Building a culture of care quality improvement - a dispatch from our combined perinatal programmes in Rwanda

Mandy Lisle, a midwife working in our Rwandan Obstetric Care Programme in the country's capital city, tells us about the efforts of local health professionals and our 'Global Links' mentors to improve the care for mothers and babies.

We are in the early stages of the first Rwandan Obstetric and Midwifery Programme (ROMP), now being piloted at Muhima Hospital, in the capital city Kigali. The hospital has a very busy maternity unit with around 9,000 deliveries each year and low staff-to-patient ratios.

Muhima Hospital was one of the first hospitals included in RCPCH’s Rwandan Neonatal Care Programme (RNCP), a sister intervention to ROMP which was launched in Muhima last year, with a six-month intensive phase supported by RCPCH Global Links Mentors.

It has been lovely to see the positive memories staff have of that time and how warmly they speak of the UK mentors. One paediatrician told me, "the Neonatal Unit was asleep before the programme came - now it is awake!" This has formed a good foundation for the start of ROMP, and we have been made to feel very welcome.

Using data to understand challenges

There is a lot of common ground between the ROMP and RNCP programme streams. One of ROMP’s main aims is to reduce incidence of birth asphyxia, which is responsible for many of the admissions to neonatology. After collecting baseline data and talking with local staff, we are working alongside our Hospital Champions to develop a ‘Facility Improvement Plan’, which is designed to enable review of areas associated with the problem, such as management of obstructed labour, assisted vaginal deliveries and delays between the decision to perform a caesarean section and the birth of the baby.

This will nurture a culture where ways to improve the care that mothers and babies receive are continually being reviewed

The plan allows us to work together to understand current problems in care, and to look at ways to overcome those issues through integrated action on training, equipment, infrastructure and system changes within the unit. Using the baseline, regular audits will then be carried out, and the Facility Improvement Plan will be updated to support a continuous QI (quality improvement) approach. Hopefully, over time, this will nurture a culture where ways to improve the care that mothers and babies receive are continually being reviewed through a QI process, resulting in better outcomes for both.

Targeting issues, improving outcomes

Another key area for both ROMP and RNCP is thermoregulation of newborns. Across Rwanda, neonatal hypothermia is a major problem. Attention to thermoregulation begins with the healthcare providers at birth. So we focus on preparation for birth, including preparation of the environment, closing windows to prevent draughts, warming up sheets to dry the baby at birth and keep them warm and encouraging prolonged skin-to-skin after birth. Babies that are kept warm at birth are less likely to require the Neonatal Unit and those babies who do require it have better outcomes if admitted with a normal temperature.

It has been great to see midwives using the transfer cot, introduced through RNCP last year, when transferring babies between Labour Ward and Neonatal; as well as having an oxygen supply, the transfer cot has an ‘Embrace Nest’ which keeps the baby warm on a heated mattress during transfer outside between floors. 


Using training to strengthen practice

Our use of the Helping Babies Breathe (HBB) training protocol - improving basic neonatal resuscitation skills - is an additional area that will link the two programmes. We are fortunate in Muhima that our Midwife Champion has recently become an HBB Master Trainer, tasked by the Rwandan Association of Midwives to run training sessions for the unit.

We look forward to coming alongside her to support her in this and to continue to build on the good work done by the RNCP last year on this very important area of care provision.

If you're interested in working internationally in a low-resource setting, explore our Global Links programme or contact the Global team on