Abstract
Background: Low- and lower-middle-income countries (LMICs) account for 89% of the global shortage of nurses and midwives,1,2 with inadequate training to address population health needs.3,4 Nurse leaders are vital in addressing this shortage through education and training.5 One approach to nurse leadership development is to foster partnerships between institutions and governments in high-income countries and LMICs through twinning.6 Twinning partnerships were exemplified by the Rwanda Human Resources for Health (HRH) program (2012-2019). While twinning partnerships are beneficial in training nurse leaders in LMICs,7,8,9 not enough is known about the factors that affect global health nurse leaders' twinned partnerships.
Methods: A qualitative descriptive study was conducted to gain an in-depth understanding of factors that affected twinned partnerships between Rwandan and US. Faculty-nurse leaders (RNL/USFNL) in the HRH program. Purposeful sampling was used to recruit RNL and USFNL who participated in the HRH program (2013-2018). The study was conducted at two teaching and referral hospitals and the University of Rwanda. Data were gathered through semi-structured in-depth interviews, observations, and document analysis. The study was guided using Upvall and Leffers’s revised conceptual model of partnership and sustainability in global health.10
Results: The study included 10 RNL and 10 USNL (10 dyads) ranging from 30-80 years of age and associate to PhD degrees in education. Participants reported that language barriers considerably affected the effectiveness of twinning partnerships during the implementation of the HRH program. Participants felt a clear framework and guidelines were absent for program implementation. Consequently, the program's initiatives were not systematically monitored or evaluated. RNLs and USFNLs were instrumental in improving Rwanda's healthcare workforce. A key achievement was launching the first master’s program in 8 nursing specialties (2015), supported by the Ministry of Health, with the midwifery track added in 2022.
Conclusion: In this qualitative exploration, RNL and USFNL, in a twinning partnership, led innovative solutions to prepare the nursing workforce, including developing Rwanda’s first master's nursing program. Future global health nurse leadership programs and partnerships should prioritize using frameworks for effective monitoring & evaluation and address language barriers by considering culture and linguistic history.
Notes
References:
1. Buchan, J., Catton, H. (2023). Recover to Rebuild: Investing in the Nursing Workforce for Health System Effectiveness. International Council of Nurses. https://www.icn.ch/sites/default/files/2023-07/ICN_Recover-to-Rebuild_report_EN.pdf
2. World Health Organization. (2021). Global Strategic Directions for Nursing and Midwifery 2021-2025. https://iris.who.int/bitstream/handle/10665/344562/9789240033863-eng.pdf?sequence=1
3. World Health Organization. (2010). Strategic directions for strengthening nursing and midwifery services 2011–2015. http://apps.who.int/iris/bitstream/10665/70526/1/WHOHRH_HP N_10.1_eng.pdf
4. Azad, A., Min, J. G., Syed, S., & Anderson, S. (2020). Continued nursing education in low-income and middle-income countries: a narrative synthesis. BMJ global health, 5(2), e001981. https://doi.org/10.1136/bmjgh-2019-001981
5. Kim, M. J., Woith, W., Otten, K., & McElmurry, B. J.(2006). Global Nurse Leaders: Lessons from the Sages. Advances in Nursing Science; ANS Adv Nurs Sci, 29(1) 27-42. doi: 10.1097/00012272-200601000-00004
6. Riviello, R., Ozgediz, D., Hsia, R. Y., Azzie, G., Newton, M., & Tarpley, J. (2010). Role of collaborative academic partnerships in surgical training, education, and provision. World Journal of Surgery; World J Surg, 34(3), 459-465. doi:10.1007/s00268-009-0360-4
7. Busse, H., Azazh, A., Teklu, S., Tupesis, J. P., Woldetsadik, A., Wubben, R. J., & Tefera, G. (2013). Creating change through collaboration: A twinning partnership to strengthen emergency medicine at Addis Ababa University/Tikur Anbessa specialized hospital-A model for international medical education partnerships. Academic Emergency Medicine; Acad Emerg Med, 20(12), 1310- 1318. doi:10.1111/acem.12265
8. Ndenga, E., Uwizeye, G., Thomson, D. R., Uwitonze, E., Mubiligi, J., Hedt- Gauthier, B., . ..Binagwaho, A. (2016). Assessing the twinning model in the Rwandan human resources for health program: Goal setting, satisfaction, and perceived skill transfer. Globalization and Health; Global Health, 12(1), 4-4. doi:10.1186/s12992-016-0141-4
9. Sandwell, R., Bonser, D., Hebert, E., Kilroy, K., Leshabari, S., Mwanga, F., . . .Moritz, (2018). Stronger together: Midwifery twinning between Tanzania and Canada. Globalization and Health; Global Health, 14(1), 123. doi:10.1186/s12992-018- 0442-x
10. Upvall, M. J., & Leffers, J. M. (2018). Revising a conceptual model of partnership and sustainability in global health. Public Health Nursing (Boston, Mass.); Public Health Nurs, 35(3), 228-237. doi:10.1111/phn.12396
Sigma Membership
Alpha Lambda
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Descriptive/Correlational
Research Approach
Qualitative Research
Keywords:
Global Leadership, Workforce, Academic-Clinical Partnership, Nurse Leadership Development, Low-Income Countries, Lower-Middle-Income Countries, LMICs
Recommended Citation
Lubimbi, Nanyombi; Pintye, Jillian; Neubauer, Leah C.; Mukeshimana, Madeleine; Crooks, Natasha; Jeremiah, Rohan; Abboud, Sarah; and Fritschi, Cynthia, "Exploring Factors Affecting Global Health Nurse Partnerships: Rwanda Human Resources-Health Program" (2025). International Nursing Research Congress (INRC). 158.
https://www.sigmarepository.org/inrc/2025/presentations_2025/158
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, USA
Conference Year
2025
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All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Exploring Factors Affecting Global Health Nurse Partnerships: Rwanda Human Resources-Health Program
Seattle, Washington, USA
Background: Low- and lower-middle-income countries (LMICs) account for 89% of the global shortage of nurses and midwives,1,2 with inadequate training to address population health needs.3,4 Nurse leaders are vital in addressing this shortage through education and training.5 One approach to nurse leadership development is to foster partnerships between institutions and governments in high-income countries and LMICs through twinning.6 Twinning partnerships were exemplified by the Rwanda Human Resources for Health (HRH) program (2012-2019). While twinning partnerships are beneficial in training nurse leaders in LMICs,7,8,9 not enough is known about the factors that affect global health nurse leaders' twinned partnerships.
Methods: A qualitative descriptive study was conducted to gain an in-depth understanding of factors that affected twinned partnerships between Rwandan and US. Faculty-nurse leaders (RNL/USFNL) in the HRH program. Purposeful sampling was used to recruit RNL and USFNL who participated in the HRH program (2013-2018). The study was conducted at two teaching and referral hospitals and the University of Rwanda. Data were gathered through semi-structured in-depth interviews, observations, and document analysis. The study was guided using Upvall and Leffers’s revised conceptual model of partnership and sustainability in global health.10
Results: The study included 10 RNL and 10 USNL (10 dyads) ranging from 30-80 years of age and associate to PhD degrees in education. Participants reported that language barriers considerably affected the effectiveness of twinning partnerships during the implementation of the HRH program. Participants felt a clear framework and guidelines were absent for program implementation. Consequently, the program's initiatives were not systematically monitored or evaluated. RNLs and USFNLs were instrumental in improving Rwanda's healthcare workforce. A key achievement was launching the first master’s program in 8 nursing specialties (2015), supported by the Ministry of Health, with the midwifery track added in 2022.
Conclusion: In this qualitative exploration, RNL and USFNL, in a twinning partnership, led innovative solutions to prepare the nursing workforce, including developing Rwanda’s first master's nursing program. Future global health nurse leadership programs and partnerships should prioritize using frameworks for effective monitoring & evaluation and address language barriers by considering culture and linguistic history.
Description
Language barriers and a lack of clear framework utilization affected the effectiveness of twinned partnerships.