Mentorship and Enhanced Supervision for Health Care and Quality Improvement in Rwanda

Nurses are the linchpin of health care. They vastly outnumber physicians and often are the chief primary care providers for patients in hospitals, health centers, and clinics around the world. This is the case in Rwanda, though the country has experienced a decades-long shortage of clinicians. Rwanda's supply of nurses, at 0.7 per 1,000 residents, is more constrained even than those of other resource-limited countries. Additionally, training and skill levels are inconsistent among nurses who work in the country, which can result in diminished quality of care.

While Rwanda's Ministry of Health has embarked on a long-term plan to increase the quantity of health care workers in the country, Partners In Health / Inshuti Mu Buzima (PIH/IMB) has collaborated with the Ministry of Health to improve the quality of care delivery and systems through the Mentorship and Enhanced Supervision for Health Care and Quality Improvement (MESH-QI) program. Since its launch in 2010, MESH-QI has connected nurse mentors with advanced training to nurses at rural health centers to improve quality of care. Mentors travel to the health centers to provide specialized training in areas such as HIV, noncommunicable diseases, and maternal and child health, as well as face-to-face support and feedback to mentees. The mentors also collect data that is used to inform program activities and further improve care.

Since MESH-QI's implementation, PIH/IMB has seen a higher quality of care delivery--from improved disease screening to better management of patients, to preliminary gains in clinical outcomes. MESH-QI also has been adapted for use in district hospitals, which has led to improvements in patient care and safety. Well-received by Rwanda's Ministry of Health, the program also has informed a national model of HIV mentorship, and it is being used by other PIH sites around the world to address the unique challenges facing their health systems.