Milestones in maternity healthcare

A nurse administers a vaccine to a child at Kacyiru District Hospital.

According to the World Health Organization, there has been substantial progress in improving maternal health in Rwanda.

Although sub-Saharan Africa remains the region with the highest global burden of maternal mortality, Rwanda is among the countries that have been considered to have achieved the Millennium Development Goal (MDG) 5, by having reduced the maternal mortality ratio by three-quarters in the past 25 years.

The 2015 findings from Rwanda Demographic and Health Survey (RDHS) show that there has been steady improvement when it comes to maternal healthcare.

Findings indicate that in 2005, the women attending at least one antenatal care was at 94 per cent, 2007/8 the percentage was at 96, 2010 at 98 per cent while in the years 2014/15 it was at 99 per cent.

For women who delivered in health facilities, the findings show that numbers have been increasing over the previous years.

For instance, in 2005, 2007/8, 2010 and 2014/15; women delivering in health facilities were at 39, 52, 69 and 91 per cent respectively.

For standard visits, in 2005 the percentage was at 13, at 35 percent in 2010 while in the year 2014/15, the number rose to 44 per cent.

Modern contraceptive rate among married women was at 10, 27, 45 and 48 per cent in 2005, 2007/8, 2010 and 2014/15 respectively.

Meanwhile, the fertility rate (average of children per women) in 2005 was at 6.1 per cent, 2007/8 registering 5.5 per cent, in 2010 at 4.6 per cent while the year 2014/15 the percentage reduced to 4.2.

Maternal mortality rate per 100,000 live births was 750 in 2005.

Initiatives put in place to assist pregnant women and childbirth

According to Felix Sayinzoga, the division manager of maternal, clinic and community health at Rwanda Biomedical Centre (RBC), there have been many initiatives put in place when it comes to assisting pregnant women and childbirth.

For instance, he mentions community health insurance, infrastructural developments as some of the measures which have been put in place that have contributed highly when it comes to assisting pregnant women and childbirth.

He says there is also the number of trained medical personnel which has steadily risen, and performance-based financing (PBF).

PBF, Sayinzoga says, is a health financing strategy that aims at motivating health providers to increase service output and improve the quality of care.

There is also a community health workers (CHW) initiative with each village having four community health workers. Among them, a female is available for maternal health purposes and responsible for community-based intervention during and after pregnancy, and for childcare.

According to officials, the country understands that women have an important role to play in achieving better health in general, and maternal and child health in particular.

It is in this regard that CHWs in charge of maternal child health (MCH) in the villages are women.

Claudine Mukeshimana, a community health worker in Nyagatare District, says because of the strong involvement of women in health measures within local communities, particularly safe delivery and reproductive health, there have been significant results in improving maternal health in general.

Besides, there is also IMIHIGO which was introduced as a home-grown performance management tool in 2006 with the aim of promoting decentralisation of governance and fast-tracking of development efforts, including health indicators.

Specific interventions

Sayinzoga says maternal death audit is also another intervention, where all maternal deaths, regardless of the place of death, are audited.

He explains that this helps to avoid similar deaths and eliminate preventable deaths by implementing recommendations from audit sessions.

Another intervention put in place, he says, is delivery by skilled health providers.

Here, Sayinzoga says most of the deliveries are happen in health facilities and this helps to manage complications that occur during or after delivery by qualified personnel.

There is also the availability of life-saving commodities and equipment. For instance, he says, that the maternities are equipped with life-saving equipment and commodities targeting key causes of death.

There are also drones, which are now delivering blood in remote areas on time in case of an emergency as far as maternal health is concerned.

The strengthening of referral system can’t be ignored, he notes, adding that the number of ambulances has been increased and are well equipped to intervene timely in case of any problem.

There is also mentorship with professional associations such as the Rwanda Society of Obstetricians and Gynaecologists and Rwanda Midwife associations (RSOG, RMA).

These have been supportive by conducting mentorship in health facilities regularly to ensure capacity building of health providers.

Meanwhile, Sayinzoga says sensitisation on seeking care on time is also encouraged.

Different channels are used to increase the use of maternal health services, but also, he points out that every six months, integrated services known to have a high impact on maternal and child healthcare are provided at the centralised level in more than 2000 sites in the community.

Challenges still prevail

According to Dr Jean De Dieu Ndagijimana Ntwali, the in charge of prevention of mother-to-child (MCT) at RBC, although the country has made strides when it comes to maternal health, challenges are still present.

There is still the misconception around family planning methods; people still shy away from embracing the methods despite awareness and efforts to encourage women to use the methods.

Sayinzoga says there are also some health facilities, especially those owned by the church that do not provide modern family planning  methods, which is a setback when it comes to improving maternal health in the country.

The reproductive health law with restriction to adolescents’ assess contraception is also an issue.

“There is still a challenge when it comes to male involvement in maternal health in general, from accompanying their spouse to antenatal care to supporting them when it comes to family planning methods.

“Some men still don’t feel concerned as they consider pregnancy a woman’s responsibility, so they don’t see the need to interrupt their business to accompany their spouses to health facilities,” Dr Ntwali he says.

He adds that there is need to keep community education, through media and other possible channels, that will help pass this vital information concerning working together as a couple to ensure good maternal health for the mother and the child.

Teenage pregnancies, insufficient number of qualified health providers at different levels of the health facilities, insufficient infrastructures, and equipment that does not meet the standards, as well as insufficient number of ambulances to improve referral systems, are still a challenge, Dr Ntwali says.