done through the organisation of the preparatory meetings with hospitals before launching the mentoring programme. Coordination meetings with beneficiaries and implementers identified strategies to overcome the challenges encountered throughout the implementation of the mentoring. Challenges and strategies to overcome them were developed during these meetings. Before starting mentorship activities, mentees filled out self-assessment surveys to identify areas that needed improvement. These surveys facilitated the mentor’s efforts to teach effectively according to mentees’ personal needs. The mentorship activities were based on the needs of each mentee and the gaps in each hospital service. Mentors also provided an assessment to give feedback to their mentees after each mentorship visit. The mentorship model encouraged a supportive mentorship environment for the mentor–mentee relationship and allowed constructive feedback and follow-up. In addition, the mentees’ performance was determined using evaluation tools. This mentorship model allows healthcare professionals to collaborate and to cross-consult to ensure the delivery of quality care. The teaching methodologies used by TSAM-MNCH mentors included bedside teaching and case scenario discussions, as well as simulation, case presentation, ward rounds, mortality and morbidity audit, debriefing sessions and managing clinical emergencies alongside the mentees.16 Each mentor works alongside their mentee to assist with daily medical assignments and assess the performance. The whole team of mentors and mentees can occasionally collaborate depending on the medical cases. This professional collaboration is most likely to happen because the mentorship programme focuses on areas that are inter-related. After each mentorship field visit, mentors fill out reflection forms. This study was a descriptive design using a qualitative approach to assess the perspectives of TSAM-MNCH mentors on the strengths and weaknesses of the mentorship model. The study participants included 50 active mentors mentoring health professionals in 10 district hospitals of TSAM-MNCH clinical mentorship programme catchment area. The researcher obtained a list of TSAM-MNCH mentors with their contact information from TSAM-MNCH administration, and then selected active mentors who had completed at least six mentorship field visits on a regular basis in TSAM-MNCH assigned district hospitals. This was to ensure that mentors have sufficient knowledge and are familiar with the mentorship programme. Initially, 18 mentors were purposively selected to participate in the study. Some participants were invited over the phone while others were invited face to face by the researcher. All the invitations were in Kinyarwanda language. With different reasons, four mentors were not able to participate, thus the study sample was 14 mentors who were representative of each profession. The sample consisted of three gynaecologists/obstetricians, three paediatricians, two anaesthetists, three midwives and three paediatric nurses. These four were not replaced because we observed that saturation was reached. Saturation was reached around the ninth interview and the researcher kept collecting data to make sure that each profession is represented in the study sample since the mentorship model is built on interprofessional collaboration and every profession plays a key and unique role in the programme. The methodology followed a Consolidated criteria for Reporting Qualitative research checklist (research checklist). Qualitative primary data were collected directly from participants using one-to-one in-depth interview. The interview guide (online supplemental file 1) was made up of 15 questions that led to an hour interview between the researcher and each participant. A semistructured interview guide was developed based on the research questions by the research team. Most questions were open ended and were based on mentorship activities and the perspectives of the mentors about the TSAM-MNCH mentorship model: its strengths, weaknesses, gaps as well as areas of improvements. The interviews were electronically recorded and field notes were taken by the researcher. bmjopen-2020-042523supp001.pdf All interviews took place in the hospital offices where mentors were conducting their mentorship visits and did not interfere with mentorship activities. Two interviews were done in the local language (Kinyarwanda) due to the participants’ request and level of comfort. A Kinyarwanda interview guide that had been prepared was used for the two interviews. In general, the interviews lasted about an hour except for two interviews which lasted approximately 35 min because the participants had to abruptly leave to assist with an emergency medical case. For these two interviews, the researcher focused on questions that specifically ask for strengths and weaknesses. There were no follow-up interviews for this study. Data collection took place from mid-June to mid-July 2019. This study used framework analysis with the aim to manage and identify themes. SU transcribed all recorded interviews and translated transcripts into English where needed. This process helped the research to be familiar with the content of each interview and to get a general overview of each participant’s responses, while focusing on the relevance to the main objective of the study. Framework analysis was particularly chosen for this study because it helped the researchers to classify data in relation to the main imposed themes which are strengths and weaknesses of the TSAM-MNCH clinical mentoring model. This approach also enabled the research team to identify subthemes and to interpret data. The research team thoroughly reviewed and classified all ideas that emerged from the transcription process by focusing on the main objective as reflected in the research questions. Each participant was assigned a code and then personal identifiers were deleted to ensure confidentiality. The first set of coding process was done manually by SU and there was no use of any computer software. SU read all transcripts and conducted the first set of coding. Other members of the research team further independently reviewed the initial set of coding and suggested some additions to enhance the readability of the results. After revisions, codes were assigned to the themes and subthemes which emerged from the transcripts. Great attention was paid on quotes and statements which responded to the research themes. At the time of the study, the corresponding female researcher SU was a Master’s student at the University of Edinburgh in the School of Social and Political Science. SU is a certified qualitative research by Market Research Society. An information sheet (online supplemental file 2) was provided to participants right before starting the interviews and then a written consent form to voluntarily participate in this study was signed by both the researcher (SU) and the participant. The consent forms were signed in the hospital offices, the same location where the interviews were conducted only between the participant and the researcher. Only the researcher had access to the interview recordings and consent forms, and there was no name attached to any recording or quotation to maintain the privacy and the confidentiality of the participants. TSAM-MNCH did not know the identity of mentors who participated in the study. The researcher has only shared a final report with TSAM-MNCH with no mentors’ identities attached to it. The researcher’s occupation, experience and study purpose were communicated to all participants. The study carried no risk to the participants. bmjopen-2020-042523supp002.pdf The mentorship programme is one of the key priorities of the health sector in Rwanda.21 Therefore, the development of the research question and outcome measures were done keeping this priority in mind. This study sample was only made of mentors providing mentorship programme and there was no interaction with patients. Therefore, it was not applicable to involve patients in the design of this study. This is the same for the involvement of the patients in the recruitment process. However, since mentors are involved in the management of the patients and in the provision of health services, the results of the study will be disseminated with different stakeholders including the hospitals and the Ministry of Health as well as the mentors themselves with a view to improve the clinical mentoring programme. This will be done through different meetings at different levels.

I-AI Digest

Study Justification:

– The study aims to identify mentors’ perspectives on the strengths and weaknesses of the Training, Support and Access Model for Maternal, Newborn and Child Health (TSAM-MNCH) clinical mentorship program in Rwandan district hospitals.
– Understanding the mentors’ perspectives can aid in the improvement of the program’s implementation.
– The study provides insights into the strengths and weaknesses perceived by mentors, highlighting areas for improvement in the mentorship program.
– The findings shed light on Rwandan health system issues that need to be addressed to ensure better quality of care for mothers, newborns, and children.

Study Highlights:

– The study used a qualitative approach with in-depth interviews.
– 14 mentors who had completed at least six mentorship visits in three selected district hospitals participated in the study.
– The strengths of the mentorship program were identified as interprofessional collaboration and training.
– Inconsistency of mentoring activities and lack of resources were identified as major weaknesses of the program.
– The mentorship model encouraged a supportive mentorship environment, constructive feedback, and follow-up.
– Mentors and mentees collaborated to ensure the delivery of quality care through various teaching methodologies.

Study Recommendations:

– Improve consistency in mentoring activities and ensure the availability of necessary resources.
– Strengthen interprofessional collaboration and training within the mentorship program.
– Address the identified weaknesses to enhance the effectiveness of the mentorship model.
– Further address the identified health system issues to ensure better quality of care for mothers, newborns, and children.

Key Role Players:

– Mentors: Experienced healthcare providers permanently working in university referral hospitals.
– Gynaecologists/obstetricians, paediatricians, anaesthetists, midwives, and paediatric nurses: Health professionals involved in the mentorship program.
– District hospital management team: Involved in the development and implementation of the mentorship model.
– TSAM-MNCH administration: Responsible for the selection and coordination of mentors.
– Ministry of Health: Stakeholder involved in the dissemination of study results and improvement of the clinical mentoring program.

Cost Items for Planning Recommendations:

– Resources for mentoring activities: Ensure availability of necessary equipment, supplies, and materials.
– Training courses: Provide refresher courses in specific skills, mentoring training, simulation and debriefing training, and quality improvement training.
– Coordination meetings: Organize meetings with hospitals to address challenges and develop strategies for implementation.
– Evaluation tools: Develop tools for assessing mentees’ performance and evaluating the effectiveness of the mentorship program.
– Dissemination meetings: Conduct meetings with stakeholders to share study results and discuss improvements in the program.
Please note that the actual cost of these items is not provided, but they are important budget items to consider when planning the recommendations.

Amandla Obufakazi

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a qualitative study that used in-depth interviews to gather data from 14 mentors involved in the Training, Support and Access Model for Maternal, Newborn and Child Health (TSAM-MNCH) clinical mentorship programme in Rwandan district hospitals. The mentors identified strengths and weaknesses of the mentorship programme, highlighting interprofessional collaboration and training as strengths, and inconsistency of mentoring activities and lack of resources as weaknesses. The findings provide insights that can be used to improve the implementation of the mentorship programme. However, the evidence could be strengthened by including information on the methodology, such as the interview questions and data analysis process. Additionally, it would be helpful to provide more details on the mentorship programme itself, such as its objectives, activities, and outcomes. This would provide a clearer context for understanding the strengths and weaknesses identified by the mentors.

Abstract

The health system in Rwanda is dominated by publicly funded healthcare facilities that include health centres, dispensaries, district hospitals, national referral hospitals and university teaching hospitals.16 Compared with the health centres, district hospitals offer services with a higher level of complexity and expertise including surgeries and complex inpatient care such as the management of high-risk cases of mothers and children that have been referred from health centres.19 Rwanda has 42 district hospitals that serve as first-line referral hospitals and receive referrals from peripheral health facilities.20 District hospitals are generally staffed by nurses, midwives and generalist physicians with basic medical training.16 Despite the limited number of specialists and resources, district hospitals are fundamental to primary care, especially in remote areas.16 The mentorship activities were conducted in neonatal, maternity and paediatric wards in the district hospitals. Through consultations with different key actors, the mentoring model was developed in early 2017. The potential mentors to be part of this mentorship model were identified and selected among experienced healthcare providers permanently working in university (tertiary) referral hospitals. Consequently, mentors had to travel to take part in mentorship activities at the district hospitals where their mentees are based. Mentors were selected by TSAM-MNCH from different professional associations in their areas of competency. The selection was based on mentors’ medical expertise, competency and willingness to transfer skills. The programme was built on interprofessional collaboration which required mentors to work in a team. Each mentoring team had five health professionals consisting of a gynaecologist/obstetrician, a paediatrician, an anaesthetist, a midwife and a paediatric nurse. This was the first mentorship model to include anaesthesia providers recognising their crucial role in the reduction of maternal, newborn and child morbidity and mortality. Each mentor was assigned two to three mentees and each mentorship visit lasted 3 consecutive days, once in 2 months. Five hospitals in the Northern Province benefited from 15 mentorship visits, while the five hospitals in the Southern Province had 13 visits each. The selected mentors received refresher courses in specific skills in their specialty and a training course on mentoring. This course on mentoring included cross-cutting themes focusing on interprofessional collaboration, gender and ethics. In addition, mentors benefited from additional training including simulation and debriefing and quality improvement. The district hospital management team was involved in the development and implementation of the mentorship model to ensure ownership of the model. This was done through the organisation of the preparatory meetings with hospitals before launching the mentoring programme. Coordination meetings with beneficiaries and implementers identified strategies to overcome the challenges encountered throughout the implementation of the mentoring. Challenges and strategies to overcome them were developed during these meetings. Before starting mentorship activities, mentees filled out self-assessment surveys to identify areas that needed improvement. These surveys facilitated the mentor’s efforts to teach effectively according to mentees’ personal needs. The mentorship activities were based on the needs of each mentee and the gaps in each hospital service. Mentors also provided an assessment to give feedback to their mentees after each mentorship visit. The mentorship model encouraged a supportive mentorship environment for the mentor–mentee relationship and allowed constructive feedback and follow-up. In addition, the mentees’ performance was determined using evaluation tools. This mentorship model allows healthcare professionals to collaborate and to cross-consult to ensure the delivery of quality care. The teaching methodologies used by TSAM-MNCH mentors included bedside teaching and case scenario discussions, as well as simulation, case presentation, ward rounds, mortality and morbidity audit, debriefing sessions and managing clinical emergencies alongside the mentees.16 Each mentor works alongside their mentee to assist with daily medical assignments and assess the performance. The whole team of mentors and mentees can occasionally collaborate depending on the medical cases. This professional collaboration is most likely to happen because the mentorship programme focuses on areas that are inter-related. After each mentorship field visit, mentors fill out reflection forms. This study was a descriptive design using a qualitative approach to assess the perspectives of TSAM-MNCH mentors on the strengths and weaknesses of the mentorship model. The study participants included 50 active mentors mentoring health professionals in 10 district hospitals of TSAM-MNCH clinical mentorship programme catchment area. The researcher obtained a list of TSAM-MNCH mentors with their contact information from TSAM-MNCH administration, and then selected active mentors who had completed at least six mentorship field visits on a regular basis in TSAM-MNCH assigned district hospitals. This was to ensure that mentors have sufficient knowledge and are familiar with the mentorship programme. Initially, 18 mentors were purposively selected to participate in the study. Some participants were invited over the phone while others were invited face to face by the researcher. All the invitations were in Kinyarwanda language. With different reasons, four mentors were not able to participate, thus the study sample was 14 mentors who were representative of each profession. The sample consisted of three gynaecologists/obstetricians, three paediatricians, two anaesthetists, three midwives and three paediatric nurses. These four were not replaced because we observed that saturation was reached. Saturation was reached around the ninth interview and the researcher kept collecting data to make sure that each profession is represented in the study sample since the mentorship model is built on interprofessional collaboration and every profession plays a key and unique role in the programme. The methodology followed a Consolidated criteria for Reporting Qualitative research checklist (research checklist). Qualitative primary data were collected directly from participants using one-to-one in-depth interview. The interview guide (online supplemental file 1) was made up of 15 questions that led to an hour interview between the researcher and each participant. A semistructured interview guide was developed based on the research questions by the research team. Most questions were open ended and were based on mentorship activities and the perspectives of the mentors about the TSAM-MNCH mentorship model: its strengths, weaknesses, gaps as well as areas of improvements. The interviews were electronically recorded and field notes were taken by the researcher. bmjopen-2020-042523supp001.pdf All interviews took place in the hospital offices where mentors were conducting their mentorship visits and did not interfere with mentorship activities. Two interviews were done in the local language (Kinyarwanda) due to the participants’ request and level of comfort. A Kinyarwanda interview guide that had been prepared was used for the two interviews. In general, the interviews lasted about an hour except for two interviews which lasted approximately 35 min because the participants had to abruptly leave to assist with an emergency medical case. For these two interviews, the researcher focused on questions that specifically ask for strengths and weaknesses. There were no follow-up interviews for this study. Data collection took place from mid-June to mid-July 2019. This study used framework analysis with the aim to manage and identify themes. SU transcribed all recorded interviews and translated transcripts into English where needed. This process helped the research to be familiar with the content of each interview and to get a general overview of each participant’s responses, while focusing on the relevance to the main objective of the study. Framework analysis was particularly chosen for this study because it helped the researchers to classify data in relation to the main imposed themes which are strengths and weaknesses of the TSAM-MNCH clinical mentoring model. This approach also enabled the research team to identify subthemes and to interpret data. The research team thoroughly reviewed and classified all ideas that emerged from the transcription process by focusing on the main objective as reflected in the research questions. Each participant was assigned a code and then personal identifiers were deleted to ensure confidentiality. The first set of coding process was done manually by SU and there was no use of any computer software. SU read all transcripts and conducted the first set of coding. Other members of the research team further independently reviewed the initial set of coding and suggested some additions to enhance the readability of the results. After revisions, codes were assigned to the themes and subthemes which emerged from the transcripts. Great attention was paid on quotes and statements which responded to the research themes. At the time of the study, the corresponding female researcher SU was a Master’s student at the University of Edinburgh in the School of Social and Political Science. SU is a certified qualitative research by Market Research Society. An information sheet (online supplemental file 2) was provided to participants right before starting the interviews and then a written consent form to voluntarily participate in this study was signed by both the researcher (SU) and the participant. The consent forms were signed in the hospital offices, the same location where the interviews were conducted only between the participant and the researcher. Only the researcher had access to the interview recordings and consent forms, and there was no name attached to any recording or quotation to maintain the privacy and the confidentiality of the participants. TSAM-MNCH did not know the identity of mentors who participated in the study. The researcher has only shared a final report with TSAM-MNCH with no mentors’ identities attached to it. The researcher’s occupation, experience and study purpose were communicated to all participants. The study carried no risk to the participants. bmjopen-2020-042523supp002.pdf The mentorship programme is one of the key priorities of the health sector in Rwanda.21 Therefore, the development of the research question and outcome measures were done keeping this priority in mind. This study sample was only made of mentors providing mentorship programme and there was no interaction with patients. Therefore, it was not applicable to involve patients in the design of this study. This is the same for the involvement of the patients in the recruitment process. However, since mentors are involved in the management of the patients and in the provision of health services, the results of the study will be disseminated with different stakeholders including the hospitals and the Ministry of Health as well as the mentors themselves with a view to improve the clinical mentoring programme. This will be done through different meetings at different levels.

Izinto zokwakha

Emisha

Based on the information provided, here are some potential innovations that could be recommended to improve access to maternal health:

1. Telemedicine: Implementing telemedicine platforms that allow healthcare providers to remotely mentor and support healthcare professionals in district hospitals. This would reduce the need for mentors to travel and increase access to specialized knowledge and guidance.

2. Mobile Health (mHealth) Applications: Developing mobile applications that provide mentorship resources, training materials, and communication channels for mentors and mentees. This would facilitate ongoing mentorship and support, even in remote areas with limited resources.

3. E-Learning Platforms: Creating online platforms that offer interactive training modules and resources for healthcare professionals in maternal health. This would enable mentors to provide continuous education and support to mentees, regardless of their physical location.

4. Mentorship Networks: Establishing mentorship networks that connect mentors and mentees across different district hospitals. This would promote collaboration, knowledge sharing, and peer support among healthcare professionals involved in maternal health.

5. Strengthening Resources: Addressing the lack of resources in district hospitals by providing necessary equipment, supplies, and infrastructure to support maternal health services. This would enhance the effectiveness of the mentorship program and improve the quality of care provided.

6. Continuous Quality Improvement: Implementing a system for continuous quality improvement in district hospitals, with regular monitoring and evaluation of mentorship activities. This would help identify areas for improvement and ensure the mentorship program is meeting its objectives.

These innovations aim to leverage technology, collaboration, and resource strengthening to enhance access to maternal health services and improve the effectiveness of the mentorship program.

AI Innovations Description

The recommendation to improve access to maternal health based on the findings of the study is to address the weaknesses identified in the clinical mentorship program. The strengths of the program include interprofessional collaboration and training, which play a significant role in its successful implementation. However, the weaknesses identified include inconsistency of mentoring activities and lack of resources, which could hinder the effectiveness of the program.

To address these weaknesses and improve access to maternal health, the following recommendations can be considered:

1. Enhance consistency of mentoring activities: Implement a structured and regular schedule for mentorship visits to ensure that mentors are consistently present and available to provide guidance and support to mentees. This could involve setting specific dates and times for mentorship visits and ensuring that mentors adhere to the schedule.

2. Allocate adequate resources: Provide mentors with the necessary resources, such as medical equipment, supplies, and training materials, to effectively carry out their mentorship activities. This could involve conducting a needs assessment to identify the specific resources required and working with relevant stakeholders to secure funding and support for these resources.

3. Strengthen mentorship program management: Improve the coordination and management of the mentorship program by involving the district hospital management team in its development and implementation. This could include organizing regular coordination meetings with mentors, mentees, and other stakeholders to address challenges and develop strategies for overcoming them.

4. Conduct mentor and mentee assessments: Implement a system for mentor and mentee assessments to evaluate the effectiveness of the mentorship program and identify areas for improvement. This could involve using evaluation tools and self-assessment surveys to gather feedback from mentors and mentees on their experiences and the impact of the program.

5. Provide ongoing training and support: Offer mentors additional training opportunities, such as refresher courses and workshops, to enhance their skills and knowledge in mentoring and maternal health. This could also involve providing mentors with ongoing support and guidance through regular meetings or mentorship networks.

By implementing these recommendations, the clinical mentorship program can be strengthened and improved, leading to better access to maternal health services and improved quality of care for mothers, newborns, and children in Rwanda.

AI Innovations Methodology

Based on the provided description, here are some potential recommendations for improving access to maternal health:

1. Strengthening mentoring activities: Address the inconsistency of mentoring activities by ensuring regular and consistent mentorship visits to district hospitals. This can be achieved by establishing a clear schedule and timeline for mentorship visits. Additionally, provide mentors with the necessary resources and support to effectively carry out their mentorship activities.

2. Increasing availability of resources: Address the lack of resources by ensuring that district hospitals have the necessary equipment, supplies, and infrastructure to provide quality maternal health services. This may involve improving the procurement and distribution processes, as well as advocating for increased funding and support for maternal health services.

3. Enhancing interprofessional collaboration: Continue to promote and strengthen interprofessional collaboration among mentors and mentees. This can be achieved through regular team meetings, workshops, and training sessions that focus on fostering effective collaboration and communication among healthcare professionals.

4. Implementing quality improvement initiatives: Develop and implement quality improvement initiatives within district hospitals to address gaps in service delivery. This may involve conducting regular audits, identifying areas for improvement, and implementing evidence-based practices to enhance the quality of care provided to mothers and children.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify specific indicators that will be used to measure the impact of the recommendations. For example, indicators could include the number of mentorship visits conducted, availability of essential resources, levels of interprofessional collaboration, and improvements in quality of care.

2. Collect baseline data: Gather baseline data on the current state of access to maternal health services, including the availability of resources, the frequency of mentorship visits, and the level of interprofessional collaboration. This data will serve as a reference point for comparison.

3. Implement the recommendations: Put the recommendations into action by implementing the proposed changes, such as establishing a regular mentorship schedule, improving resource allocation, and promoting interprofessional collaboration.

4. Monitor and evaluate: Continuously monitor and evaluate the implementation of the recommendations. Collect data on the indicators identified in step 1 to assess the impact of the changes on access to maternal health services.

5. Analyze the data: Analyze the collected data to determine the extent to which the recommendations have improved access to maternal health services. Compare the data to the baseline data collected in step 2 to identify any significant changes or improvements.

6. Adjust and refine: Based on the analysis of the data, make any necessary adjustments or refinements to the recommendations. This may involve modifying the implementation strategies, reallocating resources, or addressing any challenges or barriers that were identified during the evaluation process.

7. Repeat the process: Continuously repeat the monitoring, evaluation, and adjustment process to ensure ongoing improvement in access to maternal health services. Regularly collect data and assess the impact of the recommendations to inform future decision-making and further enhance access to maternal health.

Ababhali & Co-Ababhali

Statistics:

Citations: 1

Authors: 8

Identifiers:

DOI: 10.1136/bmjopen-2020-042523

Research Areas:

Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Social Determinants, Workforce

Study Countries:

Rwanda

Study Design:

Cohort Study, Cross Sectional Study, Grounded Theory

Study Approach:

Qualitative

Participants Gender:

Female

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