The government plans to take on 20 experienced gynaecologists from different countries as it seeks to address the shortage of specialist doctors skilled in the treatment of women’s medical conditions, especially those related to the reproductive system, The New Times understands.
According to information from the Ministry of Health, more than 200 foreigners applied for the position to serve and train general practitioners into gynaecologists at 10 selected hospitals in Rwanda—a training programme that will last for four years.
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Dr Menelas Nkeshimana, Head of the Department of Health Workforce Development at the Ministry of Health Rwanda, told The New Times that the applicants are from different countries including Uganda, Kenya, Zambia, Egypt, and Ethiopia.
At the start, he said the government will, through a competitive process, take on 20 of them—two at each of the 10 hospitals.
He said it is expected that the programme will start in April, adding that it will be implemented in partnership with the University of Rwanda’s College of Medicine and Health Sciences.
On February 5, the Minister of Health, Dr Sabin Nsanzimana, told lawmakers that the country was looking for a way to deploy two more gynaecologists per each of the 10 selected teaching hospitals that have the potential to provide services that make people come to [referral hospitals] in Kigali.
The hospitals are Kibungo, Rwamagana, and Nyamata in Eastern Province, Kibogora and Kibuye in Western Province, Ruhengeri and Byumba in Northern Province, Kibagabaga in Kigali, Kabgayi in Southern Province—all of which are level-two teaching hospitals—and the University Teaching Hospital of Butare (CHUB) also located in Southern Province.
The development, Nsanzimana said, will decrease transfers of women, from hospitals in provinces, who need advanced healthcare from gynaecologists in Kigali.
Overall, Nkeshimana said the country has a small number of healthcare workers compared to the people they have to serve, indicating that, on average, the country has a ratio of one healthcare worker per 1,000 population. The healthcare workers, he said, include nurses, midwives, and medical doctors, pointing out that there were about 2,100 registered midwives in the country.
Such a ratio is lower than that recommended by the World Health Organization to have at least four healthcare workers per 1,000 population.
According to Nkeshimana, the shortage of medical personnel results in a situation where there is poor health service delivery. He said that there are 115 gynaecologists in Rwanda, who deal with all medical conditions affecting women, including pregnancy and related complications.
He mentioned that females in the fertility category, who can conceive at any time or are pregnant, are typically between 15 and 45 years old. He approximated that out of the 13 million Rwandan population, around 3.6 million fall within this age range.
"Understandably, they [gynaecologists] are few,” he said, adding that there is a challenge in distributing them among health facilities including hospitals because of their very limited number.
Training more gynaecologists
Nkeshimana indicated that addressing the shortage of gynaecologists can be done through training enough gynaecologists, including interesting students to pursue gynaecology courses while they are still in secondary school.
There is a need to at least quadruple the current number of gynaecologists, meaning to have more than 400 gynaecologists, which requires having enough training facilities, he said, indicating that studying a medical specialty is done at teaching hospitals, which is different from general medicine that can take place at the university campus.
Under the new move, Nkeshimana said they will select two qualified gynaecologists who also can teach, and deploy them at each of the 10 hospitals.
It is projected that four general medical practitioners will be enrolled in the programme at each of the 10 hospitals per year, which totals 160 beneficiaries in four years, including those who will have completed a four-year gynaecology programme, and those who will still be in the pipeline, Nkeshimana observed.
He said they will study on a scholarship and will continue serving at their respective hospitals and receiving their salaries.
On implication, he said, "Of course it’s an improvement,” indicating that residents will benefit through reduced distance and costs thanks to the availability of the needed healthcare close to them and offered by specialised medical personnel.
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Under Vision 2050, Rwanda targets to lower the maternal mortality rate to less than 50 per 100,000 live births by 2035, and less than 20 by 2050, from 203 per 100,000 live births as per the Rwanda Demographic and Health Survey (DHS) 2019/2020 (the latest one).
For the country to achieve the 2050 vision target, Nkeshimana said it has to increase its healthcare worker-population ratio to four healthcare workers per 1,000 people.