Improving Ante-natal care towards reducing maternal mortality through cost effectiveness - PhD thesis by Dr Regis Hitimana


More use of evidence from health economic evaluations can help to save lives and improve health in low-income countries. This is shown in Regis Hitimana’s doctoral thesis titled “Cost Effectiveness of Maternal Health Interventions in Rwanda” at Umeå University-Department of Public Health and Clinical Medicine/Epidemiology and Global Health that he defended 19 December.

There is need for low-income countries to conduct more research and use more evidence in their efforts to improve health and well-being. For instance, the deaths of mothers in the process of childbearing and their babies are still unacceptably high in many low-income countries. Many of those deaths are avoidable, and a lot is known about of what works in preventing those deaths and improving mothers’ and babies’ health and well-being, including pregnancy care programs. However, not all research results are transferable from one setting to another.

The aim of the thesis is to contribute to use of health economic evidence for informed decision making in low-resource settings, using pregnancy care in Rwanda as a case study. Different methods have been used to investigate on the cost and health outcomes of the pregnancy care program in Rwanda. Those methods include measurements of Health-related quality of life using a standard tool, estimation of effects from a policy change using expert opinions, using simulation techniques to project future use of services, and systematic review of health economic evidence. Those methods are not new in the literature, but they are rarely used in low-income countries.

The key message from this thesis is that health economic evaluation methods can produce results that support health care decisions, with potential to save lives and improve health in low income countries. The findings suggest that women who adequately attended the pregnancy care program had better health-related quality of life. It also suggests that expanding the pregnancy care program, which includes increasing the number of consultations from four to eight and having at least one ultrasound scan, would be a wise investment. It would require more investments, in Rwanda between $ 6 million and $ 11 millions, but can save more lives of mothers and babies during their last weeks of pregnancy and the first week after birth.

A recommendation in the thesis is that the Government of Rwanda make that improvement in pregnancy care. The implementation of those changes should consider however, the imperative of making the service more convenient to pregnant women. It was found that already pregnant women spend a lot of time while seeking care, four and half hours on average.

Another recommendation is that more research that is relevant to the contexts of low-resource countries, especially health economic analyses, should be produced and findings used in health policy decisions. Low-income countries could highly benefit from more use of health economic evaluations because they still bear the high burden of mortality and diseases. Insufficient financial resources should not be a barrier to doing such studies, since there are low cost methods of generating evidence, including systematic reviews and modelling among others.  

Method: Attendance to consultations during pregnancy and women’s health-related quality of life were collected through a survey of 922 women in Rwanda. Future attendance was projected using simulation techniques. A survey of six health facilities was conducted to collect cost data. Expert opinions were collected to estimate the effects of policy change. A systematic review was conducted

Regis Hitimana works as Assistant Lecturer at the School of public health, University of Rwanda since 2014. He has previously worked in the planning department of the Rwandan Ministry of Health from 2010 to 2014. He holds a Bachelor of business administration and Master of Science in Epidemiology. He plans to pursue his academic Career.

By  Darius Murangwa
Communications Officer