Increased Rwandan Access to Obstetrician-Gynecologists Through a U.S.-Rwanda Academic Training Partnership

Maria Small, Urania Magriples, Rahel Ghebre, Lisa Bazzett-Matabele, David Ntirushwa, Doee Kitessa, Diomede Ntasumbumuyange, Paul Lantos, Eugene Ngabonziza, Washington Hill, Kenneth Ruzindana, Jean Damascene Rukundo, Alexandra N. Moscovitz, Patrick Bagambe, Haywood Brown, Stephen Rulisa

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


OBJECTIVE:To evaluate the first 5 years of the Human Resources for Health Rwanda program from the program onset in the July 2012-2016 academic years, and its effects on access to care through examination of: 1) the number of trained obstetrician-gynecologists (ob-gyns) who graduated from the University of Rwanda and the University of Rwanda-Human Resources for Health program and 2) a geospatial analysis of pregnant women's access to Rwandan public hospitals with trained ob-gyns.METHODS:We used GPS coordinates in this cross-sectional study to identify public (government) hospitals with ob-gyns in 2011 (before initiation of the program) compared with 2016 (year 5 of the program). We compared access to care for the years 2011 and 2016 through geocoding the proportion of pregnant women within 10 and 25 km from these hospitals and compared the travel time to these hospitals in the two time periods. We used a World Pop dataset of Rwandan pregnancies from 2015, ArcGIS for spatial operations, R for statistical analysis, zonal statistics for circular distances, and friction surface for travel time analysis.RESULTS:The number of ob-gyns in public hospitals increased from 14 to 49 nationally. Before the program, 18 residents graduated over a 7-year period (two residents per year); 33 graduated by year 5 (six residents per year). Rwandan faculty increased by 45%. In 2011, most providers were in the capital city. Between 2011 and 2016, the proportion of pregnant women living 10 km from an ob-gyn-staffed public hospital increased from 13.0% to 31.6%; within 25 km increased from 28.4% to 82.9%. Travel time analysis from 2011 to 2016 showed 49.1% of Rwandan women within 1 hour of a hospital and 85.6% within 2 hours. In 2016, this coverage increased to 87.5% and 98.3%, respectively.CONCLUSION:In 5 years, the Human Resources for Health Rwanda program improved the number of residency graduates in obstetrics and gynecology and nationwide access to these providers. The program reduced rural-urban disparities in access to ob-gyns.

Original languageEnglish (US)
Pages (from-to)149-156
Number of pages8
JournalObstetrics and gynecology
Issue number1
StatePublished - Jul 1 2019

Bibliographical note

Funding Information:
The Human Resources for Health Rwanda program is supported by the U.S. Centers for Disease Control and Prevention, the Presidents Emergency Fund for AIDS Relief (PEPFAR), Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund), and the Government of Rwanda. Presented at the Society for Maternal-Fetal Medicine’s 39th Annual Meeting, February 11–16, 2019, Las Vegas, Nevada. Each author has confirmed compliance with the journal’s requirements for authorship. Corresponding author: Maria Small, MD, MPH, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC; email:

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

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