According to reproductive health experts in Uganda, 6000 Ugandan women die every year from preventable pregnancy and child birth related complications. Yet, if women could only deliver under skilled care, about 80 percent of these deaths could be prevented. The reasons for not delivering in a health facility are several. But the main ones in Uganda include financial limitations, long distances to health facilities coupled with lack of access to transport facilities, lack of decision making power among women, inability to afford the medical supplies that are often compulsory at health facilities, rude unmotivated health workers and preference for traditional child birth settings.
FHS Phase 1
To address these issues, in Phase 1 FHS Uganda set up a 'Safe Deliveries Project' that established both demand (vouchers for transport and maternal services) and supply-side initiatives (training health workers and provision of essential equipment, drugs and supplies).
To implement the intervention, vouchers and registers for the vouchers were distributed to participating 22 health facilities in the districts of Kamuli and Pallisa. Drugs, supplies and equipments were procured and distributed to all participating health facilities to supplement the requirements for safe, clean deliveries. In addition, payments were made to transporters once every two weeks after they had submitted their transport vouchers. Health units also received payments once a month according to the number of service vouchers collected during that period.
The pilot phase was for 3 months from December 2009 to February 2010. And by the end of the pilot only conducted in Kamuli District, health facilities were already overwhelmed by the surge in numbers seeking maternal services. The number of number of facility deliveries was less than 200 per month but this increased to more than 500 per month.
FHS Phase 2
Following the success of the Safe Deliveries Projgect, the second phase of FHS Uganda will focus on developing on a more sustainable mechanism of financing and managing the project so that the gains can be sustained. In particular:
- The team will explore different methods of mobilizing community resources for maternal and newborn health. To address some of the challenges found in implementing the voucher study, they will introduce the use of community health workers, who will also provide health education and promotion about maternal and newborn health through home visits. This work will be done in Buyende, Kamuli and Iganga districts using a quasi-experimental design.
- In Pallisa, the team will use action research methods to test different approaches for mobilizing financial, social and human resources that exist within the community for improving maternal and newborn health.