Rwanda risks reversing its impressive gains in maternal health as an increasing number of mothers have limited access to adequate healthcare, Rwanda Today has learnt.
Officials from public hospitals say they are overwhelmed by the high number of mothers seeking maternity services.
While Rwanda is one of only nine countries that have achieved the Millennium Development Goal to reduce maternal mortality rates by at least 75 per cent by 2015, limited access to medical facilities and personnel increases the risk of mothers either giving birth at home without the required medical care or developing health complications that could lead to death.
Expectant women frequenting the hospitals for antenatal care as well as other pregnancy-related check-ups said they have to wait longer to see doctors as priority is given to those with pregnancy-related complications.
Those who undergo surgery claim to be discharged prematurely to create room for others.
Yet, despite the increasing number of private health facilities, this has not eased the pressure for public facilities as majority of the private clinics do not accept Mutuelle de Sante, which majority of the population use.
Now officials are appealing to the government to intervene and increase funding for expansion of public healthcare facilities to cater for the increasing demand.
“We need a structure that takes into account factors like high population growth in some areas and allocate resources accordingly,” said William Kanyankore, the director of Gisenyi Hospital in Rubavu District.
He added that there is congestion in maternity wards despite the hospital referring minor medical complications to outpatient departments.
For instance, Gisenyi Hospital has seen a sharp increase in demand for maternity services from 426,000 patients to over 600,000 patients, largely due to rapid urbanisation in Rubavu.
The hospital also receives patients from neighbouring Goma town in Democratic Republic of Congo, Nyabihu and part of Ngororero districts.
This has created a critical shortage of beds despite the hospital recently opening an additional 70-bed maternity hall early this year, increasing their capacity to 326 beds.
“When you look at the current trend, we need at least an additional 100 beds to cope with current demand. We shall need another hospital of the current capacity in 10 years,” said Dr Kanyankore.
A mini-survey by Rwanda Today shows most public hospitals continue to operate above capacity receiving approximately 20 pregnant women every day with an average of more than 400 pregnant women per month.
Some of them have only two surgery rooms and a limited number of beds, ranging from four to ten for both mothers and neonatal care.
Hospitals like Kacyiru, Masaka, Kibagabaga and Muhima in Kigali, alongside Nyagatare, Ruhengeri and Kibungo are some of the facilities that are operating beyond capacity leading to congestion.
In Muhima Hospital for instance, 25 mothers deliver babies in a day on average, some of whom may need a Caesarean section, yet the facility only has two operating theatres.
“We need at least four operating theatres to accommodate four women and provide them with the time and care needed,” said William Rutagengwa, director at Muhima Hospital.
Muhima has a 160-bed capacity and functions as both a district hospital in Nyarugenge and one of the largest maternity specialty hospitals in the country.
Kacyiru Hospital, which was initially owned by the Rwanda National Police prior to rebranding as a district hospital, said it currently handles 700 expectant women per month, who deliver in its four-bed capacity maternity ward.
The hospital director, CSP Pascal Nkubito, said this put the daily number of deliveries to between 24-28 despite limited space.
However, Kacyiru and Gisenyi Hospitals are among the beneficiaries of Heineken Africa Foundation’s Rwf600 million ($696,000) support for maternal and neonatal child care in the country.
CSP Nkubito said part of the money will go into rehabilitation of maternal infrastructure and equipment, which could ease pressure on the two hospitals.
Officials from the Ministry of Health did not respond to requests for a comment by press time.
However, hospital managers are calling for a change in the administrative structure of public hospitals to address the current challenges including tackling the high fertility rates.
The new structure is understood to be under review by the Ministry of Health, Ministry of Public service and Treasury.
According to standards set by the Ministry of Health, district hospitals should have at least 75 nurses and midwives, but most complained they needed double this figure. To fill the gap, some hospitals reportedly hired private consultants who are costly.
Data from the Ministry of Health shows district hospitals handle a big number of deliveries at 95,048 out of 119,274 total deliveries in 2016.
With a population of over 11 million, the country has over 1,200 health facilities. Figures show there is one nurse for 1,200 people and one doctor for 15,479 people.
The World Health Organisation sets 23 doctors, nurses and midwives for 10,000 people as the minimum threshold necessary to deliver essential maternal and child health services.