scholarly journals Increasing nursing student interest in rural healthcare: lessons from a rural rotation program in Democratic Republic of the Congo

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Susan Michaels-Strasser ◽  
Paul W. Thurman ◽  
Narcisse Mwinkeu Kasongo ◽  
Daniel Kapenda ◽  
John Ngulefac ◽  
...  
Keyword(s):  
Nursing Students ◽  
Rural Health ◽  
Nursing Student ◽  
Democratic Republic ◽  
Nursing Schools ◽  
Student Interest ◽  
Columbia University ◽  
Rural Healthcare ◽  
Republic Of The Congo ◽  
Rural Sites

Abstract Background Many challenges exist in providing equitable access to rural healthcare in the Democratic Republic of the Congo (DRC). WHO recommends student exposure to rural clinical rotations to promote interest in rural healthcare. Challenges to rural engagement include lack of adequate infrastructure and staff to lead rural education. This case report highlights key steps in developing a rural rotation program for DRC nursing students. Case presentation To implement a rural rotation (RR) program, ICAP at Columbia University (ICAP) consulted with students, the Ministries of Health (MoH) and Education (MoE), and nursing schools to pilot and expand a rural rotation program. Nursing schools agreed to place students in rural clinics and communities. Key stakeholders collaborated to assess and select rural sites based on availability of nursing mentors, educational resources, security, accessibility, and patient volume. To support this, 85 preceptors from 55 target schools and 30 rural health facilities were trained of which 30 were selected to be “master trainers”. These master trainers led the remaining 55 preceptors implementing the rural rotation program. We worked with rural facilities to engage community leaders and secure accommodation for students. A total of 583 students from five Lubumbashi schools and two rural schools outside Kinshasa participated across 16 rural sites (298 students in 2018–2019 school year and 285 in 2019–2020). Feedback from 274 students and 25 preceptors and nursing school leaders was positive with many students actively seeking rural assignments upon graduation. For example, 97% agreed or strongly agreed that their RR programs had strengthened their educational experience. Key challenges, however, were long-term financial support (35%) for rural rotations, adequate student housing (30%) and advocacy for expanding the rural workforce. Conclusions With nearly 600 participants, this project showed that a RR program is feasible and acceptable in resource-limited settings yet availability of ample student accommodation and increasing availability of rural jobs remain health system challenges. Using a multipronged approach to rural health investment as outlined by WHO over two decades ago remains essential. Attracting future nurses to rural health is necessary but not sufficient to achieve equitable health workforce distribution.

scholarly journals Increasing Nursing Student Interest in Rural Healthcare: Lessons From a Rural Rotation Program in Democratic Republic of the Congo

2020 ◽  
Author(s):  
Susan Michaels-Strasser ◽  
Paul W. Thurman ◽  
Narcisse Mwinkeu Kasongo ◽  
Daniel Kapenda ◽  
John Ngulefac ◽  
...  
Keyword(s):  
Nursing Students ◽  
Rural Health ◽  
Rural Areas ◽  
Democratic Republic ◽  
Rural Practice ◽  
School Year ◽  
Rural And Urban ◽  
Key Stakeholders ◽  
Republic Of The Congo ◽  
Rural Sites

Abstract BackgroundMany challenges exist in providing equitable access to healthcare in the Democratic Republic of the Congo (DRC) including resource disparities between rural and urban areas coupled with a majority rural population. One of the most promising ways to close the gap between rural and urban healthcare access and quality is through the support of human resources for health (HRH), especially nurses, in rural health settings. Current barriers including lack of nursing students from rural communities, insufficient infrastructure, and absence of programs for rural practice exposure, have allowed disparities between rural and urban healthcare to persist. MethodsTo implement a rural rotation (RR) program for nursing students in DRC, whereby students are immersed in a rural clinical and community placement for an extended period of time, ICAP at Columbia University (ICAP), with funding and support from the United States Health Resources Service Administration (HRSA), consulted with stakeholders in DRC including students, the Ministry of Health (MoH), the Ministry of Education (MoE), and nursing schools and associations to improve health workforce education including understanding the disparities and realities of rural health care. Following this, schools of nursing in the Lubumbashi area agreed to add nursing students into rural workforce settings, including time in clinical as well as community health on a rotational basis. ICAP then worked with the MoH and MoE to select rural sites that could adequately support rotating nursing students and develop expectations for the RR program. Assessments of the selected rural sites were conducted, and the availability of nursing mentors, teaching materials, security, and accessibility, as well as patient volumes, were identified. Building on prior work to strengthen preceptors, a training of trainers approach was used. Out of a cohort of 85 trained preceptors from across 55 target schools and 30 rural health facilities, 30 were selected to be “master trainers” based on their experience in training others, their performance in initial preceptor training, and willingness to contribute more to overall success of the RR program. These master trainers educated the remaining 55 preceptors in rural practice. Concurrent with the training, ICAP, along with the MoH and MoE, worked with communities around the rural health facilities to secure accommodations for nursing students and to engage them with community leaders for purposes of future health promotion and clinic collaboration.ResultsAll five target schools from the Lubumbashi area that were selected for the project chose to participate. Kinshasa was not targeted for the project but did have two schools in rural areas outside the urban center interested and willing to accept students on rotations. Over the life of the project, 583 students successfully participated in the program and completed rural rotations as planned. Sixteen rural sites and 298 students participated in the rotational program during the 2018-2019 school year. For the 2019-2020 school year (through March), 285 students participated.Post-rotation feedback RECEIVED FROM 274 students, as well as from over 25 preceptors, and nursing school leaders, has been very positive and has resulted in more nursing students seeking rural assignments upon completion of their studies. Ninety-three percent of students surveyed, for example, indicated that they agreed or strongly agreed that they would recommend participation in RR programs to their classmates. Ninety-seven percent agreed or strongly agreed that their RR program had strengthened their education experience and increased their willingness to serve in rural areas in the future. The most significant challenges, however, were financial support (35%) and housing (30%).ConclusionsWith nearly 600 successful participants, this project showed that a RR program is both feasible and acceptable for nursing students, faculty, and rural clinic staff in resource-limited settings. Student exposure to rural practice is critical to increasing interest (and therefore downstream HRH staffing) in rural area healthcare. ICAP, HRSA, and DRC ministry leadership believe these early successes are indicative of both the opportunity available and value-added of such a RR program. Going forward, HRSA, ICAP and key stakeholders will continue to collaborate to sustain this project and advocate for employment and placement of student nurses who expressed interest, into rural employment following graduation. In addition, expanding such programs to other majority rural areas of sub-Saharan Africa seems both feasible and affordable with the right up-front collaborations and program design with key stakeholders.

scholarly journals Acceptability of the community-level provision of Sayana® Press by medical and nursing students in Kinshasa, Democratic Republic of the Congo

Contraception ◽  
2017 ◽  
Vol 96 (3) ◽  
pp. 211-215 ◽  
Author(s):  
Jane T. Bertrand ◽  
Paul Bukutuvwidi Makani ◽  
Julie Hernandez ◽  
Pierre Akilimali ◽  
Bitshi Mukengeshayi ◽  
...  
Keyword(s):  
Nursing Students ◽  
Democratic Republic ◽  
Community Level ◽  
Republic Of The Congo

scholarly journals Facility conditions, obstetric and neonatal care practices, and availability of emergency obstetric and neonatal care in 72 rural health facilities in the Democratic Republic of the Congo: A cross-sectional study

2019 ◽  
Vol 3 ◽  
pp. 13
Author(s):  
Rebecca Carter ◽  
Xu Xiong ◽  
Paul-Samson Lusamba-Dikassa ◽  
Elvis C. Kuburhanwa ◽  
Francine Kimanuka ◽  
...  
Keyword(s):  
Rural Health ◽  
Postnatal Care ◽  
Democratic Republic ◽  
Neonatal Care ◽  
Health Facilities ◽  
Facility Conditions ◽  
Facility Type ◽  
Republic Of The Congo ◽  
Care Practices ◽  
Delivery Rooms

Background: Current facility conditions, obstetric and neonatal care practices, and availability of emergency obstetric and neonatal care (EmONC) were assessed in the Kwango and Kwilu provinces of the Democratic Republic of the Congo (DRC). Methods: This is an analysis of the baseline survey data from an ongoing clinical mentoring program among 72 rural health facilities in the DRC. Data collectors visited each of the facilities and collected data through a pre-programmed smartphone. Frequencies of selected indicators were calculated by province and facility type—general referral hospital (GRH) and primary health centers (HC). Results: Facility conditions varied across province and facility type. Maternity wards and delivery rooms were available in the highest frequency of rooms assessed (>95% of all facilities). Drinking water was available in 25.0% of all facilities; electricity was available in 49.2% of labor rooms and 67.6% of delivery rooms in all facilities. Antenatal, delivery, and postnatal care services were available but varied across facilities. While the proportion of blood pressure measured during antenatal care was high (94.9%), the antenatal screening rate for proteinuria was low (14.7%). The use of uterotonics immediately after birth was observed in high numbers across both provinces (94.4% in Kwango and 75.6% in Kwilu) and facility type (91.3% in GRH and 81.4% in HC). The provision of immediate postnatal care to mothers every 15 minutes was provided in less than 50% of all facilities. GRH facilities generally had higher frequencies of available equipment and more services available than HC. GRH facilities provided an average of 6 EmONC signal functions (range: 2-9). Conclusions: Despite poor facility conditions and a lack of supplies, GRH and HC facilities were able to provide EmONC care in rural DRC. These findings could guide the provision of essential needs to the health facilities for better delivery of maternal and neonatal care.

scholarly journals Facility conditions, obstetric and neonatal care practices, and availability of emergency obstetric and neonatal care in 72 rural health facilities in the Democratic Republic of the Congo: A cross-sectional study

2019 ◽  
Vol 3 ◽  
pp. 13 ◽  
Author(s):  
Rebecca Carter ◽  
Xu Xiong ◽  
Paul-Samson Lusamba-Dikassa ◽  
Elvis C. Kuburhanwa ◽  
Francine Kimanuka ◽  
...  
Keyword(s):  
Rural Health ◽  
Postnatal Care ◽  
Democratic Republic ◽  
Neonatal Care ◽  
Health Facilities ◽  
Facility Conditions ◽  
Facility Type ◽  
Republic Of The Congo ◽  
Care Practices ◽  
Delivery Rooms

Background: Current facility conditions, obstetric and neonatal care practices, and availability of emergency obstetric and neonatal care (EmONC) were assessed in the Kwango and Kwilu provinces of the Democratic Republic of the Congo (DRC). Methods: This is an analysis of the baseline survey data from an ongoing clinical mentoring program among 72 rural health facilities in the DRC. Data collectors visited each of the facilities and collected data through a pre-programmed smartphone. Frequencies of selected indicators were calculated by province and facility type—general referral hospital (GRH) and primary health centers (HC). Results: Facility conditions varied across province and facility type. Maternity wards and delivery rooms were available in the highest frequency of rooms assessed (>95% of all facilities). Drinking water was available in 25.0% of all facilities; electricity was available in 49.2% of labor rooms and 67.6% of delivery rooms in all facilities. Antenatal, delivery, and postnatal care services were available but varied across facilities. While the proportion of blood pressure measured during antenatal care was high (94.9%), the antenatal screening rate for proteinuria was low (14.7%). The use of uterotonics immediately after birth was observed in high numbers across both provinces (94.4% in Kwango and 75.6% in Kwilu) and facility type (91.3% in GRH and 81.4% in HC). The provision of immediate postnatal care to mothers every 15 minutes was provided in less than 50% of all facilities. GRH facilities generally had higher frequencies of available equipment and more services available than HC. GRH facilities provided an average of 6 EmONC signal functions (range: 2-9). Conclusions: Despite poor facility conditions and a lack of supplies, GRH and HC facilities were able to provide EmONC care in rural DRC. These findings could guide the provision of essential needs to the health facilities for better delivery of maternal and neonatal care.

Constitutional Incorporation of the (Collective) Freedom to Govern Mineral Wealth: Comparing the Democratic Republic of the Congo and the Republic of Zambia

2020 ◽  
Vol 28 (1) ◽  
pp. 1-29
Author(s):  
Alexandra Carleton
Keyword(s):  
Natural Resources ◽  
Democratic Republic ◽  
Mineral Wealth ◽  
The People ◽  
Republic Of The Congo ◽  
The Republic

Constitutionalism may be gaining ascendancy in many countries in Africa. Yet thorough investigation of the extent to which current constitutions accord to the people their internationally recognised right to governance of their mineral wealth under Article 1(2) of the ICCPR has been lacking. Understanding the existing framework of rights which may support claims to land and natural resources is important. Constitutions of the Democratic Republic of the Congo and the Republic of Zambia demonstrate the reality of multiple, overlapping land interests and the limitations upon a people's claim to freely govern their mineral wealth.

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