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Methods Of Healthcare Delivery System01:26

Methods Of Healthcare Delivery System

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Enhancing perinatal care in Rwanda: building quality improvement into system strengthening.

Lisine Tuyisenge1, Jean-Petit Habonimana1, Alexis Nsengiyumva1

  • 1Rwanda Pediatric Association, Kigali, Rwanda.

BMJ Paediatrics Open
|June 25, 2026
PubMed
Summary

Rwanda

Keywords:
Child HealthHealth PolicyHealth services researchLow and Middle Income CountriesNeonatology

Related Experiment Videos

Area of Science:

  • Neonatal Health
  • Quality Improvement in Healthcare
  • Global Health Initiatives

Background:

  • Neonatal mortality reduction has slowed in Rwanda, with most deaths occurring in healthcare facilities.
  • Key causes include prematurity, perinatal asphyxia, infection, and quality of care gaps.
  • Existing gains in maternal, newborn, and child health face challenges in neonatal outcomes.

Purpose of the Study:

  • To evaluate the impact of a multiphase perinatal care enhancement program on neonatal quality of care and mortality in Rwandan hospitals.
  • To assess changes in neonatal quality indicators and mortality rates following the implementation of in situ clinical training and quality improvement processes.

Main Methods:

  • A multiphase program involving in situ clinical training and quality improvement (QI) was implemented in 21 Rwandan hospitals from 2017 to 2023.
  • Evaluation focused on 12 hospitals with continuous neonatal data, using facility assessments, program-specific quality indicators, and Health Management Information System data.
  • Changes in neonatal quality of care and mortality were analyzed over the program period.

Main Results:

  • Significant improvements were observed in core indicators of neonatal quality of care.
  • Mortality among newborns admitted to neonatal units decreased by 47.5%, from 11.8% in 2017 to 6.2% in 2023.
  • Quality improvement processes identified systemic constraints affecting clinical improvement sustainability.

Conclusions:

  • The implemented perinatal care program led to substantial improvements in neonatal quality of care and reduced mortality in Rwandan hospitals.
  • Sustaining these clinical improvements requires addressing systemic challenges like workforce rotation, supply chain variability, and infrastructure limitations.
  • The findings highlight the effectiveness of integrated training and QI for enhancing neonatal outcomes in resource-limited settings.