Rwanda continues to register high cases of maternal deaths even as the country cut the deaths by more than half in less than a decade, according to statistics from the Ministry of Health.
The ministry’s death audits list postpartum hemorrhage, complications of prematurity and fetal distress among the main causes of maternal mortality in the country.
Postpartum hemorrhage is the loss of more than 500ml or 1,000ml of blood within the first 24 hours following childbirth while fetal distress may occur when the pregnancy lasts too long when complications of pregnancy or labour occur.
Reducing cases of avoidable deaths on the continent is top of agenda at the ongoing Sustainable Development Goals Center for Africa summit, which is discussing building and strengthening accountability in African healthcare systems.
Speaking to The New Times on the sidelines of the summit in Kigali yesterday, the Minister for Health, Dr Diane Gashumba, said that though a lot has been done to reduce the maternity deaths which led Rwanda to achieve the Millennium Development Goals in health, progress was not satisfactory.
She noted that the audits showed that a lot more needs to be done to tackle maternal death.
“We have managed to reduce maternal deaths which helped Rwanda achieve MDGs. But we still have a long way to go. We cannot be happy that we have 210 out of every 100,000 women succumbing to maternal mortality. We need to reduce this number,” she said.
In 2010, maternal mortality in Rwanda stood at 487 deaths for every 100,000 women.
According to the World Maternal Index by World Health Organisation, Unicef and United Nations Population Fund, the average maternal mortality rate in Africa is 400 deaths for every 100,000 women, almost twice the maternal mortality rate in Rwanda and twenty times higher than the average for industrialised countries.
Among the accountability mechanisms in place that the government is banking on to bring down these numbers is regular death audits, performance contracts, as well as performance based financing models for health providers.
“We have a strong system of accountability, regular death audits, Imihigo [performance contracts], and performance based financing model for evaluation of health providers,” Dr Gashumba noted.
Health experts say that most instances of maternal deaths are easily avoidable by slight adjustments and improvement in healthcare systems.
Among the often cited challenges and hindrances in most regional countries include quality of service in health facilities, skill sets of personnel, and unavailability of health information systems.
Other common challenges in the region include the unavailability of essential medical products, vaccines and technologies as well as inadequate health financing.
The Minister for Finance and Economic Planning, Amb. Claver Gatete, said that among the challenges that still persist include those related to quality of service delivery as well as mobilisation of resources.
“Meeting their (citizens) needs requires significant investments in human resources, equipment, infrastructure and systems. We, therefore, need to come up with strong strategies to mobilise sufficient resources to ensure adequate financing. Further investments are needed in strengthening accountability mechanisms by putting in place standards, qualified administrators and financial managers as well as information systems at different levels of the health sector,” Gatete said.
He noted that countries should take up technology as it will modernise systems and scale up quality of service delivery even in remote areas.
Other experts called on the government to put in place strong laws to end impunity enjoyed by some of the culprits of negligence.
Zuera Youssoufou, the chief executive of the Dangote Foundation, said that a strong and effective regulatory framework will ensure that all culprits of medical negligence are held accountable.
This, she said, should also include the private sector players.
Dr Belay Begashaw, the Director General of the Sustainable Development Goals Center for Africa, based in Kigali, said that it is unacceptable that Africans continue to succumb to avoidable causes of death.
He said that Sub-Saharan Africa has twice as many deaths following surgeries as other parts of the world.