Saving Infants’ Lives through Standardization of Care in Rwanda

{Photo credit: Philbert Rugumire}Photo credit: Philbert Rugumire

In just two years, staff at Ruhengeri referral hospital in the Northern Province of Rwanda reduced the rate of newborn deaths within their facility to 1.4 percent, one-third of their 2013 baseline. Neonatal mortality in this facility is now half the sub-Saharan African average of 2.8 percent in 2015 (WHO Global Health Observatory Data Repository).

Ruhengeri owes its success to a process that is so straightforward, it seems almost too simple. The hospital made these impressive improvements in neonatal survival by adhering to a set of standards of care developed as part of the Rwandan Hospital Accreditation System.

One of the first of its kind, the innovative country-owned accreditation system was first introduced by the Integrated Health Systems Strengthening Project (IHSSP, 2009 – 2015). Funded by the US Agency for International Development and led by Management Sciences for Health, IHSSP worked with Rwanda’s Ministry of Health and five Rwandan hospitals to develop standards of care governing all aspects of hospitals’ operations and patient care, guided by internationally-accepted best practices. With the Rwandan Essential Hospital Accreditation Standards were complete, IHSSP trained ministry and hospital staff to introduce the standards into five district hospitals and developed a system for review and oversight of the process. The Rwanda Health Systems Strengthening (RHSS) project, also funded by USAID and led by MSH, is continuing to support and develop the system.

As part of the accreditation process, Ruhengeri hospital created a quality improvement committee, trained by IHSSP in 2013. The committee investigated challenges in the neonatal unit and determined ways to reduce the spread of neonatal infections, the leading cause of infant mortality at the hospital.

The neonatal ward was 300 meters (nearly 1,000 feet) from the maternity ward and stable newborns, newborns with infections, and newborns transferred from surrounding health centers were all kept together in the crowded ward, contributing to the spread of infectious diseases.  Prior to commencing the accreditation process, staff did not regularly follow neonatal care guidelines and protocols, such as wearing gloves and boots and cleaning their hands properly before caring for newborns.  

To remedy these issues, the hospital constructed a new neonatal unit next to the maternal ward. The new unit has 23 beds, 12 state-of-the art incubators, and enough space to separate the infants according to their condition and type of care needed.

Ruhengeri Hospital has retrained staff in infection control procedures and placed posters in every room of the hospital to remind staff of safety and infection prevention protocols.

“As part of the accreditation process we have been adamant about referencing the standards and protocols as stated in the clinical treatment guidelines. All our patients, both newborns and mothers, are receiving standardized care that is tested and trusted. What we have seen so far is that incremental improvements can culminate into positive change that is reinforced by data – that’s exactly what we have observed with the new neonatal unit,” said Dr. Anne Mbiya, General Practitioner and Quality Improvement Coordinator at Ruhengeri Hospital.

IHSSP and RHSS have trained and mentored hospital staff on how to collect and use data to improve their quality of care. Through this practice, the hospital found that most of the newborns suffering from infections had been transferred from a nearby health center. Thus, Ruhengeri staff has trained health center staff on clinical treatment guidelines and safety and infection prevention protocols.

“Initially we were collecting data and simply sending it to the HMIS unit…but now we take time to consider the data and what insight it can give us,” Dr. Mbiya Said. “To increase the quality of care…we have to not only review our processes, but also take our surrounding health care providers into consideration.”

RHSS is currently supporting the accreditation process in an additional 36 district hospitals and has begun preparations for the process with private sector providers as well.  Before the end of the project, the system will be rolled out into all Rwandan hospitals and RHSS will assist with the development of accreditation standards for the country’s health centers as well.