Abstract
To obtain the perspectives of health professionals and community health workers on factors that determine health service coverage and maternal health outcomes so as to understand variations between districts. 16 Focus group discussions involving four different groups of participants were conducted in May 2015 in four purposively selected districts, complemented by three key informant interviews in one of the districts. The solidarity support for poor people and the interconnectedness between local leaders and heads of health facilities were identified as enablers of health service utilization. Geographical factors, in particular location close to borders with mobile populations and migrants, and large populations with sparsely distributed health infrastructure, exacerbated by hilly topography and muddy roads were identified as barriers. Shortages of skilled health providers at the level of district hospitals were cited as contributing to poor maternal health outcomes. There is a need to take into account disparities between districts when allocating staff and financial resources in order to achieve universal coverage for high-quality maternal health services and better outcomes. Local innovations such as the use of SMS and WhatsApp text messages by health workers and financial protection schemes for poor patients improve solidarity and are worth to be scaled up.
Highlights
Worldwide in 2015, an estimated 303,000 women died due to complications of pregnancy or childbirth [1]
The 2014/15 Demographic and health survey (DHS) in Rwanda estimated the maternal mortality ratio (MMR) at 210 deaths per 100,000 live births [7], which is significantly less than the ratios reported in the 2010 DHS (476 per 100,000) and the 2000 DHS (1071 per 100,000) [8,9]
Everything points to significant improvements, deaths related to pregnancy and childbirth are still too common and will need to be reduced further in order to reach the sustainable development goals (SDG) target for MMR of 70 per 100,000 by the year 2030
Summary
Worldwide in 2015, an estimated 303,000 women died due to complications of pregnancy or childbirth [1]. Maternal mortality is one of the health outcomes that typically show very wide gaps between rich and poor populations [4,5,6]. The 2014/15 Demographic and health survey (DHS) in Rwanda estimated the maternal mortality ratio (MMR) at 210 deaths per 100,000 live births [7], which is significantly less than the ratios reported in the 2010 DHS (476 per 100,000) and the 2000 DHS (1071 per 100,000) [8,9]. Everything points to significant improvements, deaths related to pregnancy and childbirth are still too common and will need to be reduced further in order to reach the sustainable development goals (SDG) target for MMR of 70 per 100,000 by the year 2030
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