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. 2019 Jul;134(1):149-156.
doi: 10.1097/AOG.0000000000003317.

Increased Rwandan Access to Obstetrician-Gynecologists Through a U.S.-Rwanda Academic Training Partnership

Maria Small  1 , Urania Magriples, Rahel Ghebre, Lisa Bazzett-Matabele, David Ntirushwa, Doee Kitessa, Diomede Ntasumbumuyange, Paul Lantos, Eugene Ngabonziza, Washington Hill, Kenneth Ruzindana, Jean Damascene Rukundo, Alexandra N Moscovitz, Patrick Bagambe, Haywood Brown, Stephen Rulisa
Affiliations

Increased Rwandan Access to Obstetrician-Gynecologists Through a U.S.-Rwanda Academic Training Partnership

Maria Small et al. Obstet Gynecol. 2019 Jul.

Abstract

Objective: To evaluate the first 5 years of the Human Resources for Health Rwanda program from the program onset in the July 2012-2016 academic years, and its effects on access to care through examination of: 1) the number of trained obstetrician-gynecologists (ob-gyns) who graduated from the University of Rwanda and the University of Rwanda-Human Resources for Health program and 2) a geospatial analysis of pregnant women's access to Rwandan public hospitals with trained ob-gyns.

Methods: We used GPS coordinates in this cross-sectional study to identify public (government) hospitals with ob-gyns in 2011 (before initiation of the program) compared with 2016 (year 5 of the program). We compared access to care for the years 2011 and 2016 through geocoding the proportion of pregnant women within 10 and 25 km from these hospitals and compared the travel time to these hospitals in the two time periods. We used a World Pop dataset of Rwandan pregnancies from 2015, ArcGIS for spatial operations, R for statistical analysis, zonal statistics for circular distances, and friction surface for travel time analysis.

Results: The number of ob-gyns in public hospitals increased from 14 to 49 nationally. Before the program, 18 residents graduated over a 7-year period (two residents per year); 33 graduated by year 5 (six residents per year). Rwandan faculty increased by 45%. In 2011, most providers were in the capital city. Between 2011 and 2016, the proportion of pregnant women living 10 km from an ob-gyn-staffed public hospital increased from 13.0% to 31.6%; within 25 km increased from 28.4% to 82.9%. Travel time analysis from 2011 to 2016 showed 49.1% of Rwandan women within 1 hour of a hospital and 85.6% within 2 hours. In 2016, this coverage increased to 87.5% and 98.3%, respectively.

Conclusion: In 5 years, the Human Resources for Health Rwanda program improved the number of residency graduates in obstetrics and gynecology and nationwide access to these providers. The program reduced rural-urban disparities in access to ob-gyns.

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Comment in

  • Contemporary Issues in Women's Health.
    Geary M, Chibwesha C, Stringer E. Geary M, et al. Int J Gynaecol Obstet. 2020 Jan;148(1):3-5. doi: 10.1002/ijgo.13026. Epub 2019 Nov 17. Int J Gynaecol Obstet. 2020. PMID: 31736061 No abstract available.

References

    1. Ouma PO, Maina J, Thuranira PN, Macharia PM, Alegana VA, English M, et al. Access to emergency hospital care provided by the public sector in sub-Saharan Africa in 2015: a geocoded inventory and spatial analysis. Lancet Glob Health 2018;6:e342–50.
    1. Binagwaho A, Farmer PE. The human resources for health program in Rwanda. N Engl J Med 2014;370:981–2.
    1. Bucagu M, Kagubare JM, Basinga P, Ngabo F, Timmons BK, Lee AC. Impact of health systems strengthening on coverage of maternal health services in Rwanda, 2000-2010: a systematic review. Reprod Health Matters 2012;20:50–61.
    1. National Institute of Statistics of Rwanda (NISR) [Rwanda], Ministry of Health MOH) [Rwanda], ICF International. Rwanda demographic and health survey 2014-15. Rockville (MD): NISR, MOH, ICF International; 2015.
    1. Cancedda C, Cotton P, Shema J, Rulisa S, Riviello R, Adams LV, et al. Health professional training and capacity strengthening through international academic partnerships: the first five years of the human resources for health program in Rwanda. Int J Health Policy Manag 2018;7:1024–39.

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