Baby vouchers give hope for dignified child delivery

Nov 08, 2009

EVERY pregnant woman has one foot in the grave,” goes an African adage. This may sound crude today but it is the reality for many rural poverty-stricken women like Consolata Kebikali, 38. She has survived death nine times during childbirth, but has trad

By Irene Nabusoba

EVERY pregnant woman has one foot in the grave,” goes an African adage. This may sound crude today but it is the reality for many rural poverty-stricken women like Consolata Kebikali, 38. She has survived death nine times during childbirth, but has traded her luck for four of the babies she was trying to give life.

With a small plot just enough for their two-roomed house in Kibale village, Ndeijja sub-county in Mbarara district, Kebikali had never known the inside of a health facility or a gloved hand of a midwife during childbirth.

Her labour suite had always been the banana plantation, under the instruction of an elderly neighbour and at some extremes by herself. What with the nearest government health facility — Itojo Hospital, 25 miles away?

Besides, she could not afford sh35,000 — sh50,000 charged by Kathe Medical Care Clinic located on Kabale Road (17 miles from her home). Thus from conception, through pregnancy to childbirth, everything is ‘up to God to see her through’.

But thanks to the health baby vouchers under the Out-put Based Aid (OBA) project, Kebikali’s last-born baby, now aged two months, was born in hospital, guaranteeing it a safe arrival.

She says: “I went to Kathe Clinic earlier than necessary because of false labour. I was referred to Mbarara Hospital where I was told my baby was okay after a scan. All expenses were paid courtesy of the card.”

What is ‘the card’?
The German Development Bank (KfW) and the Global Partnership on Output Based Aid (GPOBA), a World Bank-managed trust fund, are jointly financing a three-year Reproductive Health Voucher project for the management of sexually transmitted infections (STIs) and provision of safe delivery services in Mbarara, Kiruhura, Isingiro and Ibanda districts.

Under the project managed by Marie Stopes International, a UK-based health and social marketing organisation that advocates for quality reproductive health care, patients buy a card at sh3,000 to access STI screening and treatment (health life vouchers) or medical care during pregnancy and delivery (health baby vouchers), at accredited health facilities.

“The card entitles a mother to four antenatal visits, malaria screening and prophylaxis, STI and HIV screening, delivery (normal and C-section), transportation for referral in case of emergency and post-natal care within six weeks after delivery,” says Richard Semujju, the project coordinator.

He says only 15% of mothers in Isingiro give birth at health units, about 20% in Kiruhura, 30% in Mbarara, while Ibanda hardly has any statistics on skilled deliveries. Nationally, 42% of mothers deliver in health units under skilled care.

Angela Mbahwejje, a midwife and proprietor of Angela Domiciliary Clinic in Kashari sub-county, who has participated in the project since its inception in 2006 with the STI vouchers, says: “So far, we have attended to 231 mothers.

We have had 43 deliveries, three emergency deliveries which were referrals to Mbarara Hospital and three mothers returning for post-natal care.”

Only poor mothers can access the safe baby voucher. Semujju says there is a poverty grading system with home visits to ensure ithe facility is accessed by those who need it most.

Service providers’ views
For Asaf Kamugisha, a clinical officer and proprietor of Kathe Medical Care Centre, the Safe Baby Programme has boosted his business and improved his health skills.

“We receive continuous training in safe motherhood skills,” he says.
Helen Tumukunde, a midwife at the centre says expectant mothers prefer units affiliated to the programme because workers are friendly, unlike in government health centres where many staff are either rude or absent.

Fred Twinomugisha, a clinical officer and owner of Dembe Clinic in Ibanda, says the system has improved antenatal care. “I used to have 20 deliveries a month, but I now have 40.”

He says most of the ‘OBA mothers’ have been delivering at home or with the help of traditional birth attendants.
“Even those who came for antenatal care could not afford lab tests like HB, STI and urine tests.

Challenges
Mbahwejje says: “Men are discouraging their women from coming here because we talk to them about family planning.”
He says many of the mothers with vouchers have never delivered from hospital and do not know what to expect.

“One day, a mother, pregnant, for the 13th time came, seeking a skilled delivery for the first time. I referred her because she was carrying twins and their position was not good, but she refused because she thought she was going to be operated on.

The husband took her back home, only to return as an emergency case. She lost one baby.”

“The woman could not imagine being operated on yet she had been pushing all her babies normally from home,” she adds.

Agnes Twinomukama, a midwife at Dembe Clinic says due to the long distance, most women do not come for antenatal care or return for delivery, while others deliver on the way.

“They walk 10—15kms. They get here exhausted and sometimes with distressed babies or swollen cervix because of attempted ‘pushes’”, she discloses.

Keneth Kanyema, a voucher distributor says Marie Stopes should give some mothers free cards because they cannot raise the sh3,000 for the card.

Mothers speak out
Rose Tukundane, who has just had a healthy baby boy says: “This is my first baby here. I had my last one at a government health centre (IV), but I was asked to buy oxytocin, drip water, carnular, syringes and gloves.”

She says because they were out of stock, Mbarara Hospital was the only option. “I spent sh45,000 for the two days I spent in the hospital and my husband had to sell a goat,” adds the 30-year-old mother of five from Mbarara.

She praises the ‘card’, for earning her respect since she delivered from a private clinic.

For Beatrice Kyomugisha, 40, a mother of seven from Rwobuhora village in Ibanda, the card enabled her to access quality emergency obstetric care which would have otherwise turned out expensive.

“I have been delivering from home because I never encountered any complications. This time, I felt dizzy, lower abdominal pains, spotting and general body weakness, so I rushed to buy the card.”

“The clinic referred me to Mbarara Hospital but there was transport to take me there. The midwife escorted me hence saving me the queues. I would have probably lost my baby, says Kyomugisha.”

Tophious Kyosimire, 33, a mother of 13 (four died during childbirth), from Bagarama village in Kashari sub-county, says the card exposed her to family planning.

“I never used any family planning method. My friend advised me to go for injectaplan, but I still got pregnant. I did not know I was supposed to go back for another shot after three months. Now I understand it better and I am considering tubuligation.”

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