Voucher program for child birth care in Uganda

For mothers-to-be in remote villages of Uganda bringing a baby to the world can be very difficult. Walks can be long to any hospital, so the thought of receiving any prenatal care is out of the question, let alone going to the hospital for the delivery itself. Besides, who could afford any of the care or supplies the hospital would charge you?

An article in All Africa today examines a new voucher program that gives full pregnancy care at a reduced cost. The funds for the voucher program are put up by the World Bank and the German Development Bank. However, the drawback to the card program is not everyone can afford it, even with the reduced cost.

New Vision writer Irene Nabusoba examines the voucher program.

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."