Background: In Rwanda, Community Health Workers (CHWs) serve a crucial function in providing community-based maternal and neonatal health (CBMNH) services. However, limited access to refresher training contributes to knowledge gaps among CHWs, affecting their confidence and ability to execute their roles effectively. This study aimed to evaluate the impact of eLearning on enhancing and maintaining CHWs’ knowledge of CBMNH. Methods: This prospective cohort study, conducted from April-October 2021 in two Rwandan districts, evaluated knowledge acquisition and retention among 36 Community Health Workers (CHWs) participating in an eLearning course. Knowledge scores were measured using a structured questionnaire administered pre-training, post-training, and at a six-month follow-up. Descriptive analysis and paired t-tests were used to assess mean score differences, exploring the effectiveness of this eLearning approach. Results: This study demonstrated an improvement in Community Health Workers’ (CHWs) performance scores following eLearning training, with an average rise from 86.5% to 98.2%. The improvement was sustained at a six-month follow-up. Statistical significance was found between age category and CHWs’ pre and post-test performance (p=0.01, p=0.04 respectively), and between years of experience and pre-test scores (p=0.02), highlighting demographic influences on training outcomes. Conclusions: The results of this study suggest that eLearning is an effective method for enhancing and retaining CHWs’ knowledge of CBMNH. The findings support the use of eLearning as a valuable strategy for strengthening the capacity of CHWs in Rwanda and other countries with similar contexts.

Background: The Patient Voice Program and Citizen Voice and Action models use scorecard meetings for community-provider-government dialogue to improve health services. This study evaluates the responsiveness of leaders and providers to concerns voiced by citizens through these scorecard meetings at the health center and district office levels in Rwanda. Methods: We conducted a cross-sectional study from July to September 2022 in 325 Rwandan health centers across 20 districts. Responsiveness was measured by comparing resolved issues to raised issues. Logistic regression identified predictors of issue resolution, with a p-value less than 0.05 considered significant. Median responsiveness turnaround time was also analyzed. Results: In total, 59.4% (1,163) of the identified gaps were resolved. Facility-level issues experienced a higher resolution rate (65.9%) than district-level issues (35.4%). Gaps at the facility level were 3.24 times more likely to be resolved than those at the district level (OR: 3.24, p<0.001, 95% CI: [2.48,4.25]). Integrated gaps had 1.46 times higher odds of resolution compared to issues stemming from reproductive, maternal, newborn, and child health services (OR: 1.46, p<0.05, 95% CI: [1.13,1.88]). The median responsiveness turnaround time for resolving a gap was approximately 15.4 months (IQR: 6.7-25.8). Conclusions: The study shows that Patient Voice Program and Citizen Voice and Action models are effective in addressing healthcare service gaps. By promoting collaboration among communities, healthcare providers, and governments, these models facilitate targeted, locally-supported solutions that significantly improve the resolution of health service delivery issues.

Introduction: Disrespect and abuse during childbirth represents a pervasive issue worldwide. In Rwanda, however, research in this area remains scarce. This study evaluated the factors linked to disrespect and abuse during labor and delivery in two Rwandan district hospitals. Methods: Employing a mixed method, cross-sectional design, we studied 280 women giving birth at Kabutare and Kibagabaga hospitals. Analysis was conducted with SPSS version 22, using the Chi-square test to identify factors correlated with childbirth-related disrespect and abuse. Results: Our findings revealed that 27% of women reported verbal abuse and 27.5% reported abandonment by healthcare providers, with 12% experiencing physical abuse during childbirth. Factors increasing the likelihood of experiencing disrespect and abuse included residing in rural areas [AOR=4.06, 95% CI (1.12, 14.7); p=0.03], having only primary education [AOR=2.9, 95% CI: 1.10-8.9, p=0.04], and night-time delivery [AOR=2.23, 95% CI (1.34, 3.03); p=0.03]. However, having a cesarean delivery [AOR=0.23, 95% CI: 0.09-0.59, p=0.002] or having attended antenatal care [AOR=0.28, 95% CI: 0.13-0.81, p=0.029] significantly reduced the risk of such experiences. Conclusion: The study uncovers a high incidence of disrespect and abuse during labor and delivery in Rwanda. The identified risk factors, namely rural residence, lower education, and night-time delivery, highlight specific areas requiring targeted intervention. The results advocate for effective measures to ensure dignified and equitable maternity care for all women.

Background: Labor companionship has been demonstrated to enhance the childbirth experience and contribute to better maternal and neonatal outcomes. Despite this evidence, the practice remains underexplored in Rwanda. The present study aimed to investigate the perspectives and experiences of both women and healthcare providers concerning labor companionship in selected hospitals across Rwanda. Methods: We conducted a mixed-method study surveying 393 postpartum mothers within 48 hours of delivery and interviewing 23 healthcare providers and 16 mothers. Data were analyzed using frequencies, percentages, Chi-square tests, and logistic regression. Results: 95% (n=373) of mothers brought a chosen companion to the health facility, but only 11.2% (n=42) were allowed their companion’s presence during childbirth. About 47% who had companions present had reservations, mainly due to embarrassment (47%), gossip fears (14%), and privacy issues (40%). Mother’s age, education, economic status, and pregnancy planning status influenced companion presence. Barriers to labor companionship occurred at individual, provider, and institutional levels. Conclusion: This study underscores labor companionship’s role in boosting maternal-neonatal health in Rwanda, though implementation remains limited due to location, education, and socio-economic disparities. It advocates for policies and guidelines facilitating companionship during labor and delivery and emphasizes the need for healthcare provider training to enhance its application.