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Delivering maternal health services in Rwanda: The role of politics

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  • Frederick Golooba-Mutebi
  • Yvonne Habiyonizeye

Abstract

Studies examining the impact of different kinds of organisational and institutional reform on service delivery in the health sector in developing countries highlight and explain advances, strengths, weaknesses, shortcomings and failures in delivery. They rarely explore directly the role of the prevailing political arrangements in individual countries, specifically how politics is organised and practised, in influencing approaches to, and the nature and quality of, service delivery. This paper seeks to contribute towards filling the gap. It explores the extent to which the operation of Rwanda’s political system in the light of the prevailing political settlement shapes service delivery and outcomes in the health sector. A political settlement begets specific rules of the game and incentives, constraints, opportunities and risks in its own context. All things being equal, in Rwanda’s dominant party/dominant leader political settlement, the short- to medium-term prospects of the current government losing power to opposition rivals are slim. Consequently, there is no pressure on the government to deliver on popular expectations or suffer electoral defeat. In the face of marked achievements in recent times, therefore, the paper explores the possible influences on service delivery in post-genocide Rwanda. It argues that the nature of political organisation and how politics works are decisive.

Suggested Citation

  • Frederick Golooba-Mutebi & Yvonne Habiyonizeye, 2018. "Delivering maternal health services in Rwanda: The role of politics," Global Development Institute Working Paper Series esid-106-18, GDI, The University of Manchester.
    • Handle: RePEc:bwp:bwppap:esid-106-18
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    References listed on IDEAS

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    1. Levy, Brian, 2014. "Working with the Grain: Integrating Governance and Growth in Development Strategies," OUP Catalogue, Oxford University Press, number 9780199363810.
    2. Jewkes, Rachel & Abrahams, Naeemah & Mvo, Zodumo, 1998. "Why do nurses abuse patients? Reflections from South African obstetric services," Social Science & Medicine, Elsevier, vol. 47(11), pages 1781-1795, December.
    3. Marleen Dekker & Rijk van Dijk (ed.), 2010. "Markets of Well-being. Navigating health and healing in Africa," ASC Economic Books, African Studies Centre Leiden (ASCL), Leiden, The Netherlands, volume 9, number md001, 07-2018.
    4. North,Douglass C. & Wallis,John Joseph & Weingast,Barry R., 2013. "Violence and Social Orders," Cambridge Books, Cambridge University Press, number 9781107646995.
    5. David Booth & Frederick Golooba-Mutebi, 2014. "Policy for Agriculture and Horticulture in Rwanda: A Different Political Economy?," Development Policy Review, Overseas Development Institute, vol. 32(s2), pages 173-198, September.
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    1. Chinsinga, Blessings & Weldeghebrael, Ezana Haddis & Kelsall, Tim & Schulz, Nicolai & Williams, Timothy P., 2022. "Using political settlements analysis to explain poverty trends in Ethiopia, Malawi, Rwanda and Tanzania," World Development, Elsevier, vol. 153(C).

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