The Barame Project was established by the Belgian Development Agency (Enabel) and the government of Rwanda to improve access to quality reproductive, maternal, newborn, child, and adolescent health services, as well as family planning, and adolescent sexual and reproductive health services. It is also intended to increase community engagement and participation.
In 2022 hera was selected to support the evaluation of the effectiveness of the Barame project and conducted a knowledge, attitude, and practice (KAP) study to help identify gaps in community knowledge and utilization of health services related to maternal, neonatal, adolescent, sexual, and reproductive health, as well as providing recommendations for future development of communication and awareness strategies. The study focused on people aged 25 to 49 years old in seven districts in Rwanda, namely Gakenke, Gisagara, Karongi, Nyamasheke, Nyarugenge, Rulindo, and Rusizi. The hera team used mixed methods for the study including quantitative and qualitative approaches. A total of 1,782 households were visited, finding 3,323 eligible respondents. In addition, a total of 26 focus group discussions and 21 semi-structured interviews with key informants were conducted.
The main findings of the study showed that respondents had relatively high levels of knowledge on most indicators. Almost all informants (98 percent) were able to name at least one method of family planning, 95 percent knew where sexual and gender-based violence survivors could seek support, 92 percent knew where to obtain sexual and reproductive health and rights (SRHR) services, and 90 percent were aware of exclusive breastfeeding recommendations of at least 6 months.
However, there were some gaps in knowledge, particularly regarding kangaroo care within the first hour following birth, multiple methods of mother-to-child transmission of HIV, and the importance of the first 1000 days of a child's life. Many respondents suggested continuing awareness campaigns about the importance of using services, training community health workers (CHWs), and continuing CHW home visits or community meeting strategies to improve awareness and utilization of services.
While the knowledge and attitudes dimensions obtained overall a high score of over 75 percent (75 for knowledge and 76 for attitudes), respondents were less confident about their practices (56 percent). This implies that while knowledge is high, there are existing barriers and obstacles that prevent respondents from using these services. In this regard, respondents highlighted that health staff shortages, distance to health facilities, and lack of economic resources, were all factors that influenced their decision to use SRH and maternal, neonatal and child health services.
The study findings have important implications for improving maternal, neonatal, adolescent, sexual, and reproductive health in Rwanda. To address the challenges in practice, the hera team suggested improving the quality of healthcare providers, particularly for postnatal care services. They also recommended increasing community awareness of the importance of postnatal care, addressing cultural factors affecting contraceptive utilization, and strengthening the involvement of husbands/partners in supporting their wives during pregnancy and lactation.
Key recommendations included designing a context-specific and well-targeted Gender Based Violence Social Behaviour Change (SBC) strategy, availing enough staff to provide services, improving sensitization by healthcare providers, reinforcing Kangaroo care, training and equipping CHWs on the provision of contraceptive methods, involving local leaders in nutrition-related interventions, reinforcing patient education and patient voice, investing in activities that increase adherence to community-based health insurance, and conducting a follow-up survey after the implementation of the SBC strategy. These recommendations aim to address gaps in knowledge, attitudes, and practices related to reproductive, maternal, newborn, child and adolescent health (RMNCAH) in the surveyed communities.
Photo Credit: Flickr- Creative Commons: Rwanda Green Fund