Marie Rose Mukankunda, a mother from Nyamirambo sector in Nyarugenge district recalls not being at ease when she gave birth to her first born baby in a squeezed and small maternity ward in Rugarama Health Centre in November, 2022. “There was congestion in the maternity ward at Rugarama health centre when I gave birth. Even the visitors could not get space to sit. The small maternity ward was also not comfortable because every person in the hospital could pass nearby listening to whatever was happening inside,” she said. Juliene Kayitesi, another mother added that she also spent a night at this health centre before being transferred to a referral hospital. “The night I spent at the health centre, we were so squeezed. The small place was not comfortable and a mother giving birth really needs comfort and confidentiality,” she said. However, the mothers are now hopeful as the situation is set to change for the better following the intervention by Nyarugenge through the Barame project that has built a modern and well-equipped maternity ward at Rugarama Health Centre. Barame project is one of health sector interventions financed by Enabel-Belgian development agency-through the bilateral cooperation between the Federal Government of Belgium and the Government of Rwanda. The 18 million Euros project pays attention to the needs of adolescents, neonates, children under five, and pregnant women. It is being implemented in seven districts of Rwanda including Nyarugenge district. “The maternity ward was timely as it will improve the health of mothers and children in this sector,” Kayitesi said. Sylvine Mujiji, the Head Nurse of Rugarama Health Centre said that the health centre has a small room for the maternity ward although it receives between 40 and 80 mothers and fathers coming for maternity services (antenatal services, deliveries.) every day. “We had only one room for the maternity ward with two beds, one waiting room and one room where mothers go after giving birth. This was a big challenge especially when we have more than three women giving birth yet you have such a maternity ward with two beds. In such cases, the nurse and mother are not in good condition, especially since mothers need confidentiality,” she said. She said that the new well-equipped maternity ward will start operations soon “The new maternity ward facility will improve service delivery as it has capacity to receive over 10 mothers who can give birth at the same time without waiting for one another,” she said. The project also helped in the process of upgrading Nyarurenzi Health Centre, located in Mageragere sector, into Medicalised Health Centre Janvier Niyongere, the Head of Nyarurenzi Medicalised Health Centre said the health centre was upgraded and equipped by the Barame project. “The health centre covers 16,315 people. Now the medicalised health centre is delivering services like ophthalmology and dentistry. Nyarugenge district hospital deploys Medical Doctors to the health centre twice a week-on Tuesday and Thursday-to carry out consultations,” he said. “Diseases that used to affect children and pregnant mothers have drastically decreased. In 2017, we experienced 15,000 cases of malaria but this has decreased to 282 malaria cases in 2022. The health of mother and child has also improved. We have an ambulance that intervenes to ease transport of expectant mothers. Eight years have elapsed without maternal deaths. Since the health centre is medicalised, only 1/3 of that need transfer are referred to district hospitals,” he said. By June 2023, the Caesarian section at Nyarurenzi Medicalised Health Centre will be accessible to all population in catchment areas which will reduce risks of maternal and neonatal deaths or complications instead of being transferred to Nyarugenge district hospital or Nyamata in Bugesera district. Dr Deborah Abimana, the Director of Nyarugenge district hospital said that the hospital reduced the distance which residents were using to rich other hospitals. “The hospital has 120 beds and the second phase of construction will add more 180 beds. The hospital has over 100 hospitalised patients per day while those who get treated and return home the same day are about 140. We are recording between 220 births and 270 births per month and we got medical equipment to provide better service to the patients,” she said. During the media tour on Thursday February 9, to witness the project achievements, Muhima Hospital Isange One stop centre, Karama health post and other facilities were also visited. In July 2021, Karama Health post was upgraded to second generation maternity service and increased outpatient cases by 20 per cent while antenatal care services increased by 39 per cent by increasing geographical accessibility. Thanks to awareness, GBV cases reported to Muhima Isange One Stop Centre increased from 723 in 2021 to 997 cases in 2022. The number of mothers who embraced family planning increased from 1,642 to 1,749 in Kimisagara while those who embraced antenatal care services, in Butamwa Health Centre, increased from 23 per cent in 2021 to 53 per cent in 2022. Sexual and Reproductive Health Besides improving the health of mother and child, the partnership paid attention to the needs of adolescents in terms of Sexual and Reproductive Health education. In youth centres, HIV testing increased by 63 per cent, pregnancy screening increased by seven per cent, STIs screening increased by 12 per cent while family planning increased by 18 per cent. Club Rafiki in Nyamirambo sector and Maison de Jeunes in Kimisagara sector are youth centres that educate adolescents and youth about Sexual and Reproductive Health to fight against teen pregnancies and sexually transmitted diseases. Omar Tony Nsengumuremyi, the coordinator of Club Rafiki Nyamirambo commended the partnership with Nyarugenge and Enabel through Barame project to educate adolescents and youth about Sexual and Reproductive Health. “This is fighting against teen pregnancies and sexually transmitted diseases. The number of adolescents and youth attending adolescents and youth about Sexual and Reproductive Health awareness services increased from 200,000 to over 400.000 per year,” he said. Benedicte Briot, Barame International Technical Advisor said that they work with Society for Family Health (SFH), Rwanda to increase health services among young people and adolescents through centres. “There is a gap in health centres as young people are afraid to go there to ask for sexual and reproductive health services because they fear they might meet someone from the family. The youth centres are safe places for them. They gain different skills but also health services for free. It will decrease teen pregnancies and STIs,” she said. Emmy Ngabonziza, the District Executive Administrator of Nyarugenge district, said that after completion of the Barame project in July 2020, citizens’ satisfaction with health services has increased by 16 per cent according to a recent governance scorecard. “Maternal and infant health has drastically improved considering that some women in Karama could give birth at home due to long distance to hospitals far away as they had no nearby health centre. Karama health post has addressed the issue. Antenatal care services have increased. This is an example of improved health service delivery,” he said adding sexual reproductive health is an essential component of the project as teen pregnancies, STIs are set to decrease. Dirk Deprez, the Resident Representative of Enabel in Rwanda said that Barame project operates in seven districts namely Nyarugenge, Rulindo, Gakenke, Gisagara, Karongi, Nyamasheke and Rusizi. “The project results in Nyarugenge district are quite interesting. We have been interested in the overall management of Rwanda’s health sector that also managed Covid-19 crisis to which we were able to contribute. Nyarugenge district hospital was not intended to be a national centre for covid-19 treatment but it became it,” he said. This hospital was constructed under Belgium government support under Enabel project dubbed “Ubuzima Burambye”.
