By Carolyn Crist

(Reuters Health) – Rwandan women have better access to obstetrics and gynecology services thanks to an international partnership to train more doctors, a new study finds.

The yearly number of medical school graduates specializing in obstetrics and gynecology (OB-GYN) in Rwanda tripled from 2011 to 2016, and rural women’s access to care improved, with more than 87% now having an OB-GYN-staffed public hospital within an hour’s travel time, researchers report in the journal Obstetrics & Gynecology.

“In poor areas, access to care is a key issue that relates to maternal and infant death. Increasing access is known to improve the health of mothers and babies,” said lead study author Dr. Maria Small of the Duke University Medical Center in Durham, North Carolina.

The 1994 genocide in Rwanda against the Tutsi ethnic minority created profound structural, social and economic destruction, and many health professionals were either killed or forced to flee the country, Small and her colleagues write.

The Human Resources for Health Rwanda program – a partnership between the Rwandan government and 22 U.S. academic institutions – was initiated to rebuild medical education training and increase access to healthcare for all Rwandans.

U.S. faculty sign on to teach trainees at the University of Rwanda in Kigali and provide clinical support for anywhere from a couple of months to a year.

“Rwanda experienced complete decimation of its healthcare system during genocide, and one of our main goals was to train the next generation,” Small said in a phone interview. “This great group of new doctors is going to make a huge difference.”

The researchers evaluated the first five years of the OB-GYN training program and its effects on access to care.

Overall, the number of trained OB-GYNs in public hospitals rose from 14 to 49 during the program’s first five years. And the rate of graduations tripled. In 2011, before the program started, 18 OB-GYN trainee doctors had graduated over the previous seven years, for an average of two per year. During the study years, 33 graduated: an average of six per year.

Rwandan faculty numbers also increased by 45%. Many graduates have taken on leadership roles as the only trained OB-GYNs in many hospitals.

Before the program, most OB-GYN doctors were in the capital city, Kigali, and the second-largest city, Butare, leaving many rural areas without local services. Between 2011 and 2016, the proportion of pregnant women living within 10 km, or about 6 miles, of an OB-GYN-staffed public hospital increased from 13% to nearly 32%, and those who lived within 25 km, or about 15 miles, increased from 28% to 83%.

“This shows the power that a government and healthcare system can have to make substantial change in a country if there’s really a desire to do so,” Small said. “Rwanda is still poor, but the achievements made over the last decade have been inspiring to all of the healthcare providers who have worked there.”

“Every country is different. There is no way to copy and paste what has been working in other countries to our country,” said Dr. Joseph Niyitegeka of the University of Rwanda.

Niyitegeka, who wasn’t involved with this study, has analyzed travel time and neonatal outcomes among pregnant women in Rwanda, especially when it comes to receiving emergency cesarean sections. He is also an international representative of the Global Anesthesia, Surgery and Obstetric Collaboration, which focuses on access to surgery and obstetrics.

“To find the best solutions, we must know the gaps so different people can discuss them by considering the country’s context,” he told Reuters Health by email. “This increases the inclusion of people with different ideas, and of course, diverse solutions for a common goal of access to healthcare.”

SOURCE: Obstetrics & Gynecology, online June 11, 2019.