Health policies impacts on providers' SelfEsteem in Rwanda: some unexpected results

Poster Session: Poster Topic: State-of-the-Art Health Systems Research findings Presenter: Anne Fromont (School of Public Health - Universit Libre de Bruxelles) Authors (6): Anne Fromont (School of Public Health - Universit Libre de Bruxelles) , Achour Ait Mohand (National Institut of Public Health - Rwanda) , Yvonne Kayiteshonga (Rwanda Biomedical Center- Ministry of Health - Rwanda. Mental Health) , Aline Labat (School of Public Health - Universit Libre de Bruxelles) , Lilas Weber (School of Public Health - Universit Libre de Bruxelles) and Bruno Dujardin (School of Public Health Universit Libre de Bruxelles)

Abstract (300 words) Introduction Our study explored health policies' impacts on providers' self-esteem in a general context of system reforms. Rwanda's national health system has initiated mental health care policy following genocide tragedy. Actors' trainings and supervision have supported this process of decentralisation and integration since 2005. As this strategy brings to more autonomy, responsibility and cooperation, it was relevant to follow up providers' self-esteem. Methods In 2012, a survey conducted among the 40 trained mental health providers (mainly nurses) investigated self-esteem with the Rosenberg' Self-Esteem Scale (RSES) and Pierce' Organization-based Self-Esteem Scale (OBSES). Additional Likert-type questions aimed to explore antecedent factors and expected outputs of self-esteem levels (ie: relations with others services, level of commitment or satisfaction). Results Results showed consistent and all-embracing bias. RSES and OBSES internal reliabilities were notably low (respective Cronbach's alpha: 0.33 and 0.67 for approximately 0.80 and 0.85 in the literature). Reversely, RSES and OBSES produced unusual high mean scores (respectively 34.42 and 63.5 for world-wide scores between 25.5-33.0 and 29.7-51.8). Other respondents' answers confirmed this "good-respondent bias: with non-normal distributions, medians often reached the maximum score. Actually, 72.5%[CI95%:0.58-0.86] of respondents systemically chose the highest scores (6 or 7) or the opposite for negatives formulations.

Discussion These results were undeniably unexpected. Did the specific context of the survey administration (annual meeting of mental health providers) lead actors to interpreted the questionnaire as a professional evaluation? As performance-based financing takes an obvious place in Rwanda' system-wide reforms, did this new care implementation encourage providers to declare first excellent results ? Moreover, several studies in the Great Lakes area reveal atypical results compared to occidental countries. So are RSES and OBSES really adapted in such context ? Further research may help us investigate on this issue but those intermediate results already highlight the relevance for a qualitative exploration.

Key Terms: Actors' Self-Esteem, Health workforce strengthening, Health system reforms, Systemic impact of health policy, Rosenberg, Organization-based Self-Esteem, Mental health care