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1
Experiences of Implementing a Demand Side
Financing Scheme for Maternal Health Services in
Eastern Uganda Bua John 1 , Ekirapa Kiracho E1,
Nalwadda G2, Rahman H 3, Peters D3, Bishai
D3 , Pariyo G 1, Mutebi A 1 , Okui O 1. 1.
Makerere University School of Public Health,
Department of Health Policy Planning and
Management 2. Makerere University School of
Medicine, Department of Nursing 3. Johns Hopkins
University Bloomberg School of Public Health,
Department of International Health
Introduction

• Increased community awareness
• Increased community participation through
  sensitising and providing transport services
• Increased support from the community leaders
• Income generating activity for the community
• Increased demand for health workers to provide
  services

Geographical accessibility and the lack of
appropriate transport are demand-side constraints
for use of maternal health care services in
Uganda. Coupled with this is the poor quality of
services related to inadequate supplies and
unmotivated health workers. Additionally it is
common for mothers who are aware of the benefits
and need to use maternal health services to lack
the means to pay for transport and services.
These factors combined together contribute to the
low percentage of institutional deliveries (42).
Most interventions in Uganda have been directed
at addressing the supply side constraints but not
the demand side. But literature suggests that
demand side financing may have the potential to
increase access of targeted services to
vulnerable groups such as pregnant women. However
evidence about the use of demand side financing
in sub Saharan Africa is still limited.
Challenges

• Organizing appropriate referral transport
• Inadequate resources Staffing, supplies,
  equipment
• Record keeping
• Security at night
• Timely payments for the health facilities and
  transport providers
• Implementation of the multiple components of the
  project.
• Sustainability

Objective
The Future Health Systems Study in Uganda is
using both demand (vouchers for transport and
maternal services) and supply side initiatives
(training health workers and provision of
essential equipment, drugs and supplies) to
generate evidence that can inform the designing
and implementation of similar schemes.
Methodology
Figure 2 A mother with a newborn being taken
home by a transporter in Buyende District.
Positive experiences

• Increased utilization of maternal health services
• Increased motivation of health workers

Lessons learned

• Demand for services has been there but access has
  been hindered by various factors including
  transport.
• Using available resources within the community
  can help over come hindrances to access of health
  services.
• There is need to address gaps in health staffing
  by the District and its partners to maintain a
  positive trend.
• Response from such interventions may outstrip the
  available resources.

Figure 3
Figure 1 Map of Uganda showing Kamuli and Pallisa
Design Non randomized trial Setting 4
districts ( Kamuli, Buyende, Pallisa Kibuku) 2
intervention and 2 control Intervention Voucher
for transport and maternity services Health
system strengthening
Figure 4
Figure 6 Newborns delivered in Kamuli District
Hospital
Acknowledgements
Intervention

• DFID
• Mellinda Gates Foundation
• MU-JHU Twining Programme
• Ministry of Health Uganda
• Kamuli and Pallisa District officials
• The Communities of Kamuli and Pallisa District
• FHS Partner Institutions
• Researchers

Pregnant women in control
Maternal health services
Training Supervision Supplies, drugs and
equipment
Vouchers for maternal services
Pregnant women in intervention
Maternal health services
Vouchers for transport
Figure 5 Health workers conducting an MCH clinic
in Kamuli District.