A Cuban medical brigade is in Rwanda as part of the early phases of implementing the 4x4 strategy, which aims to quadruple the health workforce in the next four years.
In July 2023, the Government of Rwanda approved a 4×4 Reform, a strategy aimed at increasing the number of healthcare workers in the country to meet the WHO recommendation of at least four healthcare professionals per 1,000 people.
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Following the signing of agreements between Rwanda and Cuba in Havana earlier this year, a Cuban medical team coordinator arrived in Kigali on May 10.
Subsequent teams were scheduled to arrive in groups, with the first group of 11 doctors arriving on May 29, the second group of 13 on May 31, and the third group of 15 on June 3, according to Dr. Menelas Nkeshimana, Head of the Department of Health Workforce Development at the Ministry of Health.
"The fourth group will arrive in a few days, making a total of 47 specialist doctors and specialized nurses deployed across Rwanda in our teaching hospitals. Their arrival coincides with the implementation of the 4x4 strategy,” Nkeshimana said.
He highlighted that this mission includes a health education component in addition to clinical services delivery, emphasizing that the Cuban medical brigade is instrumental in activating Level 2 Teaching Hospitals in Rwanda.
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Together with local clinical teams, the Cuban medical professionals will participate in educating local medical trainees in Rwanda’s Teaching Hospitals. Nkeshimana noted that the Cubans are highly skilled and their expertise in areas such as critical care and surgical interventions will be transferred to the local health workforce.
Nkeshimana also mentioned that Rwanda faces challenges with the migration of its health workforce, a trend seen over the last decades, including movements from rural to urban areas and from low or middle-income countries to higher-income countries.
"This issue has political, diplomatic, and legal dimensions, hence the adoption of the WHO Global Code of Practice on International Recruitment of Health Personnel 20 years ago. Better payment is not the only factor influencing the migration of health personnel; there are many non-monetary incentives that connect a person to their country,” Nkeshimana said.
He added that the 4x4 strategy includes non-monetary incentives such as improved working environments, modern equipment, transportation and housing facilitation, and meals at the workplace.
"We are working on all these areas simultaneously. If a Rwandan medic wants to leave today for the Western world, we wouldn’t stop them, because we all know there is only one Rwanda, and home is best. Our job is to ensure they are well trained in Rwanda, work in an environment that enables them to perform well, and continuously improve their welfare. There was extensive work done when the 4x4 strategy was being developed,” he stressed.
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Nkeshimana noted that all relevant offices collaborated to enhance the training capacity in Rwanda, improve infrastructure and equipment in teaching hospitals and training institutions, address faculty needs per program, and overcome financial limitations that can prevent eligible trainees from completing their training.
He highlighted that a cooperation MoU binding all teaching hospitals, training institutions, and regulatory councils ensures that the collaboration provides quality training, licensing, and employment in an efficient manner.
Partner organisations are informed that this reform, along with other reforms communicated in July 2023, constitutes a health sector priority for which joint mobilization of resources and regular assessments are performed during implementation, Nkeshimana added.