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Understanding variation in health service coverage and maternal health outcomes among districts in Rwanda – A qualitative study of local health workers’ perceptions


Autoři: Felix Sayinzoga aff001;  Moses Tetui aff002;  Koos van der Velden aff004;  Jeroen van Dillen aff005;  Leon Bijlmakers aff006
Působiště autorů: Maternal, Child and Community Health Division, Rwanda Ministry of Health/ Rwanda Biomedical Center, Kigali, Rwanda aff001;  Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda aff002;  Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden aff003;  Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands aff004;  Department of Obstetrics and Gynaecology, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands aff005;  Department for Health Evidence, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands aff006
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pone.0223357

Souhrn

Objective

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.

Methods

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.

Results

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.

Conclusion

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.

Klíčová slova:

Finance – Health insurance – Health services administration and management – Health systems strengthening – Maternal health – Pregnancy – Rwanda – Social systems


Zdroje

1. World Health Organization. Trends in maternal mortality, 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015.

2. Victora CG, Requejo JH, Barros AJD, Berman P, Bhutta Z, Boerma T, et al. Countdown to 2015: a decade of tracking progress for maternal, newborn and child survival. Lancet. 2016; 387(10032):2049–59. doi: 10.1016/S0140-6736(15)00519-X 26477328

3. Alkema L, Chou D, Hogan D, Zhang S, Beth Moller A, Gemmill A. National, regional and global levels and trends in maternal mortality between 1990 and 2015 with scenario-based projections to 2030: a systematic analysis by the United Nations maternal Mortality Estimation Inter-Agency Group. Lancet 2016, 30;387(10017):462–474. doi: 10.1016/S0140-6736(15)00838-7 26584737

4. Zureick-Brown S, Newby H, Chou D, Mizoguchi N, Say L, Suzuki E, et al. Understanding Global Trends in Maternal Mortality. Int Perspect Sex Reprod Health. 2013; 39(1). doi: 10.1363/3903213 23584466

5. Kyei-Nimakoh M, Carolan-Olah M, McCann TV. Access barriers to obstetric care at health facilities in sub-Saharan Africa-a systematic review. Syst Rev. 2017, 6;6(1):110. doi: 10.1186/s13643-017-0503-x 28587676

6. Ronsmans C, Graham WJ on behalf of the Lancet Maternal Survival Series steering group. Maternal mortality: who, when, where, and why. Lancet 2006, 368:1189–1200. doi: 10.1016/S0140-6736(06)69380-X 17011946

7. Rwanda National Institute of Statistics. Rwanda demography and health survey 2014–2015. Rwanda, 2015.

8. Rwanda National Institute of Statistics. Rwanda demography and health survey 2010. Rwanda 2012.

9. Rwanda National Institute of Statistics. Rwanda demography and health survey 2000. Rwanda, 2002.

10. Countdown to 2030 Collaboration. Countdown to 2030: tracking progress towards universal coverage for reproductive, maternal, newborn, and child health. Lancet 2018;391(10129): 1538–48. doi: 10.1016/S0140-6736(18)30104-1 29395268

11. Bugesera district. www.bugesera.gov.rw. [Accessed 10th October 2014]

12. Rwamagana district. www.rwamagana.gov.rw. [Accessed 10th October 2014]

13. Gicumbi district. www.gicumbi.gov.rw. [Accessed 10th October 2014]

14. Nyagatare district. www.nyagatare.gov.rw. [Accessed 10th October 2014]

15. Ministry of Health. Rwanda Annual Health Statistical Booklet 2013.

16. World Health Organization. Monitoring the building blocks of health systems: A handbook of indicators and their measurement strategies. Geneva: World Health Organization; 2010.

17. Sayinzoga F, Bijlmakers L. Drivers of improved health sector performance in Rwanda: a qualitative view from within. BMC Health Serv Res 2016;16: 123. doi: 10.1186/s12913-016-1351-4 27059319

18. Morrison J, Tumbahangphe K, Budhathoki B, Neupane R, Sen A, Dahal K, et al. Community mobilisation and health management committee strengthening to increase birth attendance by trained health workers in rural Makwanpur, Nepal: study protocol for a cluster randomised controlled trial. Trials 2011;12(1): 128. doi: 10.1186/1745-6215-12-128 21595902

19. Bucagu M, Kagubare JM, Basinga P, Ngabo F, Timmons BK, Lee AC. Impact of health systems strengthening on coverage of maternal health services in Rwanda, 200–2010: a systematic review. Reproductive Health Matters 2012;20(39): 50–61. doi: 10.1016/S0968-8080(12)39611-0 22789082

20. Condo J, Mugeni C, Naughton B, Hall B, Tuazon M, Omwega A, et al. Rwanda’s evolving community health worker system: a qualitative assessment of client and provider perspectives. Human Res Health 2014;12: 71.

21. Ekirapa-Kiracho E, Waiswa P, Rahman M, Makumbi F, Kiwanuka N, Okui O, et al. Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study. BMC Intern Health Human Rights 2011:11(Suppl 1),S11. doi: 10.1186/1472-698X-11-S1-S11 21410998

22. Ministry of Health Rwanda. Human resources for health strategic plan 2011–2016. March 2011.

23. Kok MC, Namakhoma I, Nyirenda L, Chikaphupha K, Broerse J, Dieleman M, et al. Health surveillance assistants as intermediates between the community and health sector in Malawi: exploring how relationships influence performance. BMC Health Services Research 2016;16: 164. doi: 10.1186/s12913-016-1402-x 27142944

24. Ensor T, So S, Witter S. 2016. Exploring the influence of context on health district productivity in Cambodia. Cost Eff Resour Alloc 2016;14(1). doi: 10.1186/s12962-016-0051-6 26807044

25. Sayinzoga F, Bijlmakers L, van Dillen J, Mivumbi V, Ngabo F, van der Velden K. 2016. Maternal death audit in Rwanda 2009–2013: a nationwide facility-based retrospective cohort study. BMJ Open 2016;6: e009734. doi: 10.1136/bmjopen-2015-009734 26801466

26. Rwabizi D, Rulisa S, Aidan F, Small M. Maternal near miss and mortality due to post-partum infection: a cross-sectional analysis from Rwanda. BMC Pregn Childb 2016;16: 177. doi: 10.1186/s12884-016-0951-7 27439909

27. Sayinzoga F, Bijlmakers L, van der Velden K, van Dillen J. Severe maternal outcomes and quality of care at district hospitals in Rwanda–a multicentre prospective case-control study. BMC Pregn Childb 2017;17: 394. doi: 10.1186/s12884-017-1581-4 29178885


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