Similar to its perspective on the urgency of scaling up access to HAART in the early 2000s, the Rwandan Ministry of Health viewed a systematic effort to address long-term care for patients with HIV infection and those with noncommunicable diseases as a triple imperative: moral, epidemiologic, and economic. In line with the Health Sector Strategic Plan II16 as well as the WHO building blocks for health systems strengthening17 and the Treat, Train, Retain initiative,18 the Ministry of Health identified the strengthening of a specialized health workforce in Rwanda as a priority step toward fulfilling the triple imperative while sustaining infectious-disease control. In 2011, its technical working group on Human Resources for Health developed a long-term strategy and implementation plan to increase the quantity of health professionals in the country, as well as the quality and diversity of their training.15,19

Table 2. Table 2. Institutions Affiliated with the Human Resources for Health Program.

The Ministry of Health asked the Clinton Health Access Initiative — an organization that first came to Rwanda in 2002 to assist the government in the planning of its response to HIV and AIDS — to extend invitations to leading universities and academic medical centers from across the United States for the establishment of an academic consortium. With a planning grant from the ELMA Foundation, the Clinton Health Access Initiative convened a U.S. academic consortium that included 16 academic medical centers, six schools of nursing, one school of public health, and two dental schools (Table 2) to forge a 7-year partnership with the government of Rwanda. The Human Resources for Health Program focuses on knowledge transfer, sustained collaboration, and the establishment of new medical residency, nursing specialty, health management, and oral health programs within the Rwandan education system.

Launched in August 2012, the program deploys nearly 100 U.S. faculty members to Rwanda each year. Each school in the consortium sends full-time faculty members for 1-year periods to partner with Rwandan faculty-member counterparts in direct academic and clinical teaching. Several subspecialist physicians from the United States rotate throughout the year as well. The “twinning” model of the program facilitates curriculum development, clinical pedagogy, service delivery, and research capacity to develop the careers and skills of Rwandan specialist clinicians and educators who will assume all teaching and care delivery after 7 years. The model also enables scholarly collaborations between Rwandan and American training partners for clinical innovation and service delivery that will be valuable to both sides, ideally outlasting the program itself. American faculty returning to their home institutions after participating in the Human Resources for Health Program will play an integral role in strengthening global health curricula.20

Table 3. Table 3. Primary Education and Training Areas in the Human Resources for Health Program.

Rwandan students who benefit are those in medicine, nursing, health management, and oral health programs. More than 500 physicians will be trained in specialty and subspecialty areas by 2018 (Table 3). Approximately 5000 nurses will have their qualifications upgraded from secondary-school level to 3 years of postsecondary school (registered nurses, or A1 level) by means of an online training platform. Improved clinical education including an online health-learning platform will connect district hospitals with university classrooms in Rwanda and in the United States.21 Nursing and midwifery faculty who teach advanced courses (e.g., critical care, pediatrics, and midwifery) will be enrolled in advanced courses in those specialties. Beginning in 2014, general nurses will have the opportunity to become certified in a variety of nursing specialties. Simultaneously, some nurses with 3-year diplomas (A1 level) will have their qualifications upgraded to a bachelor's degree level (A0 level). The specific time-limited targets are expected to be met by 2018 (Table 1).

As is the case in other countries in the region, Rwanda does not currently have the health care management capacity that is required to support the administrative needs of each hospital. Through the Human Resources for Health Program, the School of Public Health in Rwanda will introduce two new degree programs: a master's degree in hospital and health care administration and a master's degree in global health delivery, which will focus on administration, financial management, and policy leadership. Both programs will combine coursework with supervised fieldwork. Over the course of the Human Resources for Health Program, the School of Public Health aims to graduate 75 new managers from the master's degree in hospital and health care administration program, surpassing the minimum requirement needed to ensure that at least one trained health manager is working at each of the district, provincial, and referral hospitals by 2018. To address needs in oral health care, the Human Resources for Health Program will train more than 40 dental students, 20 dental therapists, and 15 dental assistants during the first 3 years of a newly established curriculum.

The program seeks to address both the proximal and distal drivers of the human resource shortage in Rwanda by increasing the capacity and quality of medical and nursing education while also strengthening incentives to work in the public sector and in rural districts. One important consideration for the retention of health professionals that is often overlooked in discussions of “brain drain” is the persistent lack of basic equipment and supplies at facilities; physicians who benefit from improved training will not be retained if they cannot apply these skills to their clinical practice and to teaching future clinicians. Thus, the Human Resources for Health Program also focuses on adequately equipping health facilities to ensure proper teaching environments.