Reflections on a global partnership for perinatal quality improvement in Rwanda

Between 2017 and 2023, the Royal College of Paediatrics and Child Health and the Rwanda Pediatric Association (its peer institution in Rwanda) collaborated with UNICEF, the Rwandan Ministry of Health and the Rwanda Biomedical Center to design and deliver a perinatal programme to improve clinical care and outcomes across multiple hospitals and selected primary health centres. Over the period, the programme showed measurable positive impact on quality of care and clinical outcomes. However, the persistence of preventable or avoidable mortality, in particular among newborns in hospital and health centres, highlights the influence of deeper systemic constraints on care quality and outcomes within the network of clinical care facilities, as well as in wider community-level determinants of health. Quantitative results are neither the only nor, arguably, the most important aspect of the kind of programme presented here. An equal value lies in qualitative understanding of how a programme of 'quality improvement' interventions, delivered continuously over time in multiple facilities through a professional partnership between equitably authoritative international and Rwandan counterparts, can reveal underlying structural factors that mediate the translation of clinical interventions into effective care systems.