Background Community-based health insurance (CBHI) schemes are an emerging mechanism for providing financial protection against health-related poverty. In Rwanda, CBHI is being implemented across the country, and it is based on four socioeconomic categories of the “Ubudehe system”: the premiums of the first category are fully subsidized by government, the second and third category members pay 3000 frw, and the fourth category members pay 7000 frw as premium. However, low adherence of community to the scheme since 2011 has not been sufficiently studied. Objective This study aimed at determining the factors contributing to low adherence to the CBHI in rural Nyanza district, southern Rwanda. Methodology A cross-sectional study was conducted in nine health centers in rural Nyanza district from May 2017 to June 2017. A sample size of 495 outpatients enrolled in CBHI or not enrolled in the CBHI scheme was calculated based on 5% margin of error and a 95% confidence interval. Logistic regression was used to identify the determinants of low adherence to CBHI. Results The study revealed that there was a significant association between long waiting time to be seen by a medical care provider and between health care service provision and low adherence to the CBHI scheme (P value < 0.019) (CI: 0.09107 to 0.80323). The estimates showed that premium not affordable (P value < 0.050) (CI: 0.94119 to 9.8788) and inconvenient model of premium payment (P value < 0.001) (CI: 0.16814 to 0.59828) are significantly associated with low adherence to the CBHI scheme. There was evidence that the socioeconomic status as measured by the category of Ubudehe (P value < 0.005) (CI: 1.4685 to 8.93406) increases low adherence to the CBHI scheme. Conclusion This study concludes that belonging to the second category of the Ubudehe system, long waiting time to be seen by a medical care provider and between services, premium not affordable, and inconvenient model of premium payment were significant predictors of low adherence to CBHI scheme.
Background Delay in the first surgery start time at operating room (OR) could inevitably decrease utilization, lose very expensive OR resources, reduce satisfaction of patients and staff and potentially affect quality of patient care. Objectives This study utilized the Strategic Problem Solving (SPS) quality improvement approach to increase the percentage of first surgeries started on time at a tertiary hospital in Rwanda. Methods A pre-and post-intervention study was conducted between March 2016 and March 2017. The intervention included developing a policy on staff arrival time, training sessions on the policy and regular supervision of OR managers to ensure staff were arriving on time. Results Chi square tests were performed to analyze the pre-and post-intervention results. The percentage of first surgeries started on time significantly increased from 3% pre-intervention to 25% postintervention (P<0.001), average duration of delay decreased by 55 minutes (P<0.001) and the percentages of nurses, anesthetists and surgeon arrived on time also significantly increased (P<0.001). Conclusion The SPS approach can be useful in addressing the starting time of first surgery at OR. Support from the senior management team and buy-in from staff are essential. This project cannot eliminate confounding factors and the results cannot be generalizable to other settings. Longer term evaluation on sustainability is needed.
BackgroundAlthough blended learning (BL) is being adopted in public and private higher learning institutions (HLIs) in Rwanda, little is known about students’ use of BL in their learning activities. This article describes a qualitative descriptive study of students’ perceptions and experiences of BL in Rwanda’s post-secondary nursing and midwifery programs in public and private HLIs.MethodsThirty-three nursing and midwifery students from all public and private HLIs in Rwanda exposed to BL were invited to participate in three online focus group discussions (FGDs) conducted using a developed FGD guide with open-ended questions. Inductive content analysis was used to analyze the transcripts.ResultsThree main themes emerged from the data analysis:(1) BL perceived as a new and effective teaching and learning approach, (2) Contextual challenges to the BL method, and (3) Recommendations to improve the BL method. From students’ experiences, the benefits included but were not limited to the flexibility of the approach, time, and cost-saving. However, several challenges were identified, including technological issues such as lack of ICT skills and poor internet connectivity.ConclusionThis study provides insights into the usefulness of BL in HLIs and offers recommendations on how BL teaching and learning can be improved to strengthen nursing and midwifery pre-service education quality.Rwanda J Med Health Sci 2022;5(2):203-215
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