RNMU MAGAZINE

3rd SDG: Ensure Healthy Lives and Promote

Well-being for all at all ages

A Publication of the Rwanda Nurses and Midwives Union

VOLUME 3January, 2017

The Rwanda Nurses and Midwives Union

U b u s h a k a s h a t s i L e a d e r s h i p T r a i n i n g

R N M UMAGAZINE

Kwihangira imirimo

Abanyamuryango ba RNMU bungutse byinshi................P.22

Intara y’i Burasirazuba

Uturere dutandukanye twarasuwe...........................................P.28

Ibibazo byagaragajwe

MOH na MIFOTRA basezeranyije ubuvugizi........P4.

SDGs implementation

RNMU resolved to contribute ..................................................P.27

M e m b e r s R e c r u i t m e n t F e a t u r e s

The Rwanda Nurses and Midwives’ VoiceRNMU is a member of

» p.4

» p.18

4 UbushakashatsiAbayobozi muri MOH na MIFOTRA basezeranyije ubuvugizi ku bibazo mu mwuga w’ubuforomo n’ububyaza

18 Ibikorwa mu mafotoAmafoto meza kurusha ayandi yaranze ibikorwa bya RNMU mu mwaka wa 2016

20 Amahugurwa ku miyoborereKwihangira imirimo n’imiyoborere; urubyiruko rwa RNMU rw’igitsina gore rwarahuguwe

27 Features RNMU resolved to contribute to SDGs implemention in health sector

28 Ubukangurambaga ku banyamuryango

Abanyamuryango ba RNMU bo mu Ntara y’i Burasirazuba barasuwe mu turere dutandukanye

» p.27

» p.28

IBIRIMO RNMU MAGAZINE

R N M U M a g a z i n e | J a n u a r y 2 0 1 7 w w w . r n m u . r w

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With this special occasion of publishing our 2017 magazine, we take this opportunity to welcome you and express our gratitude to our partners and sponsors.

Firstly, we acknowledge the collaboration and facilitation of Unionism conducive environment for our Government, the Republic of Rwanda, through different Ministries, notably the Ministry of labour and the Ministry of Health.

We also take this opportunity to express special thanks to the NSF Board members, Executive Committee and staff for the invaluable support that they are providing to Rwanda Nurses and Midwives Union (RNMU) in terms of funding and technical support.

This support has lasted since 2012 and has uplifted RNMU from the limited organization to a strong Union which stands for the interests of the nursing profession and professionals in Rwanda.

The year 2016 has been another special year where RNMU achieved most of its goals such as sanitization of the whole country’s main health institutions about check off system and collaboration with the CNMF among others, which you will find in this magazine.

To all those who provided any kind of support for the development of RNMU, we thank you and God bless you.

André Gitembagara,RNMU President.

OWNERSHIPThe Rwanda Nurses and

Midwives Union(RNMU)

Editor Théophile Harushyamagara

Design:Théophile Harushyamagara

ContributorsAndré Gitembagara

Jean Pierre NsabimanaThéophile Harushyamagara

Fiona Mutoni

Foreword

Igihugu cyacu ni

igihugu gitera imbere

ubutitsa mu nzego zose,

n’urwego rw’ubuzima

rero rugenda ruzamuka

cyane, kuko mu mwaka

wa 1995 twari dufite

abaforomo bari munsi

ya 400, ariko ubu dufite

ababarirwa mu 15,000.

Abayobozi muri MoH na MIFOTRA basezeranyije ubuvugizi ku bibazo mu mwuga w’ubuforomo n’ububyaza

RNMU

Abayobozi bo muri Minisiteri y ’ u b u z i m a ( M o H )

n’iy’abakozi ba Leta (MIFOTRA) basezeranyije gukora ubuvugizi aho bishoboboka ngo ibibazo bijyanye n’imikorere (cl inical working conditions) bikiboneka mu mwuga w’ububyaza n’ubuforomo bibonerwe ibisubizo.

Ni nyuma y’ubushakashatsi bwakozwe na Sendika y’abaforomo, abaforomokazi n’ababyaza mu Rwanda (RNMU) bumurikwa tariki ya 22 Ukuboza 2016, bukagaragaza ibibazo bitandukanye bikiboneka muri uyu mwuga.

Mu bibazo by’ingenzi ubu bushakashatsi bwagaragaje ni uko abaforomo, abaforomokazi n’ababyaza bakenewe bakiri bake ugereranyije n’abari mu kazi.

Ku baforomo, abaforomokazi n’ababyaza 100 bakenewe 40% ni bo bahari mu bigo nderabuzima, bakaba 63% mu bitaro by’uturere.

Ibi bigatuma abaforomo bakora amasaha y’ikirenga nk’uko byavuzwe na 83% by’abaforomo, abaforomokazi n’ababyaza kuri 546 babajijwe muri ubu bushakashatsi, bavuga ko bakora amasaha arenga 45 ku cyumweru mu gihe atagombye kurenga.

“Gukora amasaha y’ikirenga bishobora gutuma abaforomo, abaforomokazi n’ababyaza bakora amakosa batewe n’umunaniro, bikaba byagira ingaruka k’ubo bakira,” ibyavuzwe na Munyagashubi Jean De Dieu wakoze ubu bushakashatsi.

Ubu bushakashats i kandi bwagaragaje ko abakora umwuga w’ubuforomo bafite impamyabushobozi yo mu kiciro cya kabiri n’icya gatatu cya Kaminuza bakiri bake cyane bitewe n’imiterere y’amavuriro agira umubare ntarengwa w’abakozi bafite ibyo byiciro, bikagira ingaruka ku myigire ndetse n’iterambere ry’abaforomo, abaforomokazi n’ababyaza.

Ubu bushakashatsi kandi bukaba bwaragaragaje ko 73% by’abakora

Uvuye i bumoso Munyagashubi Jean De Dieu wakoze ubu bushakashatsi, Gitembagara André perezida wa RNMU, Umuyobozi muri MIFOTRA Faustin Mwambari, na Umutoni Nathalie, Umuyobozi ushinzwe Politiki n’Amabwiriza yerekeye Ubuzima MoH.


Ubushakashatsi 4

umwuga w’ubuforomo n’ububyaza bavuga ko batishimiye umwuga, naho 93% bo bakaba batishimiye umushahara.

Ubu bushakashatsi kandi bwasabye Minisiteri bireba gukora ku buryo ibi bibazo bikemuka. Kuri Ministeri y’ubuzima yo, yari ihagarariwe n’Umuyobozi ushinzwe politiki n’Ubugenzuzi Umutoni Nathalie, ngo hari byinshi bimaze gukorwa.

Umutoni Nathalie, Umuyobozi ushinzwe Politiki n’Amabwiriza yerekeye Ubuzima muri MoH wari uhagarariye Minisitiri w’Ubuzima yagize ati :“ Hari ibyo badusabye gukora nabyumvise ariko hari byinshi byamaze gukorwa. Kandi n’ibigaragara ko bikirimo ibibazo, hari ibiganiro biri gukorwa kugirango bikemuke”.

Faustin Mwambari wari uhagarariye MIFOTRA we yavuze ko ubuvugizi buzakomeza gukorwa kugirango ibibazo bigezwe aho bigomba kugezwa ndetse ku bwe ngo urwego rukurikirana by’umwihariko ibibazo birebana n’umwuga wo kubyaza n’ubuforomo rwagombye kuba rukiriho.

“Ntekereza ko hakenewe ubuvugizi no gukorana bya

hafi kurushaho hagati ya MoH, MIFOTRA ndetse na Minisiteri y’Uburezi. Ndabasezeranya ko iki kibazo nzakigeza kuri Minisitiri wantumye,” ibyavuze n’uwari uhagarariye MIFOTRA

N’ubwo ariko ibi bibazo bihari, ubushakashatsi bwagaragaje ko habaye iterambere kuva nyuma ya Jenoside yakorewe abatutsi mu mwaka wa 1994.

Umuyobozi wa Sendika y’Abaforomo, Abaforomokazi n’Ababyaza mu Rwanda (RNMU) André Gitembagara, avuga ko mu bushakashatsi bwakozwe byagaragaye ko urwego rw’ubuzima rwateye intambwe ishimishije.

Ati :“Igihugu cyacu ni igihugu gitera imbere ubutitsa mu nzego zose, n’urwego rw’ubuzima rero rugenda ruzamuka cyane, kuko mu mwaka wa 1995 twari dufite abaforomo bari munsi ya 400, ariko ubu dufite ababarirwa mu 15.000, gusa muri abo abenshi ntibakora umwuga.”

Kuri aba 15.000 biyandikishije, mu r i b o 1 1 . 7 0 0 b a hawe uburenganzira bwo gukora, abagera ku 8.000 bakaba ari bo bari mu kazi.

Kudakora kwabo Gitembagara asobanura ko biterwa n’imikorere

igoye bakoreramo.Ubushakashatsi bwakozwe na

Minisiteri y’Ubuzima mu mwaka wa 2014, bugaragaza ko umuforomo umwe yita ku barwayi 1.225, mu gihe umubyaza umwe yita kuri 18.700.

Umutoni avuga ko kuba abaforomo n’ababyaza baba bakora amasaha menshi “bishingiye ku mubare muto wabo gusa akavuga ko amasaha y’akazi aba ateganyijwe ahari ahubwo ibigo nderabuzima n’ahandi bakorera ari bo bakwiye kuyubahiriza”.

Umutoni Nathalie, umuyobozi muri MoH ageza ijambo ku bari mu muhango.

Abari bitabiriye uyu muhango wo kumurika ubushakashatsi.

w w w . r n m u . r w R N M U M a g a z i n e | J a n u a r y 2 0 1 7

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The movement of Nurses in Rwanda started in 1995 with the creation of Rwanda Nurses and Midwives Association (RNMA) which was recognized in February 2006 by Ministerial Order No. 27/11.Two years after, the National Council of Nurses and Midwives (NCNM) was established through an Act of Parliament №

25/2008 of 25/07/2008. The National Council of Nurses and Midwives (NCNM) is a nursing and midwifery professional regulatory body with a mandate of protecting the public and professional integrity through the regulation of education and practice by setting and monitoring standards and policies of education and practice including professional

BACKGROUND OF THE STUDY

RNMU NATIONAL SURVEY ON NURSES AND MIDWIVES CLINICAL WORKING CONDITIONS IN RWANDA, 2016

RESEARCH NURSES DAY

SUMMARYIncreasing our understanding of how working conditions affect health care workers and the resultant risks of errors and quality of services for patients is of major importance to the health care industry, particularly those who manage or oversee health care organizations, and set policies that affect the physical or organizational working conditions, for health care workers. Across sectional study used both quantitative and qualitative methods to assess the working conditions of nurses and midwives working in clinical setting of Rwanda in order to provide evidence for supporting Rwanda Nurses and Midwives Union advocacy for improvement of the quality of nursing and midwifery services delivery to the Rwandan population. A stratified random sampling technique has been used to select 224 public and private health facilities and 542 nurses and midwives working in clinical services to assess their working conditions and their level of job satisfaction. The study aimed specifically at identifying the level of nurses and midwives staffing at different levels of the health system in Rwanda compared to the national standards and determine the level of job satisfaction among nurses and midwives working in the clinical settings of Rwanda. The findings revealed a gap in nurses and midwives staffing at all levels of the health facilities compared to the national standards for health facilities staffing. The current level of nurses and midwives staffing has been estimated between 40.6% for health centers and 63.1% for national referral hospitals. The shortage in nursing and human resources requires nurses and midwives to work overtime to meet the patients’ needs as it has been reported by 83.8 % respondents who work more than 45 hours per week. Despite working overtimes, the national standard of nurse: bed ratio is not met in some units of clinical services, leading to the increase in workload for nurses and midwives. The study revealed that the proportion of nurses and midwives holding bachelor’s and master’s degrees are very limited in clinical setting due to the current package of National health facilities that limits them in number and this has been reported as having negative impact on strategic planning for nurses and midwives human resources due to poor planning and less involvement of nurses and midwives in policy making. The study findings also show that 73.2% of nurses and midwives working in clinical services are not satisfied with their job; 93.2% of nurses and midwives are not satisfied with their salary and 53 % of nurses and midwives are not satisfied with the job stability despite the registration process that has provided practice license to 74.4% of nurses and midwives. Participants in the study have identified Rwanda Nurses and Midwives’ Union of which 68.3 % are already members, as the most suitable independent and professional body to advocate for their interests and for the improvement of their working conditions.


Research 6

conduct, and ensuring that they are implemented.In 2010, RNMA got affiliated to International Council of Nurses (ICN). In 2012 with funding from Norwegian Nurses Organization (NNO), RNMA conducted a survey on Nurses and Midwives’ on Needs Assessment. The findings from survey revealed that the socio-economic conditions of professional nurses were not good and that RNMA was powerless to respond to their needs and therefore, suggested the transformation of RNMA into a union which would be able to face the problems that lie in the workplace, education, welfare and profession.The sensitization campaign started in early 2012 February up to May 2013. All 96 participants in extra ordinary general assembly of RNMA who convened on 15th May 2013 agreed upon the transformation process which led to the creation of Rwanda Nurses and Midwives Union (RNMU) during its first General Assembly held on 30thJune 2013 at Top Tower Hotel. RNMU is committed to being a vibrant, self-sustaining organization that will protect the Professional image, improve Socio-Economic Welfare, and promote the interests of nurses and midwives through effective representation, capacity building and lead in the delivery of high quality care to the population. RNMU believes in providing high quality, ethical, accessible and equitable nursing and midwifery services to all members of the population to enable them good quality lives. Thus, while upholding this philosophy, RNMU believes that members will receive social and economic justice as rewardfrom their employers.In December 2013, RNMU got affiliated with the Trade Union Centre of Workers of Rwanda (CESTRAR) which is affiliated with the International Trade Union Confederation.Currently, Rwanda Nurses and Midwives Union (RNMU) is a Union of over 6000 nurses and midwives of Rwanda with a mission to protect the professional image, improve Socio-Economic Welfare, and promote the interests of nurses and midwives through effective representation, capacity building and lead in the delivery of high quality care to the population.In line with its mission, RNMU has mobilized funds from NORAD through Norwegian Nurses Organization for conducting national survey on Nurses and Midwives working conditions in Rwanda in order to support RNMU advocacy for policy influencing and evidence based decision making for improvement of quality nursing and midwifery care services delivery to the population.

PROBLEM STATEMENTIn its bid to strengthen health systems while scaling up efficient, effective and sustainable health care services to reduce burden of disease and contribute to the reduction of poverty among the Rwandese, the Rwandan Ministry of health reviewed health service package provided by Health Posts, Health Centers, District Hospitals and National

Referral and University Teaching Hospitals, and developed service package for Provincial Referral Hospitals in 2011. The identification of required human resource was based on facility bed capacity in each service. At the time of identifying required human resource the following elements were considered: (1) Available beds for each service, (2) bed occupancy and (3) workload. A scientific based standard staffing approach (Nurse: Bed Ratio) for nurses was adapted to the Rwandan setting. Bed ridden patients were estimated to be 2-5% of the Internal medicine. A standard of two shifts was maintained however, for specific areas like ICU and theater shifts were increased to three given the heavy workload in these services. There was a provision of one staff for every 6-12 nurses to allow nurses to go for annual leave.The data from Human Resources Information System (HRIS) 2013 and from Rwanda GeneralPopulation and Household Census 2012, there are 9,448 nurses and midwives together in Rwanda.The ratio of these professionals to the population is 1 Nurse: 1,225 people and 1 midwife: 18,790 people under his/her care. (MOH, 2014) The target is to increase the number of nurses and midwives up to 11,384 by 2018 (Binagwaho et al.; 2013). This means a ratio of 1nurse/midwife for 1050; 1062 and 1066 population respectively for low, medium and high projection scenarios according to NISR Population projection in 20181. According to the WHO (2010), if investments were made as modeled, the 49 low income countries in sub-Sahara Africa, including Rwanda wouldon average spend $54 per capita on health and there would by 2015 be 22 hospital beds per 10,000 population and 2.3 nurses/midwives per 1,000population. Even, then, these ratios would barely approach the rates observed in 2006 in the group of lower middle Income countries and none wouldsay that the low income countries have ideal, or even well-functioning health system today. (WHO, 2010).The study conducted by RNMU in January 2015” optimizing nursing and midwifery in Rwanda” shows a gap of 45% of required nurses at health center level and 20% at District hospital level by 2009 Ministry of Health guidelines.Recognizing that the global shortage of Nurses and Midwives in clinical settings requires them to work very long hours and results in fatigue, lack of concentration, apathy and lack of interest and given the present critical shortage of nurses and midwives, it is imperative to explore how both nurses and midwives perceive their jobs, so that strategies might be identified to enhance the quality of their working lives and improve retention.

OBJECTIVESGeneral objectiveThe study aims at assessing the clinical working conditions of nurses and midwives in Rwanda in order to provide evidence for supporting RNMU advocacy for improvement of quality


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of nursing and midwifery services delivery to the Rwandan population.

Specific objectivesThe study has the following specific objectives:1. To identify the number and levels (A2, A1, A0, masters and PhD) of nurses and midwives staffing in different health facilities2. To determine the nurse/midwife- bed ratio in different health facilities of Rwanda3. To benchmark the current nurse/midwife-bed ratio against the national, regional and international standards;4. To determine the level of satisfaction of nurses and midwives at different levels of health facilities of Rwanda.

Research questionsThe study attempted to answer the following research questions:- What is the current level of nurses and midwives staffing at different levels of health facilities in Rwanda,- How far are we to reach national and international clinical standards in terms of nurses/midwives-bed ratio?- What is the current level of professional satisfaction of nurses and midwives working in clinical settings of Rwanda?- Why highly qualified nurses do not appear in the new service packages for health facilities of Rwanda- What are the effects of lack of highly qualified nurses and midwives on strategic planning for improvement of quality of nursing/ midwifery service delivery?- What should be the suitable professional body to advocate for nurses and midwives and influence policies?

Scope of the studyThis study is limited to the clinical working conditions of nurses and midwives in Rwanda. It focused on exploring the working conditions and job satisfaction of nurses and midwives in public and private sector at all levels of health system in Rwanda including health centers, district referral hospitals, provincial referral hospitals and national referral hospital or University Teaching Hospital. For the private sector, the study was limited to polyclinics employing at least 50 nurses and midwives. In terms of geographical coverage, the study covered all 30 Districts of the country.

RESEARCH METHODOLOGYStudy designThis study is designed as cross-sectional study involving data collection at a defined time on the working condition of nurses and midwives in Rwanda.

Study siteThis study was conducted within 30 districts of Rwanda and it will cover nurses and midwives working in public health

sector as well as those working in the private health sector in Rwanda.

Study populationThe study population was composed of on job nurses and midwives working in public and private health facilities in Rwanda, estimated at 8, 273 nurses, and 240 midwives (MOH, 2012).

Selection of study populationa. Inclusion criteriaThe following criteria were used for the selection of the study population:- being enrolled or registered nurse/midwives- working in a health facility recognized by the Ministry of Health- having at least of 3 months of working experience as nurse or midwife in one of thefollowing services: internal medicine, surgical, pediatrics, Accidents& Emergencies, Obstetrics and Gynecology; critical care as well as nurses and midwives administrators atdifferent levels of the health system of Rwanda.

b. Exclusion criteriaThe criteria for exclusion include:- Non employed nurses/ midwives- Working in health facility not recognized by the Ministry of Health- Nurses and midwives not working in health facilities or nurses and midwives related administration.

SamplingStratified random sampling technique was used to select a representative sample of health Facilities (Health Centres, District Hospitals, Private Medical Clinics, Regional Referral Hospitals, Teaching University Hospital or National Referral Hospitals) based on their proportion number. Purposive sampling technique was used to select a representative sample of public and private nurses/midwives administrators as well as representatives of nursing/midwifery professional bodies.

Sample sizeConsidering that number of public health facilities were 523 and estimating private clinics employing at least 50 nurses and Midwives at 6, the total number of health facilities was 529, the sample size calculated by Creative Research Systems with confidence level of 95% and margin of error of 5 was 223 health Facilities and 546 Nurses and Midwives distributed proportionally as follows:


Research 8

For qualitative aspect, the survey involved a sample of 6 nurses and midwives in leadership positions including the chair person and Registrar of NCNM; president of Rwanda Nurses and Midwives Union; the chairperson of Rwanda Midwives Association; the Director of Nursing/ Kigali University Teaching Hospital and the Dean of faculty of Nursing/ UR College of Medicine and Health Sciences.

Data collection techniquesPrimary data was gathered using Nurses and Midwives Professional Satisfaction Survey Questionnaire (in appendices 5 and 6) designed from adaptation of “Questionnaire-Satisfaction Professionnelle” UARITE “Qualité des soins, gestion du risque et techniques obstétricales and qualitative interview questionnaire designed for Nurses and Midwives in leadership positions.Secondary data were collected from Heath Facilities Nurses and midwives work schedule/ duty roster and health facilities records for nurses and Midwives staffs.

Data analysisInformation from Nurses and Midwives professional satisfaction survey was analyzed quantitatively to determine the level of satisfaction of nurses and midwives of their working conditions. The Chi square test was used to compare the level of professional satisfaction for nurses and midwives with different educational background.Secondary data from Health Facilities records on Nurses and Midwives work schedule / duty roster and nurses/midwives staff was compared to the national, regional and international standards of nurse: bed ratio.Quantitative data was analyzed using SPSS version 22.0.0.0 whereas qualitative data from interview was analyzed using content analysis method.

Ethical considerationsInformation provided by participants was be kept confidential and anonymous and used for the purpose of this survey. Participation in the survey was totally voluntary after being

explained the purpose of survey on nurses and midwives working conditions and signing an Informed Consent.Authorization to conduct the study was obtained from MOH and ethical clearance was provided by RNEC prior to data collection.

DATA PRESENTATION, ANALYSIS AND INTERPRETATION OF THE FINDINGS

IntroductionThis chapter presents, analyzes and interprets the demographic data of nurses and midwives who participated in the study. It also presents and analyzes quantitative and qualitative data related nurses and midwives staffing, the level of nurses and midwives professional, job satisfactiondimension as well as nurses and midwives’ attachment to their professions.

Female participants are dominant with 352 respondents (64.9%) against 190 male respondents (35.1%). This was due to the fact that nursing and midwifery s are in majority female dominated professions.Participants are in majority nurses with 458 respondents (84.5%) followed by midwives with 74 respondents (13.7%).


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Participants with A2 level are more represented with 263 respondents (48.5%) followed by A1 represented by 251 respondents (46.3%). The participants with bachelor’s degree and Master’s degree represent respectively 4.8% and 0.4% of the respondents. 58.9% of respondents are still in the category of youth (under 35 years old) while 41.1% are 35 years old and above.

The Health centers are more represented with 398 respondents

representing 73.4% of the respondents. District Hospitals are represented by 96 nurses/ midwives representing 17.7% of therespondents while the remaining respondents work in National Referral Hospitals (4.4%), Provincial Referral Hospitals (2.2%) and Private clinics and poly clinics (2.2%).The majority of respondents (74.4%) affirm having a practice license while 25.6% do not have a practice license.The majority of respondents (68.3%) are members in a labor union while 31.7% are not.

Nurses and midwives’staffing

The Available nurses and midwives in clinical services represent 40.6% of the required at the level of health center, 56.5% at the level of District Hospital, 58.2 at the level of Provincial Referral Hospital and 63.1 % at National Referral Hospital.

Concerning the average working hour per week, 83.8 % work more than 45 hours; 15.9% work 40 to 45 hours while 0.4% work less than 40hours per week.In some units like Antenatal, Post-natal, pediatrics, IM & mental health and surgical services the bed ratios are above the recommended during the day shift. In Antenatal, IM& mental health units the current bed ratio are above the recommended during the night shift.However, it is below the recommended in Surgery. Which shows poor distribution of existing nursing human resources between different units.

IM & Mental health and surgery is above the recommended during the day shift. The current Nurse: bed ratio in antenatal is below the recommended during the night shift. However, in surgery, it is above the recommended ratio, showing poor distribution of existing nursing and midwifery human resources between different units and services.

The nurse: bed ratios in Internal Medicine and mental health and in surgery are above the recommended ratios for both

day and night shifts. However, the ratio in antenatal is below the recommended ratio for both day and night shifts, Leading to poor distribution of existing nursing and midwifery in these services/units. 83.8 % of respondents work more than 45 hours while almost 16% work 40 to 45 hours per week.

Professional satisfaction of nurses and midwives As far as the salary is concerned, 57% of respondents are dissatisfied to very dissatisfied while 43 % are moderately to very satisfied.

Considering the bonuses and other allowances, 93.0% of


Research 10

respondents are not satisfied while the remaining 7% are satisfied.

Comparing the salary and their needs, 97.0% of respondents are in the range of those who are very dissatisfied to moderately satisfied, while the remaining 3.0% are in the range of those who are satisfied and very satisfied.

Considering the salary over qualification and experience, 95.6 % of respondents are in the range of those who are very dissatisfied to moderately satisfied while the remaining 4.4 % are in the range of those satisfied and very satisfied.

Considering the amount of salary and the volume of work, 97.0 % of respondents are in the range of those who are very dissatisfied to moderately satisfied while the remaining 3.0% are in the range of those who are satisfied and very satisfied.

As the quantity and quality of available consumables to do job is concerned, 55.2% of respondents are in the range of those who are very dissatisfied to moderately satisfied while the remaining 44.8% are in the range of those satisfied and very satisfied.

Considering the availability of protection means against professional risks as factor of job satisfaction, 62.9% of respondents are in the range of those who are very dissatisfied to moderately satisfied while the remaining 37.1% are in the range of those satisfied and very satisfied.

Regarding the working hours, 71.4% of respondents are in the range of those who are very dissatisfied to moderately satisfied while the remaining 28.6 % are in the range of those satisfied and very satisfied.

Considering the workload, 83.0% of respondents are in the range of those who are very dissatisfied to moderately satisfied while the remaining 17.0% are in the range of those satisfied, and very satisfied.

As the distribution of workload among members of working team is concerned, 51.5% of respondents are in the range of those who are very dissatisfied to moderately satisfied while48.5% are in the range of those satisfied and very satisfied.

Considering the distribution of work time and other tasks, 69.2% of respondents are in the range of those who are very dissatisfied to moderately satisfied while the remaining 30.8% are in the range of those satisfied and very satisfied.

Regarding the support of colleagues in accomplishing tasks, 58.9% of respondents are in the range of those very dissatisfied to moderately satisfied while the remaining 41.1% are in the range of those who are satisfied and very satisfied.

QUICK FACTS

1 224 public and private health facilities and 542 nurses and midwives working in clinical services participated in the research,

2 The current level of nurses and midwives staffing gap has been estimated to be between 40.6% for health centers and 63.1% for national referral hospitals,

3 The shortage in nursing and human resources requires nurses and midwives to work overtime to meet the patients’ needs as it has been reported by 83.8 % of respondents,

4 73.2% of nurses and midwives working in clinical services are not satisfied with their job,

5 93.2% of nurses and midwives are not satisfied with their salary,

6 About in service training, 39.3% of respondents are moderately satisfied, 69.9% are in the range of very dissatisfied to moderately satisfied while 30.1% are satisfied and very satisfied with in service training received from the employer.

7 3.2 % of respondents are in the range of very dissatisfied to moderately satisfied with their amount of salary,

8 83.8 % of nurses and midwives reported working more than 45 hours while the labour code recommends a maximum of 45 working hours per week.

9 62.9% of nurses and midwives are not satisfied with the quality and the quantity of available nursing consumables to do their job,

10 53 % of nurses and midwives are not satisfied with their employment stability,

1173.2% of nurses and midwives reported not being overall satisfied with their job.


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As the variety of tasks is concerned, 57.2% of respondents are in the range of those very dissatisfied to moderately satisfied while the remaining 42.8% are satisfied and very satisfied.

Looking at the adequacy between tasks and skills, 47.8% of respondents are in the range of very dissatisfied to moderately satisfied while 52.1% are satisfied and very satisfied.

Concerning the level of professional responsibilities, 43.4% of respondents are in the range of those very dissatisfied to moderately satisfied while 56.6 % are satisfied and very satisfied.

Considering the job description made for their jobs, 43.4% of respondents are in the range of those very dissatisfied to moderately satisfied while 56.6 % are satisfied and very satisfied.

Comparing their job description and what they do, 50.6% of respondents are in the range of those very dissatisfied to moderately satisfied while the remaining 49.4% are satisfied and very satisfied.

For the collaboration between members of service, 24.4% of respondents are in the range of those who are very dissatisfied to moderately satisfied while 75.6% are satisfied and very satisfied.

As the recognition of the quality of work done is concerned, 49.6% of respondents are in the range of those who are very dissatisfied to moderately satisfied while 50.4% are satisfied and very satisfied.

On the topic of Performance appraisal for advancement of rank, 25.5% respondents are moderately satisfied, 17.7% are satisfied and 3.5% are very satisfied.

About the respect by superiors, 45.6% of the respondents are in the range of those who are very dissatisfied to moderately satisfied while 54.4% are satisfied and are very satisfied.

About in service training, 39.3% of respondents are moderately satisfied, 69.9% are in the range of very dissatisfied to moderately satisfied while 30.1% are satisfied and very satisfied with in service training received from the employer.

On the topic on how staff members are selected to participate in trainings, 61.3% of respondents are in the range of very dissatisfied to moderately satisfied while 38.7% are satisfied and very satisfied.

Regarding the adequacy of the proposed training the needs,

61.1% of respondents are in the range of very dissatisfied to moderately satisfied while 38.9 % are satisfied and very satisfied.

Regarding the use of knowledge gained from the training, 47.2% of respondents are in the range of very dissatisfied to moderately satisfied, 52.8 are satisfied and very satisfied of how the knowledge gained from trainings are used in their work.

Concerning the skills acquired from the training, 39.9% of respondents are in the range of very dissatisfied to moderately satisfied while 60.1% are satisfied and very satisfied with the skills acquired in their last training.

As participation in decision making is concerned, 60.7% of respondents are in the range of very dissatisfied to moderately satisfied while 39.3% are satisfied and very satisfied with opportunities given to them to participate in decision making.

About the management of structural funds, 69.0% of respondents are in the range of very dissatisfied to moderately satisfied while 31.0% are satisfied and very satisfied with the transparency in the management of structural funds.

For the quality of the work, 36.2% of respondents are in the range of very dissatisfied to moderately satisfied, while 63.9 % are satisfied and very satisfied with the quality of their work.

On the topic of practicing religion, 44.6% of respondents are in the range of very dissatisfied to moderately satisfied while 55.40% are satisfied and very satisfied with how their work place does not prevent them to practice their religion.

Concerning the professional image, 42.3% of respondents are in the range of very dissatisfied to moderately satisfied while 57.7% are satisfied and very satisfied with the image of their profession.

Regarding the regularity of salary, 43.2% of respondents are in the range of very dissatisfied to moderately satisfied while 56.8% are satisfied and very satisfied with the regularity of their salary.

Concerning the stability of job, 53.0% of respondents are in the range of very dissatisfied to moderately satisfied while 47% are satisfied and very satisfied with the stability of their job.

In summary, 18.5% of respondents are overall dissatisfied to very dissatisfied while 81.5% are moderately to very satisfied with their working conditions.


Research 12

Out of 542 respondents, 519 earn Rwf 200,000 or less per month and 23 earn more than Rwf 200,000. 73.2% of the respondents are in the range of very dissatisfied to moderately satisfied while 26.8% are satisfied and very satisfied with their job. However, the difference is not significant ( p= 0.574) , leading to the conclusion that the proportion of jobsatisfaction is the same for all the salaries brackets.

Out of 542 respondents, 361 work in rural area; among them 70.0% are in the range of very dissatisfied to moderately satisfied while 30.0% are satisfied and very satisfied with their job. The difference is extremely statistically significant (p˂0.0001); leading to the conclusion that there is an association between the working area and the overall job satisfaction of nurses and midwives.

58.8% of the respondents are under 35 years old and 41.2 % are 35 years old and above. Among them 73.2% are in the range of very dissatisfied to moderately satisfied while 26.8% are satisfied and very satisfied with their job. The difference is not statistically significant (p=0.375), leading to the conclusion that the proportion of job satisfaction is the same within all age brackets

64.9% of respondents are females while 35.1 % are males. Among respondents 73.2% are in the range of very dissatisfied to moderately satisfied while 26.8% are satisfied and very satisfied. The difference is statistically significant (p=0.034), leading to the conclusion that there is an association between the gender of respondents and the overall job satisfaction.

Nurses/midwives job satisfaction dimensionsRecognizing variations between countries on job satisfaction dimensions, the study also attempted to determine the job satisfaction dimensions for nurses and midwives in Rwanda as well as their preferences in terms of remaining or dropping out their profession.

Remuneration is ranked as the first dimension of job satisfaction (50%) followed by the management style (17%), organization and content of work (11%), tools and framework (9%), training & supervision (8%) and the moral satisfaction (6%).

62.4% of respondents would prefer pursuing nursing or midwifery in their further studies, 24% would prefer Public Health; 5.5% Health Management and 5.4% otheroptions.

47.8% of respondents would seek a new job in public or private health facility in case there an option to leave their

current job. This shows also that they are willing toremain in the health sector.

QUALITATIVE FINDINGS

Nursing human resources and the package for National health facilitiesThe participants in qualitative interview nurses revealed that nurses and midwives are not effectively involved in policies making, reason why the highly qualified nurses and midwives are not appearing in the national packages for health facilities. Apart of the existence of nursing and midwives’ bodies such as National Council of Nurses and Midwives and the Rwanda nurses and midwives’ union, Nurses and midwives don’t have space for participating in policy making at the ministerial level. However, they have reported that, policy influencing is among the major activities of Rwanda Nurses and Midwives Union. According to the respondents, Nurses used to have a division of nursing under the Ministry of Health. Since the nursing division in the ministry of Health as an entity in charge of policy making for the health sector does no longer exist the planning for nurses and midwifery is done by people who are not familiar with the nursing professional advancement, resulting in poor nursing human resource planning.

Effect of nursing human resource poor planningParticipants in qualitative were complaining about the high turnover of highly qualified nurses and midwives in respective health Facilities due to the organizational structure that doesn’t recognize their education level. There are nurses and midwives with bachelors’ degree who are working andpaid as registered nurses and midwives with advanced diploma (A1) because of the organizational structure of health facilities. Nurses and midwives who managed to upgrade their education level do not have enough opportunities for advancement in their career while still working in public health facilities where the positions of highly qualified nurses and midwives seems not recognized and this contribute to the increase of highly qualified nursing staff turnover in public health facilities. The limitation in number of highly qualified nurses and midwives also affect the strategic planning fornursing and midwifery human resources as well as their effective participation in nursing and midwifery related policies making. The participants in qualitative interview have associated the prevailing tendency to the persisting gender related stereotypes vis –a vis nursing as a traditional female dominated vocation.

The suitable professional body to advocate for nurses and midwives and influence policiesAccording to the participants, the national council of Nurses and midwives is an arm of the ministry of health


13

focusing more on protection of public from anything that may endanger their lives arising from the deeds of Nurses and Midwives rather than on strategic planning of nurses and midwives work force. Furthermore, the existence of an oversight of health professional bodies officer desk can’t address specific issues faced by nurses and midwives as the large segment of health professionals in Rwanda. The reason why the Rwanda Nurses and Midwives Union was establishedby nurses and midwives is primarily for advocating for improvement of nurses and midwives working conditions.

DISCUSSION OF THE FINDINGS

Nursing and Midwifery staffingDifferent methods are used to determine the level of nursing and midwifery staffing. The Rwanda MoH has opted for a method based on health facility bed capacity in each service, bed occupancy and workload to identify required human resources including nurses and midwives. However, theavailable literature suggests that best practice in relation to determining staffing levels cannot clearly be identified. As long as all approaches have their inherent strengths and limitations and the choice of method or system to determine staffing levels should be largely dependent on the context in which it will be used. Therefore, it seems impossible to find one suitable standard nursing and midwifery staffing approach for all levels of health facilities; e.g. the nurse: bed ratio used by the Rwanda MoH (2012) seems not a suitable standard staffing approach for health centers as it can underestimate the importance of prevention and health promotion services. For that reason, it is preferable for health centers to identify required human resources based on the population in the catchment area. The national nursing staffing standards has estimate the minimum required nurses and midwives in clinical services of a health centre at 33 nurses and midwives.The current level of nursing staffing at the level of health center (40.6%) that resulted in aggregation of statistics for nurses and midwives on the duty roster is less than the real level of nurses and midwives staffing as it didn’t consider nurses and midwives who were in their annual leave andthose who were allowed time off for having worked previously the night shift. Indeed, in most health facilities those who were on the night shift have right to time off during the next day. Based on that reasons we can assume that with consideration of nurses on annual leave and those in time off, the real nursing staffing is close to 50% of the required nursing human resources at the level of health Centre. Gitembagara Andre et al. (2015) has estimated the level of nurses and midwives staffing in health centers at 55% with reference to the standards of the MoH which were based on population in the catchment area and to the minimum package of activities to be delivered at each level of health

facilities (Rwanda MOH, 2009).The National standards for nurses/ midwives staffing require a minimum of 149 nurses and midwives in clinical services at District Hospital, 201 nurses and midwives at Provincial Referral Hospitals and 473 nurses and midwives. Using aggregated data of nurses and midwives on day and night shifts, the study came up with an estimation of the level of nurses and midwives staffing in clinical services at district hospitals, Provincial Referral Hospital and National Referral Hospital at 56.5%; 58.2% and 63.1% of the total require nurses and midwives human resources respectively in clinical services of District Hospitals, Provincial Referral Hospitals and National Referral Hospitals.Considering the nurse: bed ratio per unit and the national standards, 5 out 11 unit of clinical services at District Hospital have been identified as under staffed with nurses and midwives during the day shift and 3 units are under staffed during the night shift. Indeed, in antenatal care during the day and night shift the ratio is 1:18 against the national standard of 1:15; in Internal medicine and mental health the ratios are 1:12 during the day shift against the national standard of 1:8 and 1:16 during the night shift against the national standard of 1:12; In pediatric unit the ratio is 1:10 during the day shift against the standard of 1:8; In surgery the nurse: bed ratio during the day shift is 1:9 comparedto the national standard of 1:7. Even if the new standard staffing approach of nurse: bed ratio seems to be suitable for District, Provincial and National referral hospitals, simply because hospitalization at those levels requires much the presence of nurses and midwives; the nurse: bed ratio canunderestimate also the number of required nurses/ midwives in the context of over populated hospitals where one bed is shared by two or more patients like it used to be in internal medicine, pediatrics and post-natal wards. This means that the nurse to bed ratio does not necessary reflect the nurse- patient ratio. Evidence supporting ratios has shown that every extra patient per nurse, over four patients is linked with a seven per cent increase in the likelihood of that patient dying within 30 days of admission each additional patient per nurse, over four patients, is associated with a seven percent increase in likelihood of failure to rescue which means death from complications such as pneumonia, shock or cardiac arrest, upper gastrointestinal bleeding, sepsis or deep vein thrombosis. (Aiken et al, 2002); Other evidence has shown that every extra patient added to a nurse’s workload in pediatrics increases a medically admitted child’s risk of being readmitted within 15 to 30 days by 11 percent (Tubbs-Colley et al.2013). On the side of nurses, each additional patient per nurse, over four patients was directly linked to a 23 per cent increase in the likelihood of the nurse burning out. (Aiken et al., 2002)Apart of the number of required nurses and midwives per service and health facility, the skills mix of nurses


Research 14

and midwives is also an important issue that needs to be considered. The study has revealed that 48.5% of nurses’ manpower are enrolled nurses with A2; 46.3% are nurses and midwives with advanced diploma ( A1); 4.8% are nurses and midwives with bachelor’s degree while 0.4% are nurses and midwives with Master’s degree. This situation can be explained by the availability nurses/ midwives human resources and the current package of health services which limit the position of nurses and midwives with bachelor’s degree to nurse/ midwives’ departmental managers.Nurses and midwives with Master’s degree don’t appear on the structure probably because Master’s degree program for nurses/midwives was not available in the country at the moment of the development of the current package for health facilities and this has inevitably its negative impact onrecruitment and maintenance of highly qualified nurses and midwives in clinical services for public health facilities. With the advancement of nursing and midwifery professions more nurses and midwives are upgrading their education level and become specialized in their profession. The Government of Rwanda has also initiated bachelor’s and Master’s degree program in nursing and these progresses have to reflect the skills mix of nurses and midwives in the public health facilities. As revealed by participants in qualitative interview, limitation of positions of qualified nurses and midwives is the major source of professional dissatisfaction of highly qualified nurses. e.g in one National Referral Hospital there are 12 candidates who are doing their Masters and the currentstructure recognize one position for nurse or midwives with Master’s Degree.Even if the cost for recruitment more degree-qualified registered nurses and midwives may be high and not easily affordable for developing countries, including Rwanda, its benefits have been scientifically demonstrated: increasing degree-qualified registered nurses by 10 percent improveddeath and failure to rescue outcomes, regardless of the care environment by four percent. (Aiken et al. 2003) On the other side, hiring degree-qualified registered nurses and midwives and paying them like simple registered nurses/midwives increases dissatisfaction among high qualified registerednurses/midwives that can compromise its benefits. One participant in qualitative interview has revealed that 15 nurses with Bachelor’s degree (A0) are paid like nurses with advanced diploma (A1) due to the limitation in number of their positions.

The job satisfaction of nurses and midwivesIt is important to consider the multifaceted aspect of job satisfaction especially while measuring the job satisfaction of health professional including nurses and midwives. This study assessed the level of job satisfaction of nurses vis-a vis compensation, working hours, availability of consumables,protection against professional risks, in service training,

performance appraisal, respect by their superiors, the support received from their co-workers, opportunity for participation in decision making, and stability of job.

a. Nurses and midwives’ compensationOne of the aspects of nurses and midwives job satisfaction assessed is the extent to which there are satisfied with their compensations. The study has showed that 93.2 % of respondents are in the range of very dissatisfied to moderately satisfied with their amount of salary; which means simplythat they are not satisfied. It is true that the salary that may satisfy everyone may not be affordable for many countries. This explain why the proportion of overall job satisfaction is the same within all salary brackets (p= 0.574). In terms of nurses’ compensation, the Nursing Personnel Conventionrecommends that remuneration of nursing personnel should be fixed at levels which are commensurate with their socio-economic needs, qualifications, responsibilities, duties andexperience, which take account of the constraints and hazards inherent in the profession, and which are likely to attract persons to the profession and retain them in it. The ILO also recommends that nurses’ remuneration should be adjusted from time to time to take into account variations in the cost of living and rises in the national standard of living. (ILO, 2005)

b. Working hoursThe number of working hours has been identified among the sources of employees’ job satisfaction. Considering the number of working hours per week, 71.4% nurses and midwives are not satisfied; 83.8 % of nurses and midwives reported working more than 45 hours while the labour coderecommends a maximum of 45 working hours per week. Overtime is frequently used in health care settings to meet staffing needs due to employee shortages, patients’ influxes or both. The fact that the health facilities in rural area are more understaffed compared to those in urban area explains the relationship found between nurses/midwives working area and their satisfaction with working hours (p=0.0203).Overtime was assumed to be related to fatigue in nurses, such that the more hours nurses reported working, the more fatigued they might be. The strong relationship between nurses reporting frequent medications errors may represent a decrease in vigilance associated with fatigue. (Dean, Scott and Rogers, 2006; Jagsi et al., 2005; Rogers et al., 2004; Scott et al., 2006).

c. Availability of consumablesThe availability of sufficient and quality consumables for nursing care has been related to nurses and midwives job satisfaction. Nursing consumables includes latex examination gloves, surgical examination gloves, gauzes, bed sheets, wash cloth, soap, cotton roll, catheters and other materials used by nurses or midwives while performing nursing care. The


15

study has revealed that 55.2% of nurses and midwives are not satisfied with the quantity and the quality of available consumables to allow nurses and midwives to do their job.

d. Protection against professional risksWorking in poor working conditions with limited resources combined to emerging contagious illnesses expose nurses and midwives to high risk of professional risks. 62.9% of nurses and midwives are not satisfied with the quality and the quantity of available nursing consumables to dotheir job. Every year, approximately 600,000–800,000 occupational needle stick injuries occur in the United States and nurses were the most likely to experience a blood or body fluid exposure (U.S. Department of Labor, Bureau of Labor Statistics; 1999)..e. Satisfaction with the support of colleagues in accomplishing taskCo-worker support has the ability to make a working environment a pleasure or an unpleasant place to spend your time. 58.9% of nurses and midwives are not satisfied with the support received from their support in accomplishing task. Some researchers argue that co-worker support is more relevant to overall satisfaction with the job where as supervisor support relates to specific job satisfaction areas (Seers, McGee, Serey & Graen, 1983) An important finding made by La Rocco and Jones (1978) in their research on co-worker and leader support is that there is that there was a positive correlation between co-worker support and greater tendency to remain in the organization.

f. Employment stabilityConcerning the stability of job, 53.0% of nurses and midwives are not satisfied with their employment stability. Employment stability, usually measured by the type of contract an individual has may affect one’s job satisfaction directly as well as through its impact on other relative ariables, such as job security, since a stable position seems to bring individuals a sense of security (Aleksandra Wilczynska, Dominik Barski, Joan Torrent Sellens, 2015). In the case of nurses and midwives, the existence of professional bodies such as the nursing council that protect the population from the wrong doing by nurses and midwives and limitation in advancement in their career also contributed to the reduction of the level of nurses and midwives satisfaction with employment stability.

g. Overall nurses and midwives’ job satisfactionConsidering all factors that contribute to the job satisfaction, 73.2% of nurses and midwives reported not being overall satisfied with their job. This has negative implication on maintenance of qualified and experienced personnel. The study has found an association between the working area and the overall job satisfaction for nurses and midwives (p

0.0001). This can be explained by the poor working conditions in rural setting the fact that the majority of respondents work in the health centers where there is a huge gap in nurses and midwives staffing.

h. Nurses/midwives job satisfaction dimensionsRecognizing variations between countries on job satisfaction dimensions, the study also attempted to determine the job satisfaction dimensions for nurses and midwives in Rwanda. Remuneration has been rank first by 49.6% of respondents, followed by the management style, organization and content of work, tools and framework, training and supervision and lastly the satisfaction of the quality of their work. These findings seem to contradict nursing ethics principles which place the moral satisfaction at the first place. However, researchers have identified that job satisfaction dimensions are contextual. Where employees are still struggling to meet their basic needs and are relying only of salary to cater for their basic needs, it is obviously that remuneration will be considered as the priority for job satisfaction. As long as the ideal amount of salary that may satisfy everyone is still unknown, the recommendation of the Nursing Personnel Convention about fixing the remuneration of nursing personnel at levels which are commensurate with their socio-economic needs, qualifications, responsibilities, duties and experience, and the need for remuneration to be adjusted from time to time to take into account variations in the cost of living and rises in the national standard of living is still valid.

i. Nurses and midwives ’preferencesIn order to assess the extent to which nurses and midwives are attached to their profession, the study has investigated nurses and midwives’ preferences in case they are given opportunity for further r studies and their attitude in case they are dismissed on the current job. The findings seem not be conclusive as 62.4% of nurses and midwives reported that they would prefer to pursue nursing or midwifery in their further studies, which means that they are still attached to their profession, however when it comes to their choice after being dismissed on the current job only 47.8% would seek a new job in public or private health facility. However, these findings show that there a need to improve the working conditions for nurses and midwives in clinical setting of Rwanda in order to make it more attractive for nurses and midwives.

CONCLUSION AND RECOMMENDATIONSWorking conditions cover a broad range of topics and issues, from working time (hours of work, rest periods, and work schedules) to remuneration, as well as the physical conditions and mental demands that exist in the workplace. Working conditions for nurses and midwives vary widelydepending on a variety of factors. The largest percentage of


Research 16

nurses work in a hospital or clinical setting, dealing directly with patients. This study served as a barometer of nursing and midwifery clinical working conditions in Rwanda. Using a mixed method, the study came up with the following key findings that call decision markers’ attention for the improvement of the quality of health care services provided by nurses and midwives:- There is still a gap in nurses and midwives staffing at all levels of the health facilities. The situation is worse for the health facilities in rural area than those in urban area. Based on the statistics of nurses and midwives on their duty during the day and night shift, the current level of staffing varies between 40.6% of the required nurses and midwives at the level of health centers and 63.1% at the level of national referral hospitals.- The shortage in nursing and human resources faced by the health facilities, requires nurses and midwives to work overtime to meet the patients’ needs as it has been reported that 83.8 % of nurses and midwives work more than 45 hours per week.- Despite working overtimes, the national standard of nurse: bed ratio is not met in some units of clinical services, leading to the increased workload for nurses and midwives.- More than 94% of the current nurses and midwives manpower in clinical services is composed by enrolled nurses with A2 certificate and Registered nurses/ midwives withadvanced diploma (A2). The proportion of nurses and midwives holding bachelor’s and master’s degrees are very limited in clinical setting and the current package of National health facilities have been pointed out as having a negative effect on recruitment and maintenance of highly qualified nurses and midwives in clinical settings due to limited positions allocated to nurses and midwives with bachelor’s degree and above. This situation combined with the lacknursing division at central level has been revealed as impacting negatively on strategic planning for nurses and midwives human resources as well as their involvement in policy making for improvement of the quality of nursing/ midwifery service delivery.- Regarding the level of nurses and midwives satisfaction, 73.2% are in the range of very dissatisfied to moderately satisfied meaning that they are not satisfied with their working conditions. As compensation is concerned, 93.2% of nurses and midwives are not satisfied with their salary. Despite the registration process, which allowed 74.4% of nurses and midwives to get a practice license, 53 % of nurses and midwives are not satisfied with their job stability and- The Rwanda Nurses and Midwives’ Union has been identified as the most suitable professional and independent bodies to advocate for interests of nurses and midwives and68.3% of nurses and midwives in clinical services have reported being affiliated in a labor union .

RecommendationsBased on the findings of this study , recommendations were addressed to the Ministry of Health and RNMU .

To The Ministry of Health :1. To review the package for national health facilities and increase the proportion of nurses with bachelor’s degree and above in the structure of clinical services as this will influencepositively the recruitment and maintenance of highly qualified nurses and midwives in clinical setting2. Increase the budget allocated to health care human resources and salaries for nurses to attract more nurses and maintain highly qualified, specialized and experienced health care personnel3. To avail at central level a direction or division of nursing in order to improve nurses and midwives involvement in strategic planning for improvement of the quality of nursing and midwifery service delivery.

To the Ministry of Public Service and Labor:1. To recruit more nurses and midwives in order to reduce the existing gap in nursing and midwifery staffing2. To reinforce the implementation of the law regulating labor in Rwanda specifically in its articles regarding the legal duration of work (45 working hours per week maximum)3. To extend the general statutes for public servants to all nurses and midwives in working in Public clinical setting.

To RNMU:1. To investigate different ways to initiate a scheme that can support nurses and midwives to easily access affordable finance services and improve their well being2. To conduct CPD need assessment for nurses and midwives3. To facilitate nurses and midwives for access to CPD of their interest4. To develop an effective advocacy and lobby strategy for policy influencing

To the management of Health Facilities:1. To insure the proper distribution of existing nursing and midwifery human resources2. To consider the need of employees in different services/Units for personal growth3. To provide words for encouragement for the work well done rather than blaming only the wrong doers4. To avail and respect the job description for every recruited employee;5. To involve the representative of RNMU at the level of health Facility in decision making.


17

01RNMU President André Gitembagara delivering a

welcome remark to guests who attended a presentation of the clinical working condition survey on 22nd December 2016.

03Attentive: invited officials to the presentation of the

findings of the survey. This survey aimed specifically at identifying the level of nurses and midwives staffing at the different levels of the health system in Rwanda compared to the national standards and determine the level of job satisfaction among the nurses and midwives working in the clinical settings of Rwanda.

02 Jean de Dieu Munyagashubi is a consultant who

conducted the survey. Here, he is presenting its summary.

05 RNMU Secretary General Jean Pierre Nsabimana address-

ing the media after the presentation. The press was heavily represented during the presentation.

04RNMU president André Gitembagara during the

survey presentation. He explained that though the challenges, nursing and midwifery professions in Rwanda have progressed since 1994 after the Genocide Against Tutsi, and that can be credited to the Rwanda Government Through the Ministry of Health and that of Labor and Public Service, which enabled environment to promote advocacy for a better clinical working condition.

06The attendance of the leader-ship training which was held

from the 7th to the 8th of July 2016.

07Participants at the training united to sing Union Hymn

“Solidarity Forever”.

RNMU events in photos


Pictorial 18

08 Yvonne Mujawabega the Director for Maternity Leave

benefits at the Rwanda Social Security Board (RSSB) ,trained RNMU members on the health insurance law.

09Members of RNMU and offi-cials pose for a group photo

after a sensitization campaign. After the City of Kigali, the Northern, Southern and Western Province, it was a turn of the Eastern Province. Here, RNMU members and official pose on the last day of tour-ing Eastern Province. Bugesera, Ngoma, Kirehe, Nyagatare and Gatsibo districts were visited. Sensitization was the main activity of the year 2016 because of the check off system. All the directions of the country were reached in sensitization and members signed new consent forms. With the check off system, members’ contribu-tion is 1% of the net salary and it is done by the employer.

12A discussion in group after training on entrepreneurship

topic. The group was tasked to come up with a business idea to be developed for future female nurses and midwives proj-ect. RNMU is predisposed to support the best ideas.

11A group photo after a sensi-tization campaign in Kirehe

district.

10Nurses and midwives in Gatsibo during a sensitiza-

tion campaign.

13Attendance of the female nurses and midwives train-

ing from the 5th 9th of 12 2016. RNMU is empowering women for a better integra-tion. group photo during a female lead-ership needs assessment survey finding presentation workshop. Topics such as Nursing leadership generalities, Rwanda Health system (Health politics), Rwanda Health System structure, Important health program, Difference between NCNM, RNMU and MOH, Personal/personnel management skills, Action skills, Professional and methodical skills, Element of managerial skills, Aspects of public speaking skills: psychological, per-sonal and technical, conflict and conflict management, The nurse’s role in ethics and human rights, entrepreneurship and nursing.

14A group photo of RNMU members and officials as well as

a representative of the Ministry of Health, after the female nurses and midwives train-ing the 5th to 9th of December 2016.


19

Ab a n y a m u r y a n g o b a Sendika y’Abaforomo,

Abaforomokazi n’Ababyaza mu Rwanda (RNMU) bahuguwe ku itegeko rirebana no kuzamurwa mu ntera ngo basobanukirwe n’uko riteye bityo bashobore gukorera abanyamuryango ubuvugizi.

Abanyamuryango bahuguwe tariki ya 7-8 Nyakanga 2016 biganjemo abayoboye abandi ku rwego rw’ibitaro by’akarere ndetse n’ibigo nderabuzima.

P e r e z i d a w a R N M U Gitembagara André avuga ko Sendika ka yateguye aya m a h u g u rw a n y u m a y ’u ko bigaragaye ko abanyamuryango badasobanukiwe n’iri tegeko, ariko kandi ikibazo cyo kuzamurwa mu ntera ku baforomo, abaforomokazi n’ababyaza bari mu mwuga kikaba cyarakomeje kugarukwaho.

“Kugera ubu, umuforomo, umuforomokazi n’umubyaza winjiye mu mwuga kuri uyu munsi, ahembwa kimwe n’umazemo imyaka itandatu, kandi atari ko mu by’ukuri byagombye kuba bimeze,”

perezida wa RNMU Gitembagara avuga kuri iki kibazo.

Uwamahoro Bonaventure uyobora ishami r ishinzwe kuvugururura inzego za leta muri Ministeri y’Umurimo n’Abakozi ba Leta (MIFOTRA) akaba ari we wahuguye aba banyamuryango ba RNMU, asobanura amategeko arebana no kuzamura abakozi mu ntera, yavuze ko bikorwa mu bwoko bubiri bw’ibanze: kuzamuka mu ntera ntambike bitewe n’uburambe ku kazi ndetse n’umusaruro umukozi yatanze, hamwe no kuzamuka mu ntera mpagarike bitewe n’urwego rw’imyigire rw’umukozi.

Yasobanuye ko muri rusange kuzamuka mu ntera ntambike ari byo bikorwa ku mubare munini w’abakozi ba Leta, n’aho inzego zimwe na zimwe zigenwa n’itegeko zikaba ari zo zifite abakozi bashobora kuzamurwa mu ntera mpagarike.

Uyu muyobozi muri MIFOTRA yasobanuye ko kuzamurwa mu ntera ku mukozi wa leta bigengwa n’amategeko atatu y’ingenzi,

iteka rya Nyakubahwa Perezida wa Repubulika rigena urutonde rw’imirimo ya leta n’inzego iriho, iteka rya Minisitiri w’Intebe rigena isuzumabushobozi bw’abakozi ryo mu mwaka wa 2010 ndetse na sitati rusange y’abakozi ba Leta.

Iri teka rya Minisitiri w’intebe riteganya ko umukozi wese wa leta azamurwa mu ntera ntambike nyuma y’imyaka 3 yikurikiranya yesa imihigo. Riteganya ko uko kwesa imihigo kurimo ibice bine by’igenzi: Indashyikirwa, ni ukuvuga abakozi ba leta besheje imihigo hejuru ya 80%, igice cy’abari hagati ya 70% na 80%, abafite munsi ya 70% ariko batari munsi ya 60%, ndetse n’abari munsi ya 60%.

“abari munsi ya 60, bo bahita basezerwa nta mpaka, nyuma y’ubujurire bukorerwa mu rwego rushinzwe abakozi ba Leta,” Uwamahoro avuga ku byemezo bifatirwa umukozi utaresheje imihigo.

Avuga ku bikorerwa abesheje imihigo, yasobanuye ko abari hagati ya 60% na 70% batabona

Abanyamuryango ba RNMU bahawe ibisobanuro ku kuzamuka mu ntera

Perezida wa RNMU Gitembagara André ageza ijambo ku banyamuryango ba RNMU bari bitabiriye amahugurwa.


Ledearship 20

ubwasisi, abagize hejuru ya 70% bagahabwa ubwasisi bungana na 3% by’umushahara wabo, n’aho abagize hejuru ya 80% bagahabwa 5%.

Uwamahoro yongeyeho ko ku bakozi ba leta babarirwa hagati ya 110.000 na 120.000, abenshi besa imihigo bagashyirwa mu kiciro cya mbere n’icya kabiri ariko mu isuzuma hakaba hashobora kuba harimo amarangamutima bikaba ari byo bituma haba benshi babona amanota yo ku rwego rwo hejuru kandi bigaragara ko badatanga umusaruro, ubu hakaba hariho uburyo bushya buzatuma ibi bikosorwa.

“Ni uburyo bwo kureba ibikorwa byakozwe n’umukozi wa Leta kugirango haveho amarangamutima ashobora kuba yarakoreshwaga mu gukora isuzuma. Hazajya harebwa ibikorwa bifatika yakoze, biri mu murongo mugari wo guteza ikigo akorera imbere, ndetse binateza imbere igihugu,” Uwamahoro.

Avuga ko hari igihe abakozi babaga bafite amanota yo hejuru mu isuzuma, ariko urwego bakorera rwo rufite amanota yo ku rwego ruciriritse, ku bwe bigaragaza ko mu gutanga amanota ku mihigo bishobora kuba byarazagamo amarangamutima rimwe na rimwe.

I r i s u z u m a rikazajya rikorwa na mudasobwa, i k o r e s h w a n ’ u m u y o b o z i w’umukozi, maze kuzamurwa mu ntera bigatangwa na sisiteme.

Kuzamurwa mu ntera ni “ihame”

K u k i b a z o c y ’ a b a f o r o m o , a b a f o r o m o k a z i n ’ a b a b y a z a

batazamuka mu ntera nk’uko itegeko ribiteganya, Umuyobozi muri MIFOTRA yagize ati : “Ihame ni uko umukozi winjiye mu kazi ka Leta uyu munsi, n’undi umazemo imyaka 6, batagombye guhabwa umushahara ungana. Ubu buryo bushya rero bwo kuzamura abakozi mu ntera bwitwa RBM buzakemura iki kibazo.

“ku bakora mu buzima, uburezi, ndetse n’abandi bafite sitati yihariye, biteganywa ko muri ubu buryo bushya bwa RBM (Results Based Management), kuzamurwa mu ntera bizakorwa hagendewe ku buryo bwihariye, ku buryo umukozi azajya akora imihigo yihariye, buri mukozi agakora imihigo ijyanye n’inshingano ze ndetse n’intego ikigo gifite muri uwo mwaka cyangwa se muri iyo myaka itatu,” ibivugwa na Uwamahoro.

Ngo ibi bizatuma habaho ivugururwa ry’ibwiriza rya Minisitiri w’Intebe ndetse bitume buri mukozi wese wa leta agira imihigo.

IbiganiroUwamahoro yabwiye abari

mu mahugurwa ko mu rwego rw’ubuzima habayemo ibiganiro byinshi bigamije kureba uko abaforomo, abaforomokazi n’ababyaza bajya bazamurwa mu

ntera ntambike, ndetse bakabona n’ubwasisi bujyana na byo.

Ndetse avuga ko hari kuba ibiganiro biganisha ku ivugururwa ry’inzego z’ubuzima na PBF abaforomo abaforomokazi n’ababyaza babona ikaba ikwiye kuba ihamye ku buryo buri mukozi ayibona, kuko igaragaza uko umukozi yakoze.

Agira ati : “Ibi biri mu rwego rwa politiki, ariko kubishyira mu bikorwa bizasaba ko habaho ikurikirana rya Minisiteri y’imari n’igenamigambi ndetse na Minisiteri y’Ubuzima. Ariko ikizere kirahari.”

“Ibigaragara nk’ibibazo ni sisiteme nshya yo kuzamura abakozi mu ntera, no kureba ko yagera kuri bose, murasabwa rero gukurikirana,” ibyongerwaho na Uwamahoro.

Mu rwego rw’ubuzima yababwiye ko igihari gishya ari uko abaforomo, abaforomokazi n’ababyaza bafite urwego rw’ikiciro cya mbere cya Kaminuza bakinjira mu kazi, bazajya batangirira ku rwego rumwe na bagenzi babo b’abaganga.

Imbaraga zashyizwe mu guhuza imyanya y’ imirimo iri ku rwego rumwe, ndetse hakagabanywa ibyashobora gutera amarangamutima igihe umukozi azamurwa mu ntera.

“Ayo ni yo mabwiriza, ni yo mategeko rusange, ahubwo ni ugushaka uko ibi byakubahirizwa ku bakozi bose ba Leta ni byo dushaka kandi tugomba gufatanya na mwe ngo bishyirwe mu bikorwa.”

“Kugera ubu, umuforomo, umuforomokazi n’umubyaza winjiye mu mwuga kuri uyu

munsi, ahembwa kimwe n’umazemo imyaka itandatu,

kandi atari ko mu by’ukuri byagombye kuba bimeze.”

Uwamahoro Boneventure (uhagaze) ukora muri MIFOTRA aganiriza abari bitabiriye amahugurwa.


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|Ubundi mbere twebwe twumvaga tugomba guhora hafi y’igitanda cy’umurwayi, tukamuvura nta kindi tugomba gukora cyaduteza imbere,” Kabasinga Léa, umuforomokazi ku bitaro bya CHUK.

“Ariko aya mahugurwa yamfunguye amaso menya ko ntateshutse ku nshingano zanjye z’umuforomokazi, nshobora kugira ikindi kintu nkora kandi nkiteza imbere.”

Kwihangira imirimo n’imiyoborere: urubyiruko rwa RNMU rw’igitsina gore rwarahuguwe

Uku ni ko muri rusange abaforomokazi n’ababyaza bahawe amahugurwa ku miyoborere no kwihangira imirimo baturutse hirya no hino ku bigo nderabuzima ndetse n’ibitaro biri mu Mujyi wa Kigali basobanura icyo yabasigiye.Aya mahugurwa yateguwe n a S e n d i k a y ’ a b a f o r o m o abaforomokazi n’ababyaza mu Rwanda (RNMU) yibanze ku ngingo zireba n’imiyoborere ndetse no kwihangira imirimo.Mbabazi Perpétue ushinzwe ubushakashatsi n’amahugurwa muri RNMU avuga ko hategurwa aya mahugurwa hari hagamijwe ko abaforomokazi n’ababyaza b’igitsina gore bitinyuka, bakagira

uruhare mu miyoborere y’inzego z’umwuga ndetse n’iz’ubuyobozi bw’igihugu muri rusange.“Mbere baritinyaga. Ibi byatumye hibazwa uko bahabwa imbaraga kugirango babone ko na bo bashobora kugira icyo bigezaho, na bo bumve ko bashoboye, yaba ari mu nzego z’ubuforomo n’ububyaza cyangwa se n’izindi nzego zose z’igihugu,” Mbabazi ushinzwe ubushakashatsi muri RNMU.A b a n y a m u r y a n g o 2 5 b a RNMU bahuguwe ku ngingo zitandukanye, ababahuguraga bakaba baraturutse mu nzego nka Rwanda Women Network, Rwanda Women Council, nyuma y’uko RNMU ikoze imfashanyigisho

igomba kugenderwaho kugirango abanyamuryango b’igitsina gore na

Aimée Angelique Noella Akayezu, ushinzwe gahunda yo kwihangira imirimo muri DOT Rwanda ari guhugura abanyamuryango ba RNMU.

Mbabazi Perpétue ushinzwe ubushakashatsi n’amahugurwa muri RNMU.


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Umuntu utari muri Sendika aracikanwa, kandi bitak-agombye. Ikindbifite icy-erekezo cyo guteza imbere umunyamuryango.

bo barusheho kwiteza imbere.Mu isomo ryo kwihangira imirimo b y ’ u m w i h a r i k o , b a h u g u w e k’uko bashobora gutangirira ku kintu gito bagatangiza umushinga, basobanurirwa ibyo rwiyemezamirimo agomba kuba yujuje, hamwe n’amahirwe bashobora gukoresha ngo biteze imbere.Richard Nyirinkwaya ukora muri DOT Rwanda umuryango w ’ A b a n y a k a n a d a u g a m i j e iterambere ry’urubyiruko wahuguye aba banyamuryango, na we yumvikanisha ko abanyamuryango ba RNMU bagomba kwitinyuka. “Twabonye ko bashobora gukora umurimo w’ububyaza n’ubuforomo, ariko bakaba bashobora kugira ikindi kintu bakora ku ruhande gishobora kubinjiriza inyungu,” Richard Nyirinkwaya, ushinzwe ishami ryo kwihangira imirimo muri DOT Rwanda, umuryango watangiye mu Rwanda mu 2010, ukaba uvuga ko umaze guhugura urubyiruko rugera ku 40.000.Aimée Angelique Noela Akayezu na we ukora muri DOT Rwanda akaba ari we wabahuguye ku bijyaye no kwihangira imirimo, yasobanuye

ibiranga rwiyemezamirimo wa nyawe harimo nko gukunda ibyo akora, kumenya kwisuzuma aho ageze, kumenya amahirwe amukikije ahereye ku bumenyi afite , kugira intego n’icyerekezo, ndetse no kumenya umutungo utari amafaranga ushobora guherwaho, mbere yo kwitabaza ibigo by’ishoramari.

N y u m a y ’ a m a h u g u r w a , a b a y i t a b i r i y e b a v u z e k o yasize ahinduye imyumvire yabo ku bijyanye no kuba ba rwiyemezamirimo.Kabasinga Lea, umuforomokazi ku bitaro bya CHUK yagize

ati: “Njyewe icyo nakuyemo, namenye amategeko agenga umurimo, namenye amategeko

ashobora kurengera umuforomo, umuforomokazi n’umubyaza.U m u k e s h a M a r i e C l a i r e umuforomokazi ukorera ku kigo nderabuzima cya Ndoba mu karere ka Gasabo avuga ko yungukiye byinshi muri aya mahugurwa. “Nahungukiye kuba nashobora kuba umuyobozi w’ejo, atari ukuvuga ngo ni ukuba umuyobozi mu giforomo cyangwa mu bubyaza, ahubwo no mu bundi buyobozi. Ubu ngiye gutangira kugira uruhare muri gahunda za leta zose,” Umukesha.Avuga ko mbere gahunda za leta nk’umuganda, umugoroba w’ababyeyi yazifataga nk’izisanzwe. anemeza ko yungutse kumenya uburenganzira bw’umugore, uburenganzira bw’umwana no kumurinda ihohoterwa, kumva ko umuntu agomba kwigirira ikizere cyane cyane ku gitsina gore, nta kwitinya, icyo akoze akaba afite intego kugirango yiteze imbere. “Aya mahugurwa yamfunguye amaso ko ushobora gukora akazi k’ububyaza n’ubuforomo kandi nkagakora neza, ariko kandi nkagira ikindi kintu nakora gishobora kumbyarira inyungu, nkihangira

Ifoto y’urwibutso y’abanyamuryango ba RNMU bahuguwe, hamwe n’abayobozi ba Sendika ndetse n’aba Minisiteri y’Ubuzima.


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umurimo.”“Ingamba yo kumva ko ngomba gukunda umurimo wanjye, nkitinyuka, nkumva ko inzego zose harimo n’inzego zisanzwe z’ubuyobozi ngiriwe ikizere mfite ubushobozi bwo kuba nagira icyo nkora, kandi nkaba nshobora guhanga umurimo,” Umukesha Marie Claire avuga muri make icyo amahugurwa yamusigiye.Umunezero Marie Colombe, umuforomokazi ku bitaro bya CHUK avuga ko we yongeye kwibutswa imiyoborere na gahunda z’igihugu ndetse akumva agomba kuzigiramo uruhare.“Kugirango ejo hazaza habe heza, urubyiruko, cyangwa se umwari n’umutegarugori ni inshingano zabo ku mwihariko kugira uruhare muri gahunda za Guverinoma cyane ko twe tutakundaga kubikora,” Umenezero.Asoza aya mahugurwa ku mugaragaro, umuyobozi muri Minisiteri y’Ubuzima Claude yunze mu rya Perezida wa RNMU André Gitembagara, yibutsa abahuguwe gukomeza guharanira isura nziza y’ubuvuzi. Yabasabye kugira uruhare mu kubungabunga ubuzima, kwihangira umurimo.“kutitabira amahirwe yashyizweho ngo twiteze imbere, kubona inguzanyo… bituma umushahara utagira akamaro gahambaye. Mugomba kwihangira imirimo, bidakuyeho gukomeza kuzuza inshingano zanyu nk’abaforomokazi n’ababyaza,“ ibyavuzwe na Claude.Yabasabye ko bagombye kugira uruhare rwisumbuyeho muri gahunda y’ibigo by’ubuvuzi biciriritse (poste de santé), bakabikoramo bakagira akazi bakihemba nk’abafite umushinga wabo ku ruhande.Claude kandi yanashimye RNMU: “Igitekerezo mwagize ni nyamibwa, aba 25 mutangiriyeho babere urugero abandi kugirango barebe ko amahugurwa hari icyo yabamariye,

hanyuma biteze imbere.RNMU ivuga ko aba bahuguwe bazakomeza gukurikiranwa ku

bitekerezo by’imishinga bazaba bakoze, baterwe inkunga, maze

mu myaka itanu iri imbere hazasuzumwe aho baza bigejeje yaba mu kwihangira imirimo

cyangwa se mu kugira uruhare mu buyobozi.

Abari bitabiriye aya mahugurwa baganira mu matsinda bungurana ibitekerezo ku mushinga bashobora gukora ngo biteze imbere.

Abanyamuryango ba RNMU b’igitsina gore batanze ibitekerezo by’imishinga ishobora kuzaterwa inkunga na RNMU.


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Abaforomo, Abaforomokazi n’ababyaza bari mu nzego z’ubuyobozi bibukijwe kujya bakora imenyekanisha ku byago byose bishingiye ku mwuga byabera ku kazi kandi bakarikorera ku gihe kugirango ubwishingizi bushobore gutanga indishyi nta bibazo bibaye.

Ibi babyibukijwe na Yvonne Mujawabega ushinzwe Ishami ry’ibigenerwa umugore uri mu kiruhuko cyo kubyara mu kigo cy’igihugu gishinzwe ubwishingizi (RSSB), ubwo bahabwaga amahugurwa agamije kubasobanurira itegeko rirebana n’ubwishingizi bw’ibyago bishingiye ku kazi ndetse n’ubwishingizi bw’izabukuru.Batanga ingero, abari mu mahugurwa bagaragaje ko hari impanuka zishingiye ku mwuga bakora, nko kwitera urushinge rwatewe umuntu ufite ubwandu bwa SIDA, cyangwa kwandura igituntu, kandi abo byabayeho bakaba batarigeze bahabwa indishyi.Léodomir Harerimana, umwe mu bari muri aya mahugurwa akaba umuforomo ku bitaro bya Nema mu karere ka Gakenke agira ati:” izi ngaruka zishobora kukugeraho ndetse ukaba wakanduza umuryango wawe. Dufite n’urugero rwa mugenzi wacu wagize ubuhumyi nyuma yo gufata imiti igabanya ubwandu amaze kwitera urushinge rw’umurwayi wanduye.”Harerimana yongeraho ko iki kibazo cyatumye uyu mugenzi wabo areka

akazi, kandi akaba nta ndishyi yigeze abona.Mujawabega asobanura ko gukora imenyekanisha ry’ibyago bituruka ku kazi nk’indwara bigombye gukorwa kuri RSSB mu minsi itarenze ine ikibazo kibaye.“Kumenyekanisha ibibazo nk’ibi bishingiye ku mwuga, bikorwa mu minsi ine ikibazo cyibaye, bikamenyeshwa RSSB kugirango hashobora gutangwa indishyi nta bibazo bibaye. Ndabasaba rero ko mwajya mwihutira gukora iri menyekanisha,” Mujawabega asobanura ikigomba gukorwa mu gihe habaye impanuka ishingiye ku kazi.

Gutangirwa umusanzuMujawabega kandi yasobanuriye abari mu mahugurwa ko bagomba gukurikirana bakamenya ko abakoresha babo batanga ubwishingizi kugirango bashobore kubona indishyi zose igihe habayeho ikibazo cyangwa se bagiye mu zabukuru.Yabibukije ko ubwiteganyirize bw’izabukuru ndetse n’ibyago bikomoka ku kazi bungana na 6% by’umushahara mbumbe, umukoresha agateganyiriza umukozi we 3% , umukozi na we agatanga 3%, bityo bakaba bagomba kugenzura ko uku ari ko babikorerwa.Ubwitaganyirize burebana n’uburwayi bufitanye isano n’akazi bwo buracyari kuri 2% bw’umushahara mbumbe, kandi yose atangwa n’umukoresha.“Niba umukoresha atagukase ubu, ntashobora kugukata ku musharara ikirarane, ahubwo amafaranga

ayavana ku ngengo y’imari ye.”Mu gihe bimenyekanye ko umusanzu udatanga, ibihano bikomeye na byo byarateganyijwe, “kuko mu gihe umukoresha atinze gutangira abakozi be umushahara, acibwa amande angana na 1.5% y’amafaranga yagombaga gutanga, ndetse hakaba hemewe n’uko RSSB yagwatira umutungo w’umukoresha kugirango umusanzu w’umukozi wishyurwe.”Yaba umukozi ukorera abikorera cyangwa se Leta agomba gutangirwa uyu musanzu, ufatwa n’umukoresha akawugeza kuri RSSB. “Mujye mugenzura ko babatangira umusanzu kuko kugirango mubone indishyi ni uko umusanzu uba umaze gutangwa nibura mu myaka itanu kuko iyo habuzemo n’ukwezi kumwe, ntizitangwa…Ni byiza kumenya ko umusanzu wawe watanzwe neza, ” Mujawabega.Abanyamuryango ba RNMU basobanuriwe uburyo Leta ireberera abaturage bayo kugirango bateganyirizwe ndetse n’iyo bagize ibyago runaka ubwishingizi bubagoboke.Yababwiye ko ubwiteganyirize ari inshingano y’ibanze ya Leta kandi bushingira ku itegeko nkuko biteganywa n’ingingo ya 22 y’amasezerano mpuzamahanga y’uburenganzira bwa muntu, naho ingingo ya 10 y’Itego Nshinga ry’ u Rwanda na yo ikaba iteganya uburenganzira ku bwiteganyirize.Yabasobanuriye ko ubwiteganyirize bufite amashami icyenda y’ibanze ariko yose mu Rwanda akaba adahari.“Kugirango igihugu kivuge ko gifite ubwiteganyirize nyabwo, ni uko

Mujawabega ukora muri RSSB aganiriza abari bitabiriye amahugurwa

Abaforomo abaforomokazi n’ababyaza bari mu buyobozi bibukijwe gukora imenyakanisha igihe habaye impanuka ku kazi


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kiba gifite aya mashami yose uko ari icyenda,” ibivugwa n’uyu mukozi muri RSSB, wongeraho ko hakorwa ibishoboka ngo aya mashami yose abeho mu Rwanda.Ayo mashami ni ubwiteganyirize bw’izabukuru, ubwitaganyirize ku rupfu, ubwiteganyirize bw’umuryango, ubwishingizi bwo kwivuza, ubwiteganyirize bw’ikiruhuko cyo kubyara, Ubwitangiyirize bw’abavuye ku kazi, ubwiteganyirize bw’abatari ku murimo kubera uburwayi, ubwiteganyirize bushingiye ku bumuga umuntu agize, ubwiteganyirize bw’ibyago bikomoka ku kazi ndetse n’ubwiteganyirize bushingiye ku bumuga umuntu agize ari ku kazi.Yabibukije ko abakozi bagomba kujya ku kazi gasaba gukora urugendo rurerure bagomba kuba bafite urupapuro rw’ubutumwa, kugirango bashobore guhabwa indishyi mu gihe habayeho impanuka, kuko “mu gihe udafite uru rupapuro rwemeza ko wari uri mu kazi udashobora kubona izi ndishyi.” Abakoresha barimo bibukijwe ko bagomba kwandikisha muri RSSB umukozi wese batangiye gukoresha mu gihe kitarenze iminsi irindwi: “Umukozi agomba kumenya niba akigera mu kazi umukoresha we yamwandikishije muri RSSB. Hari abantu bajya mu kiruhuko cy’izabukuru ugasanga ni bwo babonye ko umukoresha atagiye abateganyiriza igihe cyose, ndetse bakabura n’aho babibariza. Mugomba kumenya rero ko byakozwe mugenzura ku mashami abegereye ya RSSB. Buri mwaka mujye mumenya uko kwiteganyiriza kwanyu guhagaze,” Mujawabega. yanibukije ko bagomba kumenya kuvuga ibibazo byababayeho bifitanye isano n’akazi, kuko bitandukanye n’ubundi bwishingizi bwo kwivuza, byo ikiguzi cyo kwivuza

cyishyurwa 100% kandi byasaba ko bajya kuvuzwa hanze, na byo bigakorwa.Ibi ngo birafasha kuko hari igihe uburwayi bw’ubu bushobora kuzazana ubumuga gihe kizaza, rero bikaba buri gihe biba byiza kubivuga.

IngambaAbitabiriye aya mahugurwa bavuga ko batahanye Ingamba zo gukomeza gukora ubukangurambaga n’ubuvugizi kuri politiki zirebana n ’ u b w i t e g a n y i r i z e n d e t s e n’ubwishingizi ku byago umukozi agiririra ku kazi, kugirango zishyirwe mu bikorwa n’abakoresha bari mu nzego zitandukanye z’ubuzima.Leodomir Harelimana avuga ko yungutse byinshi ku bijyanye n’ubwiteganyirize bw’izabukuru, igishingirwaho ngo umuntu ajye mu zabukuru, ndetse no kuba umuyobozi uhamye ushoboye kuvugira abakozi neza.Harelimana anavuga ko ingaruka zikomoka ku mmwuga nko kwandura igituntu ndetse n’agakoko ka SIDA ari ibintu byoroshye ku baforomo, abaforomokazi n’ababyaza ariko ko mu gihe ubwishingizi buhari bashobora kuvurwa neza ndetse no gukurikiranwa mu gihe habaye ingaruka z’uburwayi bw’igihe kirekire.“ B a t u b w i y e i b i j y a n y e n’imenyekanisha ry’ibyago bikomoka ku kazi. Nari nzi ko umuyobozi

agomba gukora iri menyekanisha mu gihe hari ibyago nk’ibi, ariko sinari nzi ko bikorwa mu minsi itarenze ine. Iki ni ikintu gikomeye, kuko gishobora kugira ingaruka ku buzima bw’umukozi. Ubu ngiye guhindura uko nabikoraga,” Harelimana.Isheja Innocent ni umuyobozi wa RNMU ku rwego rw’akarere. Avuga ko yasobanukiwe cyane n’itegeko rivuga ku bwishingizi bw’impanuka zifitanye isano n’akazi.“Twasobanukiwe n’itegeko rirengera uwahuye n’impanuka, ndetse tunasobanukirwa neza ko hari ibyo iri tegeko ridafutura ku mwuga w’ububyaza n’ubuforomo. Ubu tugiye gukora ubuvugizi kugirango itegeko uko riteye ubungubu ribarengere, ndetse no gushyira imbaraga mu buvugizi ngo rivugururwe rirusheho no kwita ku byago biba muri uyu mwuga.”

Isheja Innocent Umuyobozi wa RNMU ku rwego rw’akarere.


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Main targets

1 By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births

2 By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births

3 By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases

4 By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being

5 Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol

6 By 2020, halve the number of global deaths and injuries from road traffic accidents

7 By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health into national strategies and programmes

8 Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all

9 By 2030, substantially reduce the number of deaths and illnesses from hazardous chemicals and air, water and soil pollution and contamination

W h e n t h e M i l l e n n i u m Development Goals (MDGs) were being evaluated in 2015, Rwanda was hailed as one of the countries that best reachead the targets, and improved lives of its citizens. Now that Rwanda is determined to even better the achievements of the Sustainable Development Goals (SDGs) targets, the Rwanda Nurses and Midwives Union (RNMU) has made its priority reinforcing skills of nurses and midwives in practice, who account for more than 70% of the personnel in health sector in Rwanda, to contribute hitting the targets of SDGs in health sector.SDGs have 17 goals, and the third goal related to health is to “Ensure Healthy Lives and Promote Well-being for all at all ages”.The goal has nine main targets and 31 indicators meant to be achieved by 2030 from date the goals were set in September 2015.“We are very aware of the fact that nurses and midwives have to play an important role to achieve the targets of SDGs. At

RNMU level, we have designed C o n t i n u o u s P r o f e s s i o n a l Development (CPD)programs, to constantly upgrade professional skills of practicing nurses and midwives, thus contributing to improving delivered healthcare services, hence lives of Rwanda, and contributing to achieve the targets of the SDGs,” said RNMU president André Gitembagara.Nathalie Umutoni in charge of Planning division at the Ministry of Health commends the work of nurses and midwives, but urges them to put more effort as the SDGs are more demanding.“What I can tell them is to build from the achievements of the past decade to reach more successes. Achieving the SDGs in health sector is the priority of our Government, it has to be the priority of the institutions and personnel in the sector, including nurses and midwives,” she said. SDGs are officially known as Transforming our World: the 2030 Agenda for Sustainable

RNMU resolved to contribute to SDGs implemention in health sector


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Abaforomo n’ababyaza bakanguriwe kwibumbira muri Sendika yabo

Abayobozi ba RNMU, Sendika y’abaforomo, abaforomokazi n’abyaza b’ U Rwanda,

bazengurutse intara y’i Burasirazuba baganira n’ababyaza, abaforomo n’abaforomokazi bakora uyu mwuga, baba abakora mu bitaro ndetse n’ abakora mu bigo nderabuzima byo muri iyi ntara, babasobanurira ibyiza byo kwibumbira muri Sendika no kubakangurira kuba abanyamuryango.

Abenshi mu baforomo abaforomokazi n’ababyaza bitabiriye ibi biganiro byabereye mu turere twa Bugesera, Kirehe, Ngoma, Nyagatare, Gatsibo, na Rwamagana twose two mu ntara y’ i Burasirazuba bagaragaje ko batari bazi itandukaniro riri hagati ya RNMU, Sendika yabo, ndetse na NCNM, inama nkuru yabo igenzura cyane cyane ibirebana n’amategeko agenga umwuga, ariko banagaragaza ko bari bafite inyota yo kumenya uko Sendika yabo RNMU ibahagararira, ndetse n’inyungu bakura mu kuyinjiramo.“Ibi ni ibiganiro bishingiye ku bukangurambaga, ngo abaforomo, abaforomokazi n’ababyaza binjire muri Sendika yabo RNMU; tubasobanurira amategeko yahindutse, twinjiza abanyamuryango bashya ndetse n’abasanzwemo buzuza ifishi nshya y’umunyamuryango kuko iyari iriho yahindutse,” ibivugwa na perezida wa RNMU Gitembagara André.Muri ibi biganiro kandi abasanzwe ari abanyamuyango basabwe kuzuza ifishi nshya y’umunyamuryango, ndetse abinjiramo bwa mbere na bo bagasabwa kuyuzuza

Development” is a set of seventeen aspirational “Global Goals” with 169 targets between them. Spearheaded by the United Nations, through a deliberative process involving its 193 Member States, as well as global civil society, the goals are contained in paragraph 54 of United Nations Resolution of 25 September 2015. The Resolution is a broader intergovernmental agreement that acts as the Post 2015 Development Agenda or successor to the Millennium Development Goals.On 19 July 2014, the UN General Assembly’s Open Working Group (OWG) on Sustainable Development Goals (SDGs) forwarded a proposal for the SDGs to the Assembly. The proposal contained 17 goals with 169 targets covering a broad range of sustainable development issues. The history of the SDGs can be traced to 1972 when governments met in Stockholm, Sweden, for the United Nations Conference on the Human Environment, to consider the rights of the human family to a healthy and productive environment.It was not until 1983 that the United Nations decided to create the World Commission on Environment and Development which defined sustainable development as “meeting the needs of the present without compromising the ability of future generations to meet their own needs.” In 1992, the first United Nations Conference on Environment and Development was held in Rio. It was here that the first agenda for Environment and Development was developed and adopted, also known as MDGs.MDGs were supposed to be achieved by 2015. A further process was needed to agree and develop development goals from 2015-2030. Discussion on the post-2015 framework for international development began well in advance, with the United Nations System Task Team on Post 2015 Development Agenda releasing the first report known as Realizing “The Future We Want”. The Report was the first attempt to achieve the requirements under paragraph 246 and 249 of the Future We Want document. It identified four dimensions as part of a global vision for sustainable development: Inclusive Social Development, Environmental Sustainability, Inclusive Economic Development, and Peace and Security. Other processes included the UN Secretary General’s High Level Panel on Post 2015 Development Agenda, whose report was submitted to the Secretary General in 2013.


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kubera ko hari byahindutse, cyane cyane ku musanzu mushya uzajya utangwa“Hariho umusanzu mushya washyizweho n’urwego rukuru rwa Sendika, ungana na 1% y’umushahara w’umunyamuryango uzajya utangwa muri RNMU. I b i b i k a b a b i k u r a h o k o u m u n y a m u r y a n g o u b u n d i yatangaga amafaranga 500 buri kwezi,” Gitembagara avuga uko umusanzu mushya uzajya utangwa.RNMU iteganya ko igice cy’uyu musanzu cyafasha abanyamuryango kikababera ingwate mu gihe bashaka kubona inguzanyo mu bigo by’imari kugirango biteze imbere.Gitembagara agira ati, “20% y’umusanzu, izajya ijya mu k igeg a tw is e ‘Investments Fund’ tuzakoresha kugirango abanyamuryango biteze imbere. Muri ibi byose turi gukora harimo inyungu ziri rusange ndetse n’inyungu z’umuntu ku giti cye, igihe yagiye muri RNMU.”RNMU ikora ubuvugizi ku bibazo bitandukanye biri mu mwuga w’ubuforomo n’ububyaza.

Kuri ubu abaforomo abaforomokazi n’a b a b y a z a m u R w a n d a biyandikishije mu nama y’igihugu yabo (NCNM) barenga 11,000, abagera ku 6500 akaba ari bo bibumbiye muri Sendika ya RNMU.RNMU ivuga ko ifite intego yo gukangurira abaforomo, a b a for om o k a z i n’a b a b y a z a batarinjira muri Sendika kuza kwifatanya n’abandi, ngo babone ku byiza bijyana no kwibumbira hamwe.Ni muri uru rwego ubuyobozi bwa Sendika bwazengurutse igihugu cyose bukangurira abakora uyu mwuga w’ububyaza n’ubuforomo kwibumbira muri Sendika, ndetse n’abasanzwemo bakongera kwibutswa ibyiza byo kwishyira hamwe.Ibiganiro nk’ibi byari byarabereye m u n t a r a y ’A m a j y e p f o , Uburengerazuba, Umujyi wa Kigali, ndetse n’intara y’amajyaruguru.Perezida wa RNMU kandi yavuze ko bari kwiga ku kibazo cy’abaforomo abaforomokazi n’ababyaza kubera ko birirwa mu kazi, bahura bishobora guhungabanya ubuzima

bw’imitekerereze bwabo.RNMU, Sendika yabo yabonye ko iki kibazo gihari, ndetse perezida wayo Gitembagara André akaba avuga ko batangiye guteganya uburyo bwo gufasha abanyamur yango bagezweho n’iki kibazo cy’ihungabana mu mitekerereze. Gitembagara akaba yongeraho ko icyumba kizaba kiri mu nyubako ikicaro gikuru RNMU ikoreramo kizajya cyakira abafite ibi bibazo, ariko hakaba hari igitekerezo ko icyumba nk’iki cyashyirwa hirya no hino mu turere mu gihugu, ngo abaforomo n’ababyaza babonere ubufasha ahantu habegereye.

Gitembagara agira ati, “Ni umushinga mugari, ku buryo dushaka ko umuforomo ufite icyo kibazo azajya aza akahasanga u m u f o r o m o m u g e n z i w e wabyize, akamufasha mu buryo bw’ubujyanama, ariko akanisanga mu rugo, akumva ari mu rugo, niba aje hano kuri RNMU, agafungura, akaryama, akaruhuka agasubira ku murongo.”

Ifoto y’urwibutso y’abanyamuryango ba RNMU n’abayobozi nyuma y’ubukangurambaga bwakorewe mu ntara y’ i Burasirazuba


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Philosophy Vision

Mission

RNMU believes in providing high quality, ethical, accessible and equitable nursing and midwifery services to all members of the population to enable them live quality lives. Thus while upholding this philosophy RNMU believes that members will receive social and economic justice as a reward from their employers.

RNMU is committed to being a vibrant, self-sustaining organization that will protect the Professional image, improve Socio-Economic Welfare, and promote the interests of nurses and midwives through effective representation, capacity building and lead in the delivery of high quality care to the population.

To have an empowered nurse and midwife who is motivated to provide high quality service and uphold professional excellence while enjoying quality life.


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The Rwanda Nurses and Midwives Union

Gasabo/Rukiri II

P.O. BOX 5406 Kigali, Rwanda

Email: [email protected]

Tel: (+250) 07 87 55 11 78

© RNMU 2017

Documents

RNMU MAGAZINE