Impact of a health system strengthening intervention on maternal and child health outputs and outcomes in rural Rwanda 2005–2010

Abstract

IntroductionAlthough Rwanda’s health system underwent major reforms and improvements after the 1994 Genocide, the health system and population health in the southeast lagged behind other areas. In 2005, Partners In Health and the Rwandan Ministry of Health began a health system strengthening intervention in this region. We evaluate potential impacts of the intervention on maternal and child health indicators.MethodsCombining results from the 2005 and 2010 Demographic and Health Surveys with those from a supplemental 2010 survey, we compared changes in health system output indicators and population health outcomes between 2005 and 2010 as reported by women living in the intervention area with those reported by the pooled population of women from all other rural areas of the country, controlling for potential confounding by economic and demographic variables.ResultsOverall health system coverage improved similarly in the comparison groups between 2005 and 2010, with an indicator of composite coverage of child health interventions increasing from 57.9% to 75.0% in the intervention area and from 58.7% to 73.8% in the other rural areas. Under-five mortality declined by an annual rate of 12.8% in the intervention area, from 229.8 to 83.2 deaths per 1000 live births, and by 8.9% in other rural areas, from 157.7 to 75.8 deaths per 1000 live births. Improvements were most marked among the poorest households.ConclusionWe observed dramatic improvements in population health outcomes including under-five mortality between 2005 and 2010 in rural Rwanda generally and in the intervention area specifically.

Do memories of the Ebola Virus Disease outbreak influence post-Ebola health seeking behaviour in Guéckédou district (epicentre) in Guinea? A cross-sectional study of children with febrile illness

“…This emphasizes disparities in access to health services across sub-districts in the country, and how these shape health seeking behaviours. Health disparities across local settings have been reported to often be hidden by the improvements shown by national/global indicators (29). This result may also suggest the possibility of a greater commitment of community actors to increasing community awareness to utilise health services, and of health workers to improving health service quality in the EVD-affected sub-district.…”

Lowering hospital walls to achieve health equity

“… 15 16 Rwanda, on the other hand, has substantially reduced its infant mortality and seen improvements in other health indicators, and has begun to make progress on gender inequality. 17 18 …”

“…Potential— Large gains have been seen for several health indicators, including infant mortality. 17 18 An overarching facilitating factor has been the prevailing political will within Rwanda to tackle health inequities.…”

Integrated health system strengthening can generate rapid population impacts that can be replicated: lessons from Rwanda to Madagascar

“…While these have traditionally lacked a strong evidence base, two recent papers in BMJ Global Health show that rapid and rigorously evaluated population-level impacts can result from HSS in different political and economic contexts. 5 6 …”

“…For both sovereignty and efficiency, these partnerships were managed centrally on terms largely defined by the Rwanda government. To understand the impacts of the HSS initiative in Rwanda, Thomson et al 5 analysed cross-sectional household-level Demographic and Health Survey (DHS) data in 2005 and 2010, within the PIH catchment area in comparison with the rest of rural Rwanda. The results show rapid improvements in population health at a subnational level: under-5 mortality dropped by 64% in 5 years; this is equivalent to an annual decrease of 12.8%, which was substantially faster than the rest of rural Rwanda and triple the rate needed to meet the MDGs.…”