Exploring Perspectives of Healthcare Staff on Achieving the Healthcare Quality Standards in District Hospitals in Rwanda: A qualitative Study

Background: The World Health Organization (WHO) has recommended that quality of care (QoC) should be timely delivered within safe conditions based on patient needs and preferences. However, low- and middle-income countries face challenges such as understaffing and inadequate infrastructure, resulting in poor QoC. In 2012, Rwanda leveraged the pre-existing performance-based financing (PBF) to introduce continuous quality improvement (QI) towards accreditation recognition of district hospitals (DH). Despite these efforts, no DHs accredited by 2022. Objective: To explore perspectives of healthcare professionals (HCP) on achieving the delivery of standard QoC in Rwandan DHs. Methods: Using an interpretative epistemology, this qualitative study conducted in-depth semi-structured interviews with 14 participants purposively sampled HCPs from Masaka (urban) and Remera-Rukoma (rural) DHs. Interview data were audio-recorded, manually transcribed, and analyzed with thematic content analysis. Results: The analysis revealed three main themes: perceptions about continuous QI towards accreditation recognition, barriers to achieving accreditation, and strategies to achieve the recognition. Participants from both hospitals expressed that the accreditation program required more efforts than the PBF approach. They also highlighted that the DHs were still at the awareness stage and had not clearly implemented the quality standards due to challenges such as low staff involvement and motivation, staff turnover and shortage, and limited budget for accreditation. Recommended strategies to achieve the recognition included staff motivation through increased incentives and salaries, cascaded accreditation rollout, and integrating accreditation program into pre-service curriculum. Conclusions: This qualitative study highlighted the challenges, such as limited budget and low staff motivation, impeding progress towards DH accreditation recognition. Cascaded accreditation rollout, enhanced staff incentives and salaries, and integration of accreditation program into pre-service curriculum were key strategies suggested for Rwanda Ministry of Health and DHs to achieve the required quality standards and recognition.