Stakeholders perceptions regarding implementing maternal and newborn health care programs in Rwanda

• Published in: BMC health services research Vol. 21; no. 1; pp. 796 - 21
• Main Authors: Nishimwe, Clemence, Mchunu, Gugu G
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 11-08-2021; BioMed Central; BMC
• Subjects: Beliefs, opinions and attitudes; Birth weight; Births; Child mortality; Childbirth & labor; Childrens health; Community Health Workers; Content analysis; Female; Health care; Health facilities; Health services; Humans; Infant Health; Infant health services; Infant mortality; Infant, Newborn; Maternal & child health; Maternal and newborn health program; Maternal health; Maternal Health Services; Maternal mortality; Medical personnel; Mixed methods research; Newborn babies; Newborn health; Obstetrics; Perception; Pregnancy; Quality management; Rwanda; Stakeholders; Success factors; Womens health; Rwanda; Ethiopia; Sub-Saharan Africa; Africa; Stakeholders; Maternal health; Maternal and newborn health program; Newborn health; Rwanda
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-021-06824-3

While maternal and newborn deaths has been decreasing since 2008 in Rwanda, there is room for improvement to meet its sustainable development goals. The maternal and newborn health care program needs to be monitored to ensure its effective implementation. This study therefore aimed to explore stakeholder's perceptions of the Rwandan maternal and newborn health care program to identify areas for improvement.
The convergent, parallel, mixed method study used quantitative and qualitative data in a single phase. The quantitative data was obtained from 79 health care workers, ranging from maternal community health care workers to program supervisors. The 10 areas of the Project Implementation Profile (PIP) instrument checklist with a five-point Likert scale were used to indicate their perceptions (strongly disagree to strongly agree). The qualitative interviews of five nurse managers used a manifest inductive content analysis, directed approach that entailed using existing theory and prior research to develop the initial coding scheme before starting data analyse.
There was disagreement about the level of top management support, human resources was regarded as an area of concern, with 18.7% (n = 14/79) indicating that they did not agree that this was adequately provided for; urgent solutions for unexpected problems was regarded as an areas of concern by 46.8% (n = 36/79). Top management support weakness were inadequate support training, materials, money for home visits, supervision and leaderships, and training of newly recruited maternity health care workers. For human resources, there were insufficient trained staff to take care of mothers and newborns due to the shortages of health providers. The management of unexpected problems was also an area of concerns and related to getting patients to health facilities during pregnancy emergencies and the lack of qualified birth attendants at health facilities.
The study identified three areas for improvement: top management support, human resources and urgent solutions for unexpected problems, as they may be affecting the provision of maternal and newborn health care program services. Using the PIP enable managers to improve the country's maternal and newborn health care program, and to provide ongoing monitoring and evaluation of with respect to the desired outcomes of reducing maternal and neonatal mortality.