Factors Influencing Quality Implementation Of Primary Healthcare Services Among Patients Attending Health Posts Facilities In Rutsiro District Rwanda, 2026

Abstract

Mukakibibi Clenie and Dr. Maurice B Silali

This study examined factors influencing the quality implementation and management of Primary Healthcare (PHC) services among patients attending health posts in Rutsiro District, Rwanda. Despite the critical role of PHC in promoting health, preventing disease, and providing basic curative care, limited local evidence exists on its implementation, accessibility, and service quality. The study aimed to determine the prevalence and utilization of PHC services, assess accessibility and socio-economic determinants affecting service quality, and evaluate healthcare staffing at health posts. A mixed-methods approach was employed using cross-sectional design, combining structured questionnaires and interviews, supported by cohort analysis and thematic triangulation. The study targeted outpatient and inpatient service users, with a sample size of 208 respondents determined using Yamane’s formula. Data were analyzed using SPSS to generate descriptive and inferential statistics. Ethical approval was obtained from Mount Kenya University (MKU) and Rutsiro District authorities. Findings showed strong utilization of PHC services: 61.5% (n=128) reported regular immunization coverage, 60.1% (n=125) indicated essential services were always available, and 53.8% (n=112) confirmed consistent medicine availability, though some shortages persisted. Accessibility was generally favorable, with 66% (n=138) living within 3 km of a health post, 63% (n=130) spending ≤500 RWF on transport, and 71% (n=148) experiencing waiting times of ≤60 minutes. Additionally, 82% (n=170) reported medicines as always or often available, while 75% (n=158) indicated medical equipment was functional and services were moderately to highly comprehensive.Socio-economic factors significantly influenced access and quality. A majority, 57%, earned less than 50,000 RWF per month, while only 14% earned above 100,000 RWF. Health insurance coverage through CBHI was 63%, leaving 24% uninsured. Income affected healthcare access for 58% of respondents, and financial difficulties impacted care for 39%. However, 80% reported good understanding of health information, and 82% noted that insurance improved perceived service quality. Healthcare staffing was generally adequate: nurses served 67% of patients, community health workers 24%. Staff training was rated very good or moderate by 81%, professionalism by 80%, and staffing levels were considered sufficient by 80%. Patient load was ≤10 patients per provider for 71%, though 29% reported higher workloads. Staff competence improved patient satisfaction for 87% of respondents. The study concludes that PHC services in Rutsiro District are relatively strong in availability, accessibility, and utilization. However, financial barriers, occasional medicine shortages, and workload imbalances remain key challenges. It is recommended that the Ministry of Health expand CBHI subsidies and improve equitable facility distribution, while Rwanda Biomedical Centre strengthens supply chain systems and staff capacity-building. Health posts should optimize staff allocation to reduce waiting times and enhance service delivery. 

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