Maternal Health in Rwanda

maternal mortality reduces in Rwanda

In recent years, Rwanda has experienced sustained and dramatic improvements, especially in reducing maternal mortality (SDG3.1) which has declined from 468 per 100,000 live births in 2010 to 210 per 100,000 live births in 2015. 

This month, we have spoken to Dr Eugene Ngoga, President, Rwandan Society Obstetrics and Gynecology (RSOG) and Chief Consultant Obstetrics and Gynecology, Clinical Services Division Manager RMH in Rwanda, to hear more about RSOG’s mission to contribute to the improvement in women’s health in Rwanda.

Dr Eugene Ngoga explains:

Maternal death audits, introduced in 2008, were one of the strategies that contributed to the reduction in maternal mortality because they allowed health professionals to identify causes of death, and the contributing factors. This allowed the development of strategies that linked to identified factors. 

According to the maternal death audit results, Postpartum Hemorrhage (PPH) was highlighted as the leading cause of maternal mortality in Rwanda. It was, therefore, necessary to conduct an in-depth analysis to identify the causes or categories of PPH. The following changes happened in our approach:

  • Availing uterotonic at the primary level of the health system (parenteral oxytocin at the health centre and misoprostol at the community level)
  • Capacity building of health workforces at the community level, health facility level through training, mentorship and supportive supervision where more experienced providers and specialists are deployed in health facilities with a high rate of PPH 
  • Midwives were trained and appointed at the health centre level. At least one midwife available at each health centre
  • More effort was put in place to address any issues related to the availability of blood. Now, drones are delivering blood in remote areas

We started to conduct peer maternal death review workshops with audit committees from different hospitals and introduced a confidential enquiry into maternal deaths. In the end, it demonstrated that post-C-Section PPH, due to low competence of young Doctors, was a new kind of PPH, among others such as uterine atony, tears and retention of placenta. 

After identifying that Post C-Section was one of the causes of PPH, the OBGYN Community played a significant role to address this issue. Cascading training, supported by RSOG, on C-Section performance started countywide, the beneficiaries of those training were young doctors, and intensive mentorship was organised for hospitals with the high number of maternal deaths. Now mentorship conducted by RSOG is scaled up in all hospitals to help junior medical doctors to perform well C- sections. 

OBGYN’s also helped to develop and update guidelines and clinical protocols, and they play a role in the maternal death audit in classification of gaps and formulation of recommendations and key actions.

Some of the gaps identified include the necessity of skilled health providers and the absence and insufficiency of some equipment and commodities. From those gaps, we formulated recommendations and critical actions to be implemented at all levels of the health system. The implementation of those actions has led to the reduction of avoidable maternal death.

Whether it’s the training of health care professionals, raising capability of health practitioners’ teams leading to a long-term sustainable edge in the health sector, RSOG’s focused interventions have helped achieve key health care outcomes.

We are excited to be hosting FIGO’s next Regional Congress in Kigali, Rwanda in June 2020 in collaboration with regional partners.

The goal of the congress is to gather experts in the field for knowledge and experience sharing. Those participating will benefit a lot through different presentations and discussion on improving the management of patients, and will help advise policymakers to take suitable strategies in fighting conditions related to OBGYN.

It is also an opportunity of creating networks with global experts for future projects and research in the bid to improve women’s health.

Find out more about FIGO Regional Congress, Kigali at www.figokigali2020.org