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

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.