Do Transport Vouchers Using Local Available Means Increase Attended Deliveries? A Case Study of a Rural Community in Uganda

Abstract

Problem Statement: In Uganda, only 37 per cent of mothers have a skilled attendant at delivery, and only 6 per cent of babies born at home get post natal care. There is an unacceptably high maternal mortality ratio (MMR) for Uganda of 435 per 100,000 Live Births (UDHS 2006) from 505 per 100,000 Live Births (UDHS 2001) and 506 per 100,000 Live Births (1995). For every woman who dies three others suffer disability. MDG 5; States that MMR be reduced by 75%. Pallisa and Kamuli districts are no exception of this high MMR. One of the major delays is transportation of pregnant women and reaching the health facility on time. Objectives: This study sought to increase attended deliveries using a transport voucher to provide free transport to pregnant women going to deliver in both government and private not for profit health units in the intervention areas in Pallisa and Kamuli districts. Methodology: This study was a quasi-experimental trial in 4 rural health sub districts of Pallisa and Kamuli districts. There was an intervention and control area in this district. The transport voucher was only distributed in the intervention areas. There were 22 health units in the intervention areas and 26 health units in the control areas. The ultimate sampling unit was the health unit where data on number of deliveries was collected by Research assistants trained on how to extract data from the delivery registers. Results: The number of women delivering in health facilities more than doubled since the inception of the study in June 2010. All the 22 health units in the intervention areas showed increases in utilization resulting from the transportation of pregnant women from all over the study area. According to the baseline data collected before the intervention, the health unit with the least number of deliveries had an average of 14 per month but for the first month of implementation the number increased to 75 deliveries while the health unit with the highest deliveries had on average 84 deliveries per month before implementation and after the 1st month they had increased to 125 deliveries. In the control area, there were very small changes or no changes at all because the lowest unit had an average of 33 but after the 1st month it had 35 deliveries while the unit with the highest had 122 and after the 1st month had 117 deliveries. On average all health units in the intervention area witnessed a tremendous increase in number of deliveries and the health workers attributed this increase to the free transport offered using the transport vouchers. Conclusions: In the intervention group, deliveries were significantly higher compared to the control group (chi2 Recommendations: The transport voucher scheme has been a very successful intervention in increasing attended deliveries in Pallisa and Kamuli districts and if free transport for pregnant women is maintained then the MDG 5 target could be achieved. If funds can be availed the transport voucher scheme is highly recommended for adaption by other districts to increase attended deliveries.