Background: The Patient Voice Program and Citizen Voice and Action models use scorecard meetings for community-provider-government dialogue to improve health services. This study evaluates the responsiveness of leaders and providers to concerns voiced by citizens through these scorecard meetings at the health center and district office levels in Rwanda. Methods: We conducted a cross-sectional study from July to September 2022 in 325 Rwandan health centers across 20 districts. Responsiveness was measured by comparing resolved issues to raised issues. Logistic regression identified predictors of issue resolution, with a p-value less than 0.05 considered significant. Median responsiveness turnaround time was also analyzed. Results: In total, 59.4% (1,163) of the identified gaps were resolved. Facility-level issues experienced a higher resolution rate (65.9%) than district-level issues (35.4%). Gaps at the facility level were 3.24 times more likely to be resolved than those at the district level (OR: 3.24, p<0.001, 95% CI: [2.48,4.25]). Integrated gaps had 1.46 times higher odds of resolution compared to issues stemming from reproductive, maternal, newborn, and child health services (OR: 1.46, p<0.05, 95% CI: [1.13,1.88]). The median responsiveness turnaround time for resolving a gap was approximately 15.4 months (IQR: 6.7-25.8). Conclusions: The study shows that Patient Voice Program and Citizen Voice and Action models are effective in addressing healthcare service gaps. By promoting collaboration among communities, healthcare providers, and governments, these models facilitate targeted, locally-supported solutions that significantly improve the resolution of health service delivery issues.

Introduction: Disrespect and abuse during childbirth represents a pervasive issue worldwide. In Rwanda, however, research in this area remains scarce. This study evaluated the factors linked to disrespect and abuse during labor and delivery in two Rwandan district hospitals. Methods: Employing a mixed method, cross-sectional design, we studied 280 women giving birth at Kabutare and Kibagabaga hospitals. Analysis was conducted with SPSS version 22, using the Chi-square test to identify factors correlated with childbirth-related disrespect and abuse. Results: Our findings revealed that 27% of women reported verbal abuse and 27.5% reported abandonment by healthcare providers, with 12% experiencing physical abuse during childbirth. Factors increasing the likelihood of experiencing disrespect and abuse included residing in rural areas [AOR=4.06, 95% CI (1.12, 14.7); p=0.03], having only primary education [AOR=2.9, 95% CI: 1.10-8.9, p=0.04], and night-time delivery [AOR=2.23, 95% CI (1.34, 3.03); p=0.03]. However, having a cesarean delivery [AOR=0.23, 95% CI: 0.09-0.59, p=0.002] or having attended antenatal care [AOR=0.28, 95% CI: 0.13-0.81, p=0.029] significantly reduced the risk of such experiences. Conclusion: The study uncovers a high incidence of disrespect and abuse during labor and delivery in Rwanda. The identified risk factors, namely rural residence, lower education, and night-time delivery, highlight specific areas requiring targeted intervention. The results advocate for effective measures to ensure dignified and equitable maternity care for all women.