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 3
January, 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 Tr a i n i n g
R N M U
MAGAZINE
Kwihangira imirimo
Abanyamuryango ba RNMU
bungutse byinshi................P.22
Intara y’i Burasirazuba
Uturere dutandukanye twarasu
we...........................................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 tF e a t u r e s
TheRwandaNursesandMidwives’Voice
RNMU is a member of

»» p.4
»» p.18
4 Ubushakashatsi
Abayobozi muri MOH na MIFOTRA basezeranyije ubuvugizi ku
bibazo mu mwuga w’ubuforomo n’ububyaza
18 Ibikorwa mu mafoto
Amafoto meza kurusha ayandi yaranze ibikorwa bya RNMU mu
mwaka wa 2016
20 Amahugurwa ku miyoborere
Kwihangira 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
2

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.
OWNERSHIP
The Rwanda Nurses and
Midwives Union(RNMU)
Editor
Théophile Harushyamagara
Design:
Contributors
André Gitembagara
Jean Pierre Nsabimana
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 (clinical 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 bushakashatsi 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.
Ubushakashatsi4

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,
muri bo 11.700 bahawe
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
5

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.
Twoyearsafter,theNationalCouncilofNursesandMidwives
(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
SUMMARY
Increasing 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.
Research6

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 reward
from 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 STATEMENT
In 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.
ThedatafromHumanResourcesInformationSystem(HRIS)
2013 and from Rwanda General
Population 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 would
on 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 would
say 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.
OBJECTIVES
General objective
The 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
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
7

of nursing and midwifery services delivery to the Rwandan
population.
Specific objectives
The 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
facilities
2. To determine the nurse/midwife- bed ratio in different
health facilities of Rwanda
3. 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 questions
The 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 study
This 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 METHODOLOGY
Study design
This 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 site
This 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 population
The 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 population
a. Inclusion criteria
The 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 the
following services: internal medicine, surgical, pediatrics,
Accidents& Emergencies, Obstetrics and Gynecology;
critical care as well as nurses and midwives administrators at
different levels of the health system of Rwanda.
b. Exclusion criteria
The 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.
Sampling
Stratified 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 size
Considering 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:
Research8

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 techniques
Primary data was gathered using Nurses and Midwives
ProfessionalSatisfactionSurveyQuestionnaire(inappendices
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 analysis
Information 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 considerations
Informationprovidedbyparticipantswasbekeptconfidential
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
Introduction
This 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 satisfaction
dimension 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%).
9

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.
TheHealthcentersaremorerepresentedwith398respondents
representing 73.4% of the respondents. District Hospitals are
represented by 96 nurses/ midwives representing 17.7% of the
respondents 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
Research10

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 while
48.5% 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.
962.9% 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.
11

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
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
moderatelysatisfied,69.9%areintherangeofverydissatisfied
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
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
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
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.
Research12

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
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 job
satisfaction 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
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 dimensions
Recognizing 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% other
options.
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 to
remain in the health sector.
QUALITATIVE FINDINGS
Nursing human resources and the package for National
health facilities
The 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 planning
Participants 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 and
paid 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 for
nursing 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 policies
According 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 established
by nurses and midwives is primarily for advocating for
improvement of nurses and midwives working conditions.
DISCUSSION OF THE FINDINGS
Nursing and Midwifery staffing
Different 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, the
available 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 and
those 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 compared
to 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 can
underestimate 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
Research14

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
morenursesandmidwivesareupgradingtheireducationlevel
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 current
structure 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 improved
death 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 registered
nurses/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 midwives
It 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’ compensation
One 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
satisfied with their amount of salary; which means simply
that 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 Convention
recommends that remuneration of nursing personnel should
be fixed at levels which are commensurate with their socio-
economic needs, qualifications, responsibilities, duties and
experience, 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 hours
The 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 code
recommends 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 consumables
The 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 risks
Working 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 do
their 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 task
Co-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 stability
Concerning 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 satisfaction
Considering 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).Thiscanbeexplainedbythepoorworkingconditions
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 dimensions
Recognizing 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 ’preferences
In 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 RECOMMENDATIONS
Working 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 widely
depending on a variety of factors. The largest percentage of
Research16

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 with
advanced 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 lack
nursing 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 and
68.3% of nurses and midwives in clinical services have
reported being affiliated in a labor union .
Recommendations
Based 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 influence
positively the recruitment and maintenance of highly
qualified nurses and midwives in clinical setting
2. 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 personnel
3. 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 staffing
2. 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 being
2. To conduct CPD need assessment for nurses and midwives
3. To facilitate nurses and midwives for access to CPD of
their interest
4. 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 resources
2. To consider the need of employees in different services/
Units for personal growth
3. To provide words for encouragement for the work well
done rather than blaming only the wrong doers
4. 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
specificallyatidentifyingthelevelofnurses
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.
02Jean de Dieu Munyagashubi
is a consultant who
conducted the survey. Here, he is
presenting its summary.
05RNMUSecretaryGeneralJean
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

Pictorial18

08Yvonne 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

Abanyamuryango ba
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
mahugurwa nyuma y’uko
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 rishinzwe
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.
Ledearship20

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.
Iri suzuma
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.
“kubakoramubuzima,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.
Ibiganiro
Uwamahoro 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
namwengobishyirwemubikorwa.”
“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.
21

|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.
“Arikoayamahugurwayamfunguyeamasomenyakontateshutsekunshinganozanjyez’umuforomokazi,
nshobora kugira ikindi kintu nkora kandi nkiteza imbere.”
Kwihangiraimirimon’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
na Sendika y’abaforomo
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.
MbabaziPerpétueushinzweubushakashatsi
n’amahugurwa muri RNMU.
Ledearship22

Umuntu utari muri Sendika
aracikanwa, kandi bitak-
agombye. Ikindbifite icy-
erekezo cyo guteza imbere
umunyamuryango.
bo barusheho kwiteza imbere.
Mu isomo ryo kwihangira imirimo
by’umwihariko, bahuguwe
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’Abanyakanada ugamije
iteramberery’urubyirukowahuguye
aba banyamuryango, na we
yumvikanisha ko abanyamuryango
ba RNMU bagomba kwitinyuka.
“Twabonye ko bashobora gukora
umurimow’ububyazan’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 ,
abayitabiriye bavuze ko
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.
Umukesha Marie Claire
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
nkagakoraneza,arikokandinkagira
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.
23

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
inshinganozanyunk’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.
Ledearship24

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
amahugurwaagamijekubasobanurira
itegeko rirebana n’ubwishingizi
bw’ibyago bishingiye ku kazi ndetse
n’ubwishingizi bw’izabukuru.
Batangaingero,abarimumahugurwa
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
ndetseukabawakanduzaumuryango
wawe. Dufite n’urugero rwa mugenzi
wacu wagize ubuhumyi nyuma yo
gufataimitiigabanyaubwanduamaze
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
imenyekanishary’ibyagobiturukaku
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 umusanzu
Mujawabega 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,
umukoreshaagateganyirizaumukozi
we 3% , umukozi na we agatanga 3%,
bityo bakaba bagomba kugenzura ko
uku ari ko babikorerwa.
Ubwitaganyirizeburebanan’uburwayi
bufitanyeisanon’akazibwoburacyari
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.”
Mugihebimenyekanyekoumusanzu
udatanga, ibihano bikomeye na byo
byarateganyijwe, “kuko mu gihe
umukoreshaatinzegutangiraabakozi
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
indishyiniukoumusanzuubaumaze
gutangwa nibura mu myaka itanu
kukoiyohabuzemon’ukwezikumwe,
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
arikoyosemuRwandaakabaadahari.
“Kugirango igihugu kivuge ko gifite
ubwiteganyirize nyabwo, ni uko
MujawabegaukoramuriRSSBaganiriza
abari bitabiriye amahugurwa
Abaforomo abaforomokazi n’ababyaza bari mu buyobozi
bibukijwe gukora imenyakanisha igihe habaye impanuka
ku kazi
25

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,
ubwiteganyirizebw’ibyagobikomoka
ku kazi ndetse n’ubwiteganyirize
bushingiyekubumugaumuntuagize
ari ku kazi.
Yabibukijekoabakozibagombakujya
ku kazi gasaba gukora urugendo
rurerure bagomba kuba bafite
urupapurorw’ubutumwa,kugirango
bashoboreguhabwaindishyimugihe
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.Mugombakumenya
rerokobyakozwemugenzuraku
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,byoikiguzicyokwivuza
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
bikababurigihebibabyizakubivuga.
Ingamba
Abitabiriye aya mahugurwa
bavuga ko batahanye Ingamba zo
gukomezagukoraubukangurambaga
n’ubuvugizi kuri politiki zirebana
n’ubwiteganyirize ndetse
n’ubwishingizi ku byago umukozi
agiririrakukazi,kugirangozishyirwe
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,ndetsenokubaumuyobozi
uhamye ushoboye kuvugira abakozi
neza.
Harelimana anavuga ko ingaruka
zikomokakummwugankokwandura
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’imenyekanishary’ibyagobikomoka
ku kazi. Nari nzi ko umuyobozi
agombagukorairimenyekanishamu
gihe hari ibyago nk’ibi, ariko sinari
nzi ko bikorwa mu minsi itarenze
ine. Iki ni ikintu gikomeye, kuko
gishoborakugiraingarukakubuzima
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’ububyazan’ubuforomo.Ubutugiye
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.
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
Ledearship26

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,theRwandaNurses
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
Continuous Professional
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
Features 27

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
bitabiriyeibibiganirobyabereyemutureretwaBugesera,
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’abasanzwemobuzuzaifishinshyay’umunyamuryango
kuko iyari iriho yahindutse,” ibivugwa na perezida wa
RNMU Gitembagara André.
Muri ibi biganiro kandi abasanzwe ari abanyamuyango
basabwekuzuzaifishinshyay’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.
Members Recruitment28

kubera ko hari byahindutse, cyane
cyane ku musanzu mushya uzajya
utangwa
“Hariho umusanzu mushya
washyizweho n’urwego rukuru
rwa Sendika, ungana na 1%
y’umushaharaw’umunyamuryango
uzajya utangwa muri RNMU.
Ibi bikaba bikuraho ko
umunyamur yango ubundi
yatangaga amafaranga 500 buri
kwezi,” Gitembagara avuga uko
umusanzu mushya uzajya utangwa.
RNMU iteganya ko igice cy’uyu
musanzucyafashaabanyamuryango
kikababera ingwate mu gihe
bashaka kubona inguzanyo mu bigo
by’imari kugirango biteze imbere.
Gitembagara agira ati, “20%
y’umusanzu, izajya ijya mu
kigega twise ‘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.
Kuriubuabaforomoabaforomokazi
n’ab abyaza mu Rwand 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,
abaforomokazi n’ababyaza
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
mu nt ar a y ’Am aj ye pfo,
Uburengerazuba, Umujyi wa Kigali,
ndetse n’intara y’amajyaruguru.
PerezidawaRNMUkandiyavuzeko
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
abanyamuryango 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
umuforomo mugenzi we
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
29

30

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
philosophyRNMUbelieves thatmembers
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.
31

The Rwanda Nurses and Midwives Union
Gasabo/Rukiri II
P.O. BOX 5406 Kigali, Rwanda
Email: info@rnmu.rw
Tel: (+250) 07 87 55 11 78
© RNMU 2017

RNMU MAGAZINE

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