TY - JOUR T1 - Impact of a health system strengthening intervention on maternal and child health outputs and outcomes in rural Rwanda 2005–2010 JF - BMJ Global Health DO - 10.1136/bmjgh-2017-000674 VL - 3 IS - 2 SP - e000674 AU - Dana R Thomson AU - Cheryl Amoroso AU - Sidney Atwood AU - Matthew H Bonds AU - Felix Cyamatare Rwabukwisi AU - Peter Drobac AU - Karen E Finnegan AU - Didi Bertrand Farmer AU - Paul E Farmer AU - Antoinette Habinshuti AU - Lisa R Hirschhorn AU - Anatole Manzi AU - Peter Niyigena AU - Michael L Rich AU - Sara Stulac AU - Megan B Murray AU - Agnes Binagwaho Y1 - 2018/04/01 UR - http://gh.bmj.com/content/3/2/e000674.abstract N2 - Introduction Although Rwanda’s health system underwent major reforms and improvements after the 1994 Genocide, the health system and population health in the southeast lagged behind other areas. In 2005, Partners In Health and the Rwandan Ministry of Health began a health system strengthening intervention in this region. We evaluate potential impacts of the intervention on maternal and child health indicators.Methods Combining results from the 2005 and 2010 Demographic and Health Surveys with those from a supplemental 2010 survey, we compared changes in health system output indicators and population health outcomes between 2005 and 2010 as reported by women living in the intervention area with those reported by the pooled population of women from all other rural areas of the country, controlling for potential confounding by economic and demographic variables.Results Overall health system coverage improved similarly in the comparison groups between 2005 and 2010, with an indicator of composite coverage of child health interventions increasing from 57.9% to 75.0% in the intervention area and from 58.7% to 73.8% in the other rural areas. Under-five mortality declined by an annual rate of 12.8% in the intervention area, from 229.8 to 83.2 deaths per 1000 live births, and by 8.9% in other rural areas, from 157.7 to 75.8 deaths per 1000 live births. Improvements were most marked among the poorest households.Conclusion We observed dramatic improvements in population health outcomes including under-five mortality between 2005 and 2010 in rural Rwanda generally and in the intervention area specifically. ER -