Enhancing Formal Educational and In-Service Training Programs in Rural Rwanda: A Partnership Among the Public Sector, a Nongovernmental Organization, and Academia

Cancedda, Corrado MD, PhD; Farmer, Paul E. MD, PhD; Kyamanywa, Patrick MD, MMed, MPH; Riviello, Robert MD, MPH; Rhatigan, Joseph MD; Wagner, Claire M.; Ngabo, Fidele MD; Anatole, Manzi MPhil, MPH; Drobac, Peter C. MD, MPH; Mpunga, Tharcisse MD; Nutt, Cameron T.; Kakoma, Jean Baptiste MD, PhD, MMed; Mukherjee, Joia MD, MPH; Cortas, Chadi MD, MSc, MPH; Condo, Jeanine MD, MSc, PhD; Ntaganda, Fabien MD, MMed; Bukhman, Gene MD, PhD; Binagwaho, Agnes MD

Academic Medicine:
doi: 10.1097/ACM.0000000000000376
Articles
Abstract

Global disparities in the distribution, specialization, diversity, and competency of the health workforce are striking. Countries with fewer health professionals have poorer health outcomes compared with countries that have more. Despite major gains in health indicators, Rwanda still suffers from a severe shortage of health professionals.

This article describes a partnership launched in 2005 by Rwanda’s Ministry of Health with the U.S. nongovernmental organization Partners In Health and with Harvard Medical School and Brigham and Women’s Hospital. The partnership has expanded to include the Faculty of Medicine and the School of Public Health at the National University of Rwanda and other Harvard-affiliated academic medical centers. The partnership prioritizes local ownership and—with the ultimate goals of strengthening health service delivery and achieving health equity for poor and underserved populations—it has helped establish new or strengthen existing formal educational programs (conferring advanced degrees) and in-service training programs (fostering continuing professional development) targeting the local health workforce. Harvard Medical School and Brigham and Women’s Hospital have also benefited from the partnership, expanding the opportunities for training and research in global health available to their faculty and trainees.

The partnership has enabled Rwandan health professionals at partnership-supported district hospitals to acquire new competencies and deliver better health services to rural and underserved populations by leveraging resources, expertise, and growing interest in global health within the participating U.S. academic institutions. Best practices implemented during the partnership’s first nine years can inform similar formal educational and in-service training programs in other low-income countries.

Author Information

Dr. Cancedda is associate physician, Divisions of Global Health Equity and Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, instructor of medicine, Harvard Medical School, Boston, Massachusetts, and former director of medical education and training, Partners In Health Rwanda/Inshuti Mu Buzima, Rwinkwavu, Rwanda.

Dr. Farmer is associate physician and division chief, Divisions of Global Health Equity and Infectious Diseases, Brigham and Women’s Hospital, professor of medicine and department chair, Department of Global Health and Social Medicine, Harvard Medical School, and cofounder, Partners In Health, Boston, Massachusetts.

Dr. Kyamanywa is dean and associate professor, School of Medicine, University of Rwanda, College of Medicine and Health Sciences, Butare, Rwanda.

Dr. Riviello is director, Global Surgery Programs, Brigham and Women’s Hospital, Center for Surgery and Public Health, instructor in surgery, Harvard Medical School, and director, Global Surgery Programs, Partners In Health, Boston, Massachusetts.

Dr. Rhatigan is associate physician and associate division chief, Division of Global Health Equity, Brigham and Women’s Hospital, instructor in medicine, Harvard Medical School, and director, Global Health Delivery Partnership, Partners In Health, Boston, Massachusetts.

Ms. Wagner is research fellow, Global Health Delivery Partnership, Harvard Medical School, Boston, Massachusetts.

Dr. Ngabo is director, Division of Maternal and Child Health, Ministry of Health, Kigali, Rwanda.

Mr. Anatole is program director, Mentoring and Enhanced Supervision–Quality Improvement Program, Partners In Health Rwanda/Inshuti Mu Buzima, Rwinkwavu, Rwanda.

Dr. Drobac is associate physician, Divisions of Global Health Equity and Infectious Diseases, Brigham and Women’s Hospital, Boston, Massachusetts, instructor in medicine, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, executive director, Partners In Health Rwanda/Inshuti Mu Buzima, Rwinkwavu, Rwanda, and chair, Board of Directors, Rwanda Biomedical Center, Kigali, Rwanda.

Dr. Mpunga is physician, Ministry of Health of Rwanda, Kigali and medical director, Butaro Hospital, Butaro, Rwanda.

Mr. Nutt is research fellow, Dartmouth Center for Health Care Delivery Science, Hanover, New Hampshire.

Dr. Kakoma is dean and professor, School of Public Health, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda.

Dr. Mukherjee is associate physician, Divisions of Global Health Equity and Infectious Diseases, Brigham and Women’s Hospital, associate professor, Department of Global Health and Social Medicine, Harvard Medical School, and chief medical officer, Partners In Health, Boston, Massachusetts.

Dr. Cortas is associate physician, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, instructor of medicine, Harvard Medical School, Boston, Massachusetts, and director of medical education and training, Partners In Health Rwanda/Inshuti Mu Buzima, Kigali, Rwanda.

Dr. Condo is deputy director for research, School of Public Health, University of Rwanda, College of Medicine and Health Sciences, Kigali, Rwanda.

Dr. Ntaganda is physician, National Cancer Program, Ministry of Health of Rwanda, Kigali, Rwanda.

Dr. Bukhman is associate physician, Division of Global Health Equity, Brigham and Women’s Hospital, Boston, Massachusetts, assistant professor of medicine and director, Program in Global Non-Communicable Diseases and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, senior advisor for health and policy, Partners In Health, Boston, Massachusetts, and director, Non Communicable Diseases Synergies Initiative, Kigali, Rwanda.

Dr. Binagwaho is minister of health, Ministry of Health of Rwanda, Kigali, Rwanda, senior lecturer, Department of Global Health and Social Medicine, Harvard Medical School, and clinical professor of pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.

Funding/Support: Although this reflective analysis was not funded by any specific grants, the authors are grateful for the support of the Government of Rwanda; the Global Fund to Fight AIDS, Tuberculosis and Malaria; the U.S. President’s Emergency Plan for AIDS Relief; Partners In Health; Brigham and Women’s Hospital; Harvard Medical School; the Clinton Health Access Initiative; the Bill and Melinda Gates Foundation; and the Doris Duke Charitable Foundation.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Dr. Cancedda, Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave., Boston, MA 02115; telephone: (617) 432-1707; e-mail: ccancedda@partners.org.

© 2014 by the Association of American Medical Colleges