Improved Survival of Mothers and Infants in Rwanda

“As participants learn, they find they want to change bad habits,” says Viviane Mukakarara, family planning and maternal and child health coordinator with IntraHealth in Rwanda. Mukakarara is responsible for organizing provider trainings in emergency obstetric and neonatal care (EmONC) in the four districts supported by the USAID-funded IntraHealth HIV/AIDS Clinical Services Program (HCSP).

During the practical capacity-building trainings, participants develop individualized action plans.  “We follow up afterwards to ensure the participants implement the action plans,” says Mukakarara.

Training providers in emergency care

Since April, Mukakarara has coordinated the training of 64 providers in EmONC and maternal death audit. Providers from facilities other than HCSP-supported sites also benefit from this vital training. Maternal death audits contribute not only to improved quality of care but also to reductions in maternal mortality. “When a woman dies, health workers sit together as a team and analyze the situation and cause of death, and plan how to avoid similar situations in the future,” explains Mukakarara.

In early 2010, at the request of Rwanda’s Ministry of Health, the HCSP conducted a rapid needs assessment to identify gaps in training and services related to the integration of family planning, EmONC, and HIV/AIDS clinical services. The trainings—meant to fill the gaps—aimed at developing providers’ EmONC knowledge and competency so that they could not only provide high-quality care to both mothers and children but also reduce maternal and neonatal illness and death rates.

Combining theory with practice

Each training spans ten days in the classroom, followed by five days of practicum in a designated health facility. Topics covered in the trainings included antenatal and prenuptial consultations, infection prevention, prevention of vertical transmission of HIV, dealing with complications during labor, infant care, postnatal consultation for the mother and infant, and care and treatment for postpartum complications.

Gaining new skills and motivation

Ildephonse Rutaganira, a nurse with Kibagabaga Hospital in Rwanda’s capital city of Kigali, oversees maternal and child health supervision and training at the hospital and all health centers in Gasabo District. He says that one of the barriers to clients receiving services is inadequate room. “The environment—the space—is not large enough to receive everybody.”

Rutaganira says both the training and the subsequent practicum gave him a clearer picture of how best to organize services. For example, he learned how better to triage patients who may present at the facility for different problems, and how to ensure the provision of necessary materials.

Rutaganira also says the training pushed him to want to improve the care he offers. “This helps me to avoid just settling into a routine,” he says. “This allows for improvement in the quality of maternity care and treatment.”

Another participant, Nicole Umuhoza, is a nurse responsible for Kimironko Health Center’s maternity ward. She receives clients and follows up with them through delivery and, after birth, with the infant as well. In addition, Umuhoza serves as a mentor for students from the five nursing and midwifery schools in Rwanda and from the Kigali Health Institute. She said she appreciated the training workshop—that it not only improved her skills, but that she will be able to take concrete steps towards improving the quality of maternal and child health services in her facility thanks to an action plan that she developed during the workshop.

Overcoming barriers to services

Mukakarara says that the training helps overcome barriers to service. “Not all providers are qualified enough to offer all services. In general, all providers have basic training, but as medicine evolves, things change.

“The training keeps all providers up-to-date, which helps them provide quality services. My objective is that the population receives all the services they need—and that they are happy with their ability to manage their health.”