Rwanda has recorded 1,700 maternal deaths in the past five years, of which more than half are linked to delays and poor quality care, and two-thirds occur during the night shift when staffing and resources are most constrained, according to Health Management Information System (HMIS). ALSO READ: Elevating midwifery: A transformative journey to reach zero preventable maternal deaths in Rwanda To increase enrolment and expand training capacity in both public and private institutions, to eventually upsurge the number of qualified healthcare professionals and ensure proper workforce distribution across the country to reduce the number of maternal deaths, the government launched an obstetrics and gynaecology (OB-GYN) residency training programme on May 24, 2024, at Rwamagana Level Two Teaching Hospital, in Eastern Province. The programme which will reach all teaching hospitals aligns with the government-approved 4x4 Reform that intends to quadruple healthcare worker production within the next four years to meet the WHO recommendation of at least 4 healthcare professionals per 1,000 population density, and also strengthen the healthcare system, improve access to quality sexual and reproductive health services, and address the healthcare needs of women and girls. ALSO READ: Rwanda's ‘4x4 Reform’ signals a transformative shift in healthcare During the launch, Dr Yvan Butera, Minister of State for Health, told resident doctors that they are embarking on an exceptional journey of learning to provide proper service and care to the people. “We encourage you to do your best and we will render any kind of support you need,” he said. Butera stressed that OB-GYN is the first programme but promised a launch of other projects very soon. He mentioned that progress has been made in the last 15 years, though it’s not at a speedy pace, but with dedication and tenacity, he anticipates refinement. Butera urged resident doctors to work closely with the training hospitals and district leadership, as well as engage with the community to better understand the concerns of the locals and find solutions. “This programme will soon yield results as maternal and child health and training of the workforce are at the centre of our priorities,” he stressed. Senait Fisseha, Vice President of Global Programs at the Susan Thompson Buffett Foundation, said it was an honour to celebrate the key events to improve maternal and reproductive health and the health and well-being of women and girls in Rwanda. “Today is evidence of how seriously the Ministry of Health has responded to the challenge of the health workforce gaps across the country. Eighteen months ago, the ‘4x4 Reform’ was an idea on paper and today we are celebrating its launch. “Rwanda has 120 OB-GYNs, serving a population of 13 million. Although there is more focus on women specialists, we need men as well for the health and well-being of communities. We have nurses, midwives, general practitioners, and community health workers because it takes an entire ecosystem and community to tackle this problem,” Fisseha stated. She highlighted that the effort embarked on by the Ministry of Health and its partners will help to accelerate, and increase the number of gynaecologists, and that the programme demonstrates that Africa can rely on itself. Fisseha mentioned that the training is not a singular fix to maternal and reproductive health challenges in Rwanda, stressing the need to pair it with other systems and policy reforms. “We need task-shifting services so as not to rely on OB-GYNs. How do we train our community health workers? How does the ministry shift policies? How do we work with parliament to ensure that sexually active young girls can access contraception? We can’t deny the fact that our communities see a high rate of gender-based and sexual violence. That means young girls need to be protected. We are yet to start community health programmes to create stronger links between health facilities and communities. But this is an incredibly tremendous step towards every Rwandan woman and girl having the care they need and deserve.” According to Dr Ariella Ntadohoka, a resident in OB-GYN, the residency programme is a milestone that doctors have all worked tirelessly to achieve. She noted that their journeys to this point have been filled with years of rigorous study, countless exams, and invaluable clinical experiences. Yet, despite all the preparation, nothing quite compares to the reality of starting the next chapter in a career. “As first-year residents, we are eager to learn, grow, and contribute, and mostly embrace the long hours, late nights, and the steep learning curve that comes with this demanding yet fulfilling profession. We are committed to developing the skills and knowledge necessary to provide exceptional care to our patients,” Ntadohoka said. The postgraduate OB-GYN programme will train up to 60 residents annually and is a collaborative effort of various stakeholders, including the Ministry of Health, the Rwanda Society of Obstetricians and Gynaecologists (RSOG), the University of Rwanda (UR), and 10 Level Two teaching hospitals.
