Exploring Factors Affecting Global Health Nursing Partnerships and Sustainability

Background: Nurses and midwives constitute more than 50% of the health worker shortage in global health. Low-income and lower-middle-income countries account for 89% of the shortage. Nurses and midwives in many low- and middle-income countries (LMIC) are not adequately trained to meet the global population’s needs. Nurse leaders are essential in training nurses and midwives to address the global health crisis. Developing institutional and governmental partnerships between high-income and LMIC is one method to address the crisis. The Rwanda Human Resources for Health program (HRH) was an example of this type of partnership. While twinning partnerships have shown to be very useful, not enough is known about the factors affecting HRH programs' sustainability. Methods: This qualitative descriptive study used a purposeful sampling of 20 “twinned” US faculty nurse leaders (USFNL) and Rwandan nurse leaders (RNL) who participated in the HRH program ( 2013-2018). Data was collected using semi-structured Interviews, observations, and document analysis. The Upvall and Leffers revised conceptual model for partnership and sustainability in global health guided the study. Results: Previous studies have not extensively discussed how the language barrier issue affected twinning partnerships during the implementation of the HRH program, considering the context of Rwanda’s linguistic history. In addition, there was a lack of a clear framework and guidelines for program implementation. The concept of twinning was used to pair USFNLs with RNLs; however, an actual twinning model was not used to guide the processes. This resulted in the inconsistency of monitoring and evaluation of program initiatives. Furthermore, the COVID-19 pandemic largely affected staffing ratios, contributing to variations in the sustainability of implemented programs and activities. Recommendations: Future studies should continue to address the need for optimized & structured planning, use of appropriate frameworks, monitoring & evaluation, and equitable participation when implementing global health programs using twinning partnerships. Consider adding a language barrier category to global health frameworks. Twinning frameworks such as the WHO Twinning Partnership for Improvement are recommended to guide program implementation. The pandemic’s priorities should be considered when evaluating the sustainability of current global health programs