The pace of development in northern Uganda’s rural district of Oyam, which is home to approximately 400,000 people, has generally been slow. Doctors with Africa CUAMM’s “Mothers and Children First” program has experimented there with two types of incentives to help pregnant women overcome geographic and financial barriers to their use of maternal health services: providing mothers-to-be with transport vouchers that enable them to travel by motorcycle to a health facility offering such services, and new mothers with “baby kits” containing various items useful for the care of newborns.
Our 12-month study (January through December 2014) assessed the impact and financial cost of providing these incentives and investigated their impact on women’s use of prenatal care, deliveries assisted by skilled attendants and postnatal care. We used a “difference in differences” technique to conduct our research, looking at areas that were similar in terms of population and the availability of services, but only some of which were targets of our intervention.
We found significant increases in the number of prenatal care visits and assisted deliveries in the health facilities in which the two incentives were introduced. The percentage of women who went to such a facility to give birth jumped from 31% to 53% with the introduction of the baby kits, and from 13% to 53% with that of the transport vouchers, whose provision also led to a major increase – from 8% to 47% – in the percentage of women taking advantage of all four antenatal care visits. The cost of an institutional delivery came to US$ 9.40 for each transport voucher used and US$ 10.50 for each baby kit, while the incremental cost per unit increment in institutional deliveries was US $15.90 with the transport vouchers and US$ 30.60 with the baby kits.
Therefore both types of incentive, but especially the transport vouchers, proved effective in increasing the community’s use of maternal and neonatal care services by significantly reducing demand-side barriers.