Improving Maternal Health in Rwanda: The Role of Community-Based Interventions: A Systematic Review (2005-2015)

Abstract

Introduction: Rwanda has achieved Millennium Development Goal target (5A). To improve maternal health, the Government of Rwanda, in the context of its vision 2020 and related health sector reforms and policies, has been investing in the essential health interventions for reducing maternal mortality. We initiated this study aimed at exploring the role of community–based interventions. Materials and Methods: This paper presents evidence on improvements in maternal health in Rwanda. We performed a systematic literature search in PubMed, limited to articles published between 2005 and 2015. Our literature search yielded 63 potentially relevant papers. This paper is a systematic review of 12 relevant peerreviewed articles. Results: The maternal mortality ratio in Rwanda has been reduced by 78% from 1,300/100,000 live births to 567/100,000 live births (2005) and 290/100,000 live births (2015), with fewer women dying from preventable causes of maternal death. The key maternal health indicators increased by two to four folds between 2005 and 2015, with the most significant changes registered in rural areas. Each village in Rwanda has a community health worker (CHW), ‘a female known as mobilizer for maternal Health’ who is responsible for community–based interventions during and after pregnancy. In 2011, a short message (SMS)-based system was set up to improve maternal and child health (MCH) using RapidSMS, a free and open–source framework, providing great opportunities for community health workers to contribute to implementing essential maternal health interventions, through communication. To achieve Millennium Development Goal 5A target, Rwanda has moved from ‘home birth’ to ‘facility–based childbirth’ policy, supported by innovative health sector reforms for the last two decades. Community health workers played a critical role in linking up communities to the health facilities and in providing relevant support for health promotion, maternal health service delivery and referral system, family planning as well as data collection for health system management.