The vision of the World Health Organization (WHO) is a world where every pregnant woman and newborn receive quality care throughout pregnancy, childbirth, and the postnatal period. New guidelines were developed in 2016 to respond to the complex nature of the issues surrounding the Ante Natal Care (ANC) services and practices.

WHO recommends all pregnant women to receive one ultrasound (US) scan before 24 weeks to estimate gestational age, improve early detection of anomalies and multiple pregnancies and improve pregnancy experience. In 2018, Rwanda adopted the policy and decided to equip the 500 health centers with ultrasound machine for obstetric and antenatal care services. Initially the US scan services were performed by medical doctors, at hospital level or within private clinics and at a cost of approximately 10€.

Enabel/Barame project contributed to the strategy by providing 107 modern US machines and by training two nurses per health centre in six districts.

To monitor the performance and effectiveness of this service at health facility level then at national level, a digital tool was designed, built on the existing health information system. Each health center with US machine received a tablet and was trained on how to track pregnant women who come for US scan. Cases which need special care are referred at a higher level for further management.

3370 ultrasound scans were so far performed in Karongi and Rusizi districts where the programme started, with an increase of 8% in ANC first visit. 26% of cases were referred to the hospital. Most users were satisfied in terms of accessibility and information received. The key informants found the strategy useful in reducing unnecessary transfers and increasing the utilization of services.    

Uzamukunda Shakila, a 24-year-old young woman,  found at Kabusunzu health center in Nyarugenge District, at her ANC she said: “I was not aware that US scan services could be found at Health Center, when I was told about it, I was happy to go for it. During the scan, I was able to see different parts of my baby. The nurse also made me hear the heartbeats of my baby.  Since then, I was assured that I am expecting a healthy baby”

Another 39 year old woman called Chantal Uwitonze from the same health center who was coming for her 4th  pregnancy test, said: “it is so amazing, I used to make a long distance of about 30 km to go for US scan and pay expensively, before a nurse could come and do some palpation only, you could leave the health center without knowing if what you are expecting is a baby or not, but now with the US scan you see your baby, you hear its heartbeats and they help you even with the estimation of your delivery date”.

The US scan services are now accessible, available, and closer to the community for all pregnant women and at an affordable cost, of around 0.2 €.