Understanding variation in health service coverage and maternal health outcomes among districts in Rwanda – A qualitative study of local health workers’ perceptions

Abstract

ObjectiveTo obtain the perspectives of health professionals and community health workers on factors that determine health service coverage and maternal health outcomes so as to understand variations between districts.Methods16 Focus group discussions involving four different groups of participants were conducted in May 2015 in four purposively selected districts, complemented by three key informant interviews in one of the districts.ResultsThe solidarity support for poor people and the interconnectedness between local leaders and heads of health facilities were identified as enablers of health service utilization. Geographical factors, in particular location close to borders with mobile populations and migrants, and large populations with sparsely distributed health infrastructure, exacerbated by hilly topography and muddy roads were identified as barriers. Shortages of skilled health providers at the level of district hospitals were cited as contributing to poor maternal health outcomes.ConclusionThere is a need to take into account disparities between districts when allocating staff and financial resources in order to achieve universal coverage for high-quality maternal health services and better outcomes. Local innovations such as the use of SMS and WhatsApp text messages by health workers and financial protection schemes for poor patients improve solidarity and are worth to be scaled up.

Integrating Client Tracker Tool Into Fistula Management: Experience From the Fistula Care Plus Project in the Democratic Republic of Congo, 2017 to 2019

“…Respondents said that the CT induces additional workload, which is sometimes difficult to manage. Excessive workload among health workers has been documented in different contexts as affecting the quality of health services ( 19 – 21 ). A review of the CT forms involving staff at operational and programmatic levels can support shortening of the forms and their harmonization with existing routine forms.…”

Evaluating continuum of maternal and newborn healthcare in Rwanda: evidence from the 2019–2020 Rwanda demographic health survey

“…These NGOs focused mainly on maternal and newborn care, worked closely with the ministry of health (MOH) and provided highly effective support that included; direct care provision, ensuring adequate and qualified staff, infrastructure development, robust quality improvement mechanisms and financial and technical assistance to support clinical innovation areas [14,15]. Likewise, the smoother landscape found in eastern provinces compared to the northern region could be attributed to a higher likelihood of MCH service uptake because it enables for easier access to health facilities, as other studies have shown [54,55]. The odds of having CoC in the western region were less.…”