Rwanda has taken bold steps to improve maternal and reproductive health. A year ago, on May 24, 2024, the Ministry of Health launched the first decentralized Obstetrics and Gynaecology (OB-GYN) residency programme at Rwamagana Level Two Teaching Hospital. The new OB-GYN training initiative is part of Rwanda’s 4x4 Reform, which aims to quadruple health worker production within four years and meet the WHO threshold of at least four health professionals per 1,000 population. It was the beginning of a journey to expand specialist training beyond the capital and invest in local solutions to long-standing challenges: staffing shortages, uneven distribution of care, and delayed emergency response. The program was not just about increasing numbers—it was about equity, access, and impact. One year later, the results speak volumes. Bringing specialists closer to mothers For years, Rwanda faced a troubling pattern: Over two-thirds of maternal deaths were linked to poor quality care and delayed interventions. Since the launch of this residency programme in May 2024, the Ministry of Health in collaboration with various stakeholders including the University of Rwanda, the Rwanda Society of obstetricians and Gynecologists (RSOG) has deployed and currently training 80 residents across the 10 district-level hospitals in all four provinces, working under supervision to provide lifesaving obstetric care at all hours. During that period, data from the Health Management Information System (HMIS) revealed maternal mortality rate has dropped from 110 per 100,000 live births (2023/2024) to 82 per 100,000 live births (2024/2025). Further analysis of this decrease in maternal mortality rate shows a steady decline, decreasing significantly as the residency programme consolidates in these hospitals; maternal mortality rate reduction from 96 per 100,000 live births after six months of residency programmes to 57 per 100,000 live births at the end of one year. Referrals of women with obstetric complications during labour or after delivery to national referral hospitals have also decreased by 29.9%. These figures reflect the power of having skilled professionals embedded in district-level hospitals, offering timely care where it matters most, and indeed provide a clear manifestation of what collective commitment can achieve. Strengthening the ecosystem This programme is not just a training track; it is part of a broader shift towards strengthening Rwanda’s health system. The Ministry of Health is committed to aligning health education with health service delivery, ensuring that no region is left behind. The goal is to build a sustainable pipeline of OB-GYN specialists. In this first year, we have seen residents take great initiative and become pillars of service delivery in their host hospitalsWhile the training program is a major step forward, it does not stand alone. Other parallel reforms have supported its success: the recruitment of other specialists, including pediatricians, anesthesiologists, general surgeons, and Intensive Care staff, has helped build a functional and responsive care ecosystem. These training hospitals have been equipped, maternity and surgical infrastructure upgraded, and multiple training sessions for midwives and theatre nurses conducted. Teaching hospitals have worked diligently to ensure that teaching environments are strengthened and that supervision is reinforced to ensure maximum safety to patients. Challenges remain -- but so does our resolve While the gains are encouraging, the Ministry of Health and collaborators are not blind to the road ahead. Some hospitals need better infrastructure and equipment to handle obstetric and newborn emergencies or provide comprehensive reproductive services. But what this year has shown is that decentralised specialist training works and that Rwanda is capable of building world-class care, from Kigali to the remotest regions of our country. A call to continue In just one year, this programme has shown promising outcomes. With every resident trained, every facility upgraded, and every mother saved, we move closer to the Rwanda we aspire to -- a country where no woman dies giving life. As we look ahead, our goal is to scale up this model, strengthen other specialties. We welcome those who share this vision to join us in sustaining and building on this momentum. Dr Madeleine Byukusenge is a Residency Program Analyst at the Ministry of Health – Rwanda. The views expressed in this article are of the writer.
