The Impact of Hospital Accreditation on Health Utilization and Outcome in Rwanda: An Interrupted Time Series Analysis

Background: Over the past 30 years, Rwanda has improved health outcomes and access to care, though progress has slowed in the last decade. In 2013, the government launched a hospital accreditation program to enhance efficiency and care quality. The program has 79 measurable standards evaluated at three levels. Level 1 consists of having policies, guidelines, and plans in place, and when there is evidence that health facilities implement those documents, level 2 is achieved. If data is used to guide clinical and quality improvement decisions, level 3 is also achieved. The level 1 program was implemented from 2013 to 2021, and in 2022, the country shifted to level 2. However, there is no evidence that this upgrade in the level of evaluation has resulted in improved clinical outcomes and service utilization. Methods: Using routine data from February 2020 to December 2024, we employed interrupted time series analysis to evaluate the impact of increasing the level of evaluation of the hospital accreditation program to 10 outcome indicators. The interruption period was March 2022, we took 24 monthly observations before and 33 monthly observations after the intervention period. Findings: The upgrading of the evaluation level was associated with a statistically significant immediate monthly increase in hospital admissions per 10,000 population (β = 2.08; 95% CI: 0.44 to 3.72) and a monthly reduction in post-surgical infection rates (β = -0.82; 95% CI: -1.30 to -0.34). Statistically significant monthly trends were also observed for admissions (β = -0.14; 95% CI: -0.26 to -0.02), neonatal asphyxia rate (β = 0.05; 95% CI: 0.03 to 0.06), and the proportion of newborns not breathing who were successfully resuscitated (β = -0.26; 95% CI: -0.41 to -0.10). No immediate or trend changes in outpatient visits per 10,000, peri-operative mortality, under-5 mortality, neonatal mortality, intrahospital mortality, and maternal mortality rates. Conclusion: We observed that upgrading the level of evaluation of Rwanda hospital's accreditation was associated with improvements in selected outcome indicators, others showing concerning trends and several other indicators showed limited or no response. We recommend Policy makers to continue investment in accreditation but also implementing targeted interventions to address persistent gaps in service quality and health outcomes.