Improving access to maternal health services for women

By Faith Kyateka

Demand side financing is a tool that is being utilized to improve the utilization of under used services among the poor and under-served populations by placing purchasing power as well as choice of provider directly in the hands of the recipients (World health Report 2010).

This is an important innovation in health care systems where access remains poor and therefore the utilization and uptake of services very low among those who would benefit most from these services, that is to say the poor and vulnerable sections of the populations.

This is especially true for services such as family planning, maternal health and child health.

Every year there are 1,600,000 pregnancies in Uganda and many of these pregnant women face the probability of living or dying while giving life. According to the World Health Statistics report 2015, maternal mortality is at 320/100,000

Matched with the poor health seeking behavior (less than half of Ugandan women deliver with a skilled attendant) the need for a demand side intervention that actively engages both the private and public sector is clear.

In Uganda various demand side financing interventions have been tried which involve the use of subsidies or vouchers.

Voucher schemes like the Uganda Reproductive Health Voucher project implemented by Ministry of Health with Marie Stopes Uganda as the voucher management agency, are designed for women of reproductive age living below the poverty line.

Community health workers sell the voucher to pregnant women that entitle poor women to attend to skilled care during pregnancy, delivery and post-natal period in South Western and Eastern Uganda.

In this case a voucher is a document that authorises payment of a health service; therefore, it is a token that can be exchanged for a pre-defined set of health services or products. The voucher enables public subsidies for services or products to follow the client rather than being tied to providers.

The voucher system which is aimed at boosting maternal health services in 240 health facilities is being implemented in 25 districts of south west and eastern parts of the country.

Since the project started in April 2016, 65,000 expectant mothers have benefited from the project.

Specifically a total of 32,000 babies have been delivered to women from a socio-economic group that had a very low rate of uptake of maternal health services prior to the project. The demand for the voucher continues to be very high often exciding supply.

Dr. Michael Bukenya (chairperson of the health committee of Parliament) says that the voucher project proves that health financing is possible and therefore provides good lessons and benchmarks for the National Health Insurance Scheme which has been under review for a long time.

In conclusion, demand side financing projects particularly vouchers have proved to be effective in enhancing people's motivation to seek for health services, improving health system performance and boosting facility deliverables as well as skilled birth attendance thereby contributing to the reduction of maternal mortality.

These services should be widely available to pregnant women in low resource settings. Therefore, as we mark International women's day, It is critical that every pregnant woman and new-born has access to and receives good quality care and life saving interventions around the time of birth.

The writer is the head of communications and public relations at the Marie Stopes Uganda