Maternal Mortality in Uganda and Rwanda: A comparative health system analysis

Members

Principal investigator

Despite advances in health technologies and evidence based interventions, maternal mortality remains a significant social and public health problem in the developing counties. Sub Saharan Africa (SSA) accounts for over half of the 287,000 maternal deaths each year and remains the place with the highest risk of maternal death (1:39). The decline in the Maternal Mortality Ratio (MMR) remains far below the expected 75% between 1990 and 2015. It is highly unlikely to be achieved in SSA. The problem remains inequitable access to emergency obstetric care, HIV/AIDS in South and East Africa and limited access to family planning.  HIV/AIDS is still endemic in South and East Africa. Despite this gloomy picture of the region, a few examples stand out, such as Rwanda, Eritrea and Equatorial Guinea, all of which are likely to meet MDG 5.

 

Rwanda’s success in reducing MMR and improving other health indicators stands out in SSA despite the destruction of the economy and health systems during the 1994 genocide. Rwanda’s MMR was 1.5 times that of Uganda in 1990 but by 2010 they were running neck-to-neck. For the decade of 2000 to 2010, Rwanda registered the highest average annual reduction of MMR of 8.7% among 75 priority countries with the highest MM burden. Although context differs, Rwanda still provides the best case for comparison with other low resource setting like Uganda.

 

A comparative study of Uganda and Rwanda was done using a health systems analysis framework to explore factors responsible for differences in MMR trends.  This analysis was based on the WHO building blocks of a health system namely: financing, human resource, Governance and leadership, service delivery, medicines and technologies and information. This study also looked at population factors as a determinant of service demand. This is one of the few studies to compare MMR in two Low Income Countries in Sub Saharan Africa. It highlights the opportunities for low income countries to learn from each other.

 

The study used mixed methods data collection and analysis, that is, literature review of both scholarly and grey literature, secondary data analysis, key informant interviews (n=16) and facility observations. Interviews in Uganda included policy makers at the Ministry of Health, WHO, UNFPA and the parliamentary health committee, Interviews were also held with policy implementers, including district health officers, directors and Senior nursing officers at regional referral hospitals, NGOs, WHO and UNFPA field office and health policy analyst at Makerere University School of public health. Respondents were chosen purposively and sometimes snowballing technique based on their experience in maternal health policy issues in Uganda.

 

The study used mixed methods data collection and analysis, that is, literature review of both scholarly and grey literature, secondary data analysis, key informant interviews (n=16) and facility observations. Interviews in Uganda included policy makers at the Ministry of Health, WHO, UNFPA and the parliamentary health committee, Interviews were also held with policy implementers, including district health officers, directors and Senior nursing officers at regional referral hospitals, NGOs, WHO and UNFPA field office and health policy analyst at Makerere University School of public health. Respondents were chosen purposively and sometimes snowballing technique based on their experience in maternal health policy issues in Uganda.

Updated:  26 June 2017/Responsible Officer:  Director/Page Contact:  Coordinator