Annette Uwamariya, a 34-year-old pregnant mother of five, and a resident of Gatsata Sector, Gasabo District, delivered four of her children from home.

Despite advice from community based health workers, she still believed that going to health facilities for routine antenatal care and  baby delivery was a waste of time, since there was a traditional birth assistant in the neighbourhood.

However, after the delivery of her fourth baby, Uwamariya bled profusely and become unconscious for hours. A traditional birth attendant was present but could not offer any help. She was whisked away to a nearby health centre.

"I wished I had taken the advice of the community based health workers. I have since resolved never to deliver from home. I had my 5th delivery from Muhima Hospital, Nyarugenge District, and I am planning to have this one from there too,” Uwamariya said.

She said the hospital does not only ensure safer child delivery but also ensures that the mother and baby are in good condition before being discharged.

Uwamariya is one out of the many women who have heeded advice to produce under the watchful eye of  health professionals in a bid to prevent maternal and infant deaths.

Statistics

A report released by the World Health Organisation earlier this year showed that maternal deaths in Rwanda had declined by 77 per cent since 1990, enabling the country to meet  the United Nations Millennium Development Goal (MDG5) of reducing the number of women who die during pregnancy or shortly after giving birth by three-quarters.

In 2013, the country had 320 maternal deaths per 100,000 live births while in 1990, the benchmark year for measuring progress, there were 1,400 maternal deaths, according to the same report.

Another WHO biennial country office report, released at the start of July this year, indicates that between 2005 and 2010, infant mortality rate in the country dropped from 86 deaths per 1000 live births to 50 deaths per 1000 live births.

On top of that, the under-five mortality rate was reduced from 152 deaths per 1,000 live births in 2005 to 76 deaths per 1000 live births in 2010.

Hospital figures

A mini survey by The New Times showed that several health facilities have enrolled the services of community health workers to sensitise expectant mothers about the benefits of producing from health facilities.

Figures from Kibagabaga Hospital, in Gasabo indicate that cases of maternal and infant mortality rate especially during or immediately after birth, have greatly dropped.

For instance, out of 4,295 child deliveries in 2013 at the hospital, only  three mothers died  during birth, and 12 babies immediately after birth, compared to five mothers and 13 babies who died during child birth in 2012.

Information from La Croix Du Sud Hospital (popularly known as Kwa-Nyirinkwaya) Remera, also indicates that mother and child mortality has reduced over the years; for instance between 2008 and 2010, no mother died while giving birth at the hospital.

And the number of child deliveries handled also keeps growing each year; for instance, in 2013, over 3,400 child births were registered and by mid-2014, already over 2,900 births had been registered.

Community health workers Jeanne Nyiransabimana, the head of maternity department at Kibagabaga Hospital, Gasabo District, said they work with over 255 community based health workers spread across 17 health centres whose duty includes looking out for and monitor pregnant mothers.

"They use a rapid short message service (SMS) to inform health centres, our hospital and the Health ministry about new cases of pregnant women in their areas and are in charge of reminding them to go for routine antenatal care.”

She said two ambulances are always on standby at health centres to cater for emergencies related to maternity care.

Nyiransabimana said the hospital has quarterly, in house trainings for her 33-member team. The team also holds weekly evaluation meetings to identify challenges in their area and devise solutions.

"The hospital sends a supervisor to each of the 17 health centres on a weekly basis to monitor, advise and  report on the quality of maternity care  offered, among other things.”

Damian Mugabo, a gynaecologist working with Alpha clinic in Kimironko, Gasabo, attributed the improvement in maternal and infant health care to the role of community based health insurance (Mutuelle de Sante).

"People no longer fear going to hospitals because bills are already catered for,” he observed. 

Nyiransabimana cites inadequate space and equipment as the biggest challenge. She revealed that the child delivery ward at Kibagabaga has only three beds, yet sometimes they have about five patients requiring the service at the same time.

Last year, the Rwandan government spent Rwf3.7 billion on maternal health, according to official information.

Globally, there were 289,000 maternal deaths in 2013, a decline of 45 per cent from 1990. Sub-Saharan Africa accounted for 62 per cent (179,000) of  the global deaths.