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



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.

Klíčová slova:

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


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2019 Číslo 10
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