Department of Planning, Faculty of IT and Design, Aalborg University, Aalborg.
Afr J Prim Health Care Fam Med. 2020 Sep 16;12(1):e1-e10. doi: 10.4102/phcfm.v12i1.2197.
Skill-mix imbalance is a global concern for primary healthcare in low-income countries. In Rwanda, primary healthcare facilities (health centres, HCs) are predominantly led by nurses. They have to diagnose a multitude of health complaints. Whether they feel capable of undertaking this responsibility has yet to be explored.
This study explored how healthcare providers (HPs) at Rwandan HCs perceived their capability in the diagnostic practice.
Rural and urban HCs in Muhanga district, Rwanda.
Qualitative, semi-structured interviews with nurses and clinical officers, and observations of consultations were made. Findings were analysed thematically.
Rwandan HPs were confident in their competences to perform diagnostic procedures although nurses felt that the responsibilities lay beyond their professional training. Clinical officers believed that their professional training prepared them to function competently and autonomously in the diagnostic practice, although all HPs experienced a high dependency on medical history taking, physical examination and laboratory tests for reaching a diagnosis. Resource constraints (time, rooms and laboratory tests) were seen as a barrier to perform diagnostic tasks optimally, and HPs experienced in-service training and supervision as insufficient. They increased their diagnostic competences through work experience, self-learning and supportive peer collaboration.
Clinical officers perceived themselves as capable in the diagnostic practice. Nurses may compensate for insufficient school training through in-service learning opportunities and feel capable in the diagnostic practice. Formative mentorship schemes and tailored education may prove valuable, but further research on how to improve HPs' diagnostic capability in Rwanda's primary healthcare sector is needed.
技能组合失衡是低收入国家初级医疗保健的全球性问题。在卢旺达，初级医疗保健机构（卫生中心，HCs）主要由护士领导。他们必须诊断多种健康投诉。他们是否觉得自己有能力承担这一责任还有待探讨。
本研究探讨了卢旺达 HCs 的医疗保健提供者（HPs）如何看待他们在诊断实践中的能力。
卢旺达穆汉加区的农村和城市 HCs。
对护士和临床医生进行定性、半结构化访谈，并观察咨询情况。对调查结果进行了主题分析。
卢旺达 HPs 对自己执行诊断程序的能力充满信心，尽管护士认为责任超出了他们的专业培训范围。临床医生认为，他们的专业培训使他们能够在诊断实践中胜任和自主地工作，尽管所有 HPs 都经历了对病史、体检和实验室检查的高度依赖，以做出诊断。资源限制（时间、房间和实验室检查）被视为优化诊断任务的障碍，并且 HPs 认为在职培训和监督不足。他们通过工作经验、自我学习和支持性同伴合作来提高他们的诊断能力。
临床医生认为自己在诊断实践中具有能力。护士可能会通过在职学习机会来弥补学校培训的不足，并在诊断实践中感到有能力。形成性指导计划和量身定制的教育可能会证明是有价值的，但需要进一步研究如何提高卢旺达初级医疗保健部门 HPs 的诊断能力。
