Since 2000, Rwandan reproductive health has taken numerous precautions to prevent maternal and newborn deaths among many other national health improvements.[1] From 2006 on, major changes began in rural areas to provide community-based health insurance.[1]
Health sector reforms
editRwanda has advanced their policies in six main categories: health workforce, service delivery, financing, leadership and governance, medical products, vaccines and technologies, and information.[1] Due to the 1994 Rwandan genocide, a great deal of health related infrastructure and professionals were destroyed, but the government increased the number of healthcare providers from 2005 to 2008 especially in rural areas.[1] As for financing, Rwanda has increased from $16.94 per capita in 2003 to $45.42 per capita in 2008 with funds provided to health services based on performance in pre-natal care, postpartum natal care, and transmission of HIV from mother to child.[2] The leadership and governance of Rwanda saw the need to address maternal care and reproductive health issues in order to reduce poverty in the country.[1] Additionally, the government distributed predominately mainstream drugs in order to combat HIV/AIDS.[1] For information, the government developed one database that provides healthy competition between health care providers and tracks their overall progress.[1] The increase in mutual health insurance (MHI) has also led to an increase in the use of health services.[3]
Maternal health
editHalf of the deaths faced in maternal health are caused by hemorrhage, sepsis and unsafe abortion, with 18% of deaths caused by unsafe abortions which makes it a critical issue in Rwanda.[1] Although, skilled care at delivery reached up to 90% in 2015, proving that Rwanda has implemented expansive health reforms and community-based insurance.[1] Interestingly, female-headed households are less likely to deliver in a health facility which can lead to complications.[4] The likelihood of a woman seeking a health facility for delivery shares a positive correlation with the level of education received, the wealth of a family, and an urban location, while it also shares a negative correlation with employment.[4] One major issue continually faced is the amount of prenatal care received- if there is none or a limited amount, a woman is likely to not even seek professional assistance during home delivery.[4]
Family planning
editFamily planning was strongly discouraged and widely unknown about following the Rwandan genocide and need for population regrowth.[5] However, a new national population policy was implemented by female legislators in 2003.[5] The Rwandan Ministry of Health launched a new family planning policy in 2006 to provide outreach services and performance-based incentives.[1] Part of this included the government influenced branding of Prudence Plus condoms in outlet stores.[6] These condoms are used regardless of socioeconomic status in the average household.[6] There is also a movement to provide condoms for students in secondary schools.[7] This concept is frowned upon due to cultural standards for adolescent sex, yet some schools recognize the need for condom distribution to promote healthy sexual behaviors.[7] While abortion has been legal in Rwanda since May 2012 for cases of rape, incest, and fetal impairment, many more abortions take place.[8] The average cost for an unsafe abortion is $26 while a safe abortion is cited around $53.[8] The use of the birth control pill has also been put in place since 2010 which has shown no negative results to the quality of life and/or work habits seen in women.[9]
HIV/AIDS
editThe community-based insurance developed in 1999 in order to protect those with financial barriers (widows, the poor, orphans, and those living with HIV) to extend health insurance to all citizens.[1] Since 2006, all citizens have had access to public health care.[1] HIV focused health care does not have any direct links to the decline of delivery in other health care services.[10] In fact, HIV treatments further improve the delivery of essential health care services, especially antenatal care.[10]
References
edit- ^ a b c d e f g h i j k l Bucagu, Maurice; Kagubare, Jean M.; Basinga, Paulin; Ngabo, Fidèle; Timmons, Barbara K; Lee, Angela C (January 2012). "Impact of health systems strengthening on coverage of maternal health services in Rwanda, 2000–2010: a systematic review". Reproductive Health Matters. 20 (39): 50–61. doi:10.1016/S0968-8080(12)39611-0. ISSN 0968-8080. PMID 22789082. S2CID 24641267.
- ^ "Total primary energy supply per capita". doi:10.1787/410627844581.
{{cite journal}}: Cite journal requires|journal=(help) - ^ Saksena, P. (October 20, 2011). "Mutual health insurance in Rwanda: evidence on access to care and financial risk protection". Health Policy (Amsterdam, Netherlands). 99 (3): 203–9. doi:10.1016/j.healthpol.2010.09.009. PMID 20965602.
- ^ a b c Chandrasekhar, S.; Gebreselassie, Tesfayi; Jayaraman, Anuja (February 2011). "Maternal Health Care Seeking Behavior in a Post-Conflict HIPC: The Case of Rwanda". Population Research and Policy Review. 30 (1): 25–41. doi:10.1007/s11113-010-9175-0. ISSN 0167-5923. S2CID 71719795.
- ^ a b Westoff, Charles F. (February 2013). "The Recent Fertility Transition in Rwanda". Population and Development Review. 38: 169–178. doi:10.1111/j.1728-4457.2013.00558.x. hdl:10.1111/j.1728-4457.2013.00558.x.
- ^ a b Meekers, D. (2001-05-01). "Explaining discrepancies in reproductive health indicators from population-based surveys and exit surveys: a case from Rwanda". Health Policy and Planning. 16 (2): 137–143. doi:10.1093/heapol/16.2.137. ISSN 1460-2237. PMID 11358914.
- ^ a b Tuyisenge, Germaine; Hategeka, Celestin; Aguilera, Ruben Alba (2018-11-13). "Should condoms be available in secondary schools? Discourse and policy dilemma for safeguarding adolescent reproductive and sexual health in Rwanda". The Pan African Medical Journal. 31: 173. doi:10.11604/pamj.2018.31.173.16549. ISSN 1937-8688. PMC 6488254. PMID 31086625.
- ^ a b Vlassoff, Michael; Musange, Sabine F; Kalisa, Ina R; Ngabo, Fidele; Sayinzoga, Felix; Singh, Susheela; Bankole, Akinrinola (2014-02-17). "The health system cost of post-abortion care in Rwanda". Health Policy and Planning. 30 (2): 223–233. doi:10.1093/heapol/czu006. ISSN 1460-2237. PMC 4325535. PMID 24548846.
- ^ Chin-Quee, Dawn; Mugeni, Cathy; Nkunda, Denis; Uwizeye, Marie Rose; Stockton, Laurie L.; Wesson, Jennifer (December 2015). "Balancing workload, motivation and job satisfaction in Rwanda: assessing the effect of adding family planning service provision to community health worker duties". Reproductive Health. 13 (1): 2. doi:10.1186/s12978-015-0110-z. ISSN 1742-4755. PMC 4702334. PMID 26732671.
- ^ a b Price, Jessica E.; Leslie, Jennifer Asuka; Welsh, Michael; Binagwaho, Agnès (May 2009). "Integrating HIV clinical services into primary health care in Rwanda: a measure of quantitative effects". AIDS Care. 21 (5): 608–614. doi:10.1080/09540120802310957. ISSN 0954-0121. PMID 19444669. S2CID 13721923.