Despite significant improvements in its maternal health indicators, sub-Saharan Africa remains one of the most dangerous regions in the world in which to give birth. Ensuring safe motherhood for rural African women requires a package of goods and services, provided by a number of different actors. But every part of this package can face delivery challenges.
Typical bottlenecks at the local point of delivery include poor quality health care and professional standards, low staff morale and motivation, delays in transferring women to higher level health facilities and choices about health-care that reflect suspicion of modern health services.
Over the past decade, Rwanda has managed to overcome many of the critical bottlenecks to make impressive progress on maternal health. It has done so despite the fact that health spending per capita in the country remains below the sub-Saharan African average.
Based on eleven months of fieldwork in the rural Rwandan districts of Nyamagabe and Musanze, this study documents the progress being made and indicates that service delivery bottlenecks can be overcome without additional material resources.
