Understanding variation in maternal health service coverage and maternal health outcomes among districts in Rwanda

Abstract

37Objective: To identify factors that explain variations between districts in maternal 38 health service coverage and maternal health outcomes. 39 Methods: Individual key informant interviews and focus group discussions using 40 structured topic lists were conducted in May 2015 in four purposively selected 41 districts. 42 Results: The solidarity support for poor people and the interconnectedness between 43 local leaders and heads of health facilities were identified as enablers of health service 44 utilization. Geographical factors, in particular location close to borders with mobile 45 populations and migrants, and large populations with sparsely distributed health 46 infrastructure, exacerbated by hilly topography and muddy roads were identified as 47 barriers. Shortages of skilled health providers at the level of district hospitals were 48 cited as contributing to poor maternal health outcomes.49Conclusion: There is a need to take into account disparities between districts when 50 allocating staff and financial resources in order to achieve universal coverage for 51 high-quality maternal health services and better outcomes. Local innovations such as 52 the use of SMS and WhatsApp text messages by health workers and financial 53 protection schemes for poor patients improve solidarity and are worth to be scaled up. 54 55 innovations 57 59 Worldwide in 2015, an estimated 303,000 women died due to complications of 60 pregnancy or childbirth [1]. Most of them died because of severe bleeding after 61 childbirth, infections, hypertensive disorders or unsafe abortions. Low and middle 62 income countries account for 99% of these deaths, with sub-Saharan Africa alone 63 accounting for roughly two-thirds (201,000 deaths in 2015) [1]. Maternal mortality is 64 one of the health outcomes that typically show very wide gaps between rich and poor 65 populations [1]. 66 The 2014/15 Demographic and health survey (DHS) in Rwanda estimated the 67 maternal mortality ratio (MMR) at 210 deaths per 100,000 live births [2], which is 68 significantly less than the ratios reported in the 2010 DHS (476 per 100,000) and the 69 2000 DHS (1071 per 100,000) [3,4]. Although everything points to significant 70 improvements, deaths related to pregnancy and childbirth are still too common and 71 will need to be reduced further in order to reach the SDG target MMR of 70 per 72 100,000 by the year 2030. 73Globally, health service coverage rates have increased but many countries are still a 74 long way from universal coverage for most essential reproductive, maternal, newborn 75 and child health (RMNCH) interventions. Furthermore, intra-country variations in 76 service coverage rates are reducing in most countries but the pace is slow. The main 77 impediments to the delivery of high-quality services are a combination of health 78 sector specific and non-health sector drivers [5]. Reliable and timely information is 79 required for effective remedial action at local, regional and national health sector 80 management levels, in order to address intra-...

Critical Interpretive Synthesis of Qualitative Data on the Health Care Ecosystem for Vulnerable Newborns in Low- to Middle-Income Countries

“…Similarly, Rwanda has shown tremendous gains in health systems strengthening for MNCH over the past two decades (Hategeka et al, 2020;Sayinzoga et al, 2019). In the coming years, the global and national efforts and resources may focus on strengthening health care systems in the wake of COVID-19, leading to more stability.…”