Rwanda: Management of Services

The Mentoring and Enhanced Supervision for Health Care (MESH) program was introduced in Rwanda to improve quality of care, with a particular focus on the WHO’s Integrated Management of Childhood Illness (IMCI) protocol. The goals of MESH were twofold: 1) improve the skills of health workers through mentoring in health centers and 2) support quality improvement efforts to improve facility systems and operations.1 The program introduced qualified nurse mentors into health centers to provide mentorship, coaching, and support. There were three important elements that distinguished MESH from traditional IMCI implementation: 1) MESH training was provided in the health facilities rather than off-site, 2) additional, intensive supervision was provided, and 3) clinical supervisors were responsible for improving the use of data for performance monitoring.1

There was both a qualitative and quantitative evaluation of this program. Qualitative findings showed that providers appreciated the supportive nature of their supervision, including active listening and a focus on improvement and learning rather than supervision for punitive action. Additionally, providers reported that mentors were able to identify important areas for system improvement within the facility which ultimately made their work more efficient.1 Quantitative results found that most indicators of IMCI assessment, classification, and treatment improved after one year with the exception of the use of a growth chart.2 Barriers to the implementation of MESH were primarily related to inputs; insufficient infrastructure and frequent stock-outs often made it challenging for both providers and mentors to carry out their responsibilities.


  1. Manzi A, Magge H, Hedt-Gauthier BL, Michaelis AP, Cyamatare FR, Nyirazinyoye L, et al. Clinical mentorship to improve pediatric quality of care at the health centers in rural Rwanda: a qualitative study of perceptions and acceptability of health care workers. BMC Health Serv Res. 2014 Jun 20;14:275.
  2. Magge H, Anatole M, Cyamatare FR, Mezzacappa C, Nkikabahizi F, Niyonzima S, et al. Mentoring and quality improvement strengthen integrated management of childhood illness implementation in rural Rwanda. Arch Dis Child. 2015 Jun;100(6):565–70.