South to south collaboration: advancing quality of abortion care through health care professionals exchange program.

Background: South-South Cooperation (SSC) is recognized as a vital component of goal 17 - 'Partnerships for the goals' within the SDGs and countries in the global south has been utilizing this cooperation mainly in research. We report the first health care professional exchange program through this south-to-south collaboration focusing on advancing quality of abortion care in the Sub-Saharan region.

Methods: We conducted a comprehensive mixed method study, incorporating both quantitative and qualitative approaches, to assess the impact of health care professionals' exchange program within the obstetrics and gynecology departments of two teaching institutions in Ethiopia and Rwanda over the course of a year (February 1, 2023-January 31,2024). Our methodology involved administering a self-administered questionnaire on Google Form to health professionals who participated in the exchange program. Qualitative data were collected through an in-depth interview with representative subjects from these professionals. Simple descriptive statistics using SPSS version 23 was employed to analyze the quantitative data. For the qualitative data, recruitment of participants continued until thematic saturation was achieved, signifying no emergence of new themes. Thematic analysis, following initial coding and inter-coder agreement, was employed to identify key themes from the interviews. Finally, triangulation of qualitative and quantitative data was performed to provide a comprehensive understanding of the program's impact.

Results: Among 60 health care professionals whom we have approached for this survey, 55 consented and participated in the survey, representing a response rate of 92%. Among them, 35 (63.6%) were from Rwanda, 20 (36.4%) were from Ethiopia, 23.6% were females, 80.0% were residents and 16.4% were midwives. The overall mean scores for knowledge, attitude, and practice transformation on safe abortion care by Rwandese professionals were 84.9%, 84.5%, and 84.6%, respectively. From the Ethiopian side, the overall score for knowledge and attitude, and intent to practice demonstration were 81.3, 83.4%. Essentially, they expressed that it allowed them to inspire Rwandese counterparts on the importance of women's reproductive rights and implementation of global best practice (89%). On analysis of the qualitative data, we identified 3 overarching themes: 1) Opportunities created by the exchange 2) Inputs on safe abortion care quality improvement 3) Recommendations for future exchange programs. Most participants indicated that the exchange program was very helpful in advancing knowledge, attitude, and intent to practice quality abortion care. Participants from both sides agreed that the safe abortion care services provided in Ethiopia is far advanced, which can be reproduced in Rwanda by implementing the lessons learned from the exchange program.

Conclusion: South-to-south collaboration through health care professionals exchange programs among developing countries (including Sub-Saharan Africa) is feasible and helpful in transforming the level of reproductive health practice (mainly safe abortion care) as well as advocating for better reproductive health rights in these countries.