Effects of demand-side incentives in improving the utilisation of delivery services in Oyam District in northern Uganda: a quasi-experimental study

Massavon, William; Wilunda, Calistus; Nannini, Maria; Majwala, Robert Kaos; Agaro, Caroline; Vivo, Emanuela De; Lochoro, Peter; Putoto, Giovanni; Criel, Bart

doi:10.1186/s12884-017-1623-y

Cited by 17 publications

(20 citation statements)

References 34 publications

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“…The schemes were also seen to be very helpful to the most vulnerable and disadvantaged groups such as single mothers 30. These findings are consistent with those of the quantitative study that evaluated the effects of the incentives 23. Notwithstanding, this study provides further insights into the pathways through which the interventions helped to achieve the effects that is, through changing the role of TBAs, the involvement of men in maternal health issues, and community involvements in the interventions.…”

Section: Discussionsupporting

confidence: 82%

“…This study was conducted in four subcounties in Oyam district, where baby kit and transport voucher schemes were implemented by CUAMM. Details about the setting, the selection of the subcounties and the incentive schemes have been described elsewhere 23. In brief, two subcounties with the lowest institutional delivery coverages in the district were purposively selected after consultations with local authorities.…”

Section: Methodsmentioning

confidence: 99%

“…Each baby kit consisted of a plastic basin, a bar of soap, a polythene bag, 1/2 kg of sugar, and a piece of cotton cloth for wrapping the baby. Each voucher was valued at US$ 4 23. Two comparable subcounties were selected as controls 23.…”

Section: Methodsmentioning

confidence: 99%

“…Each voucher was valued at US$ 4 23. Two comparable subcounties were selected as controls 23. Based on the findings, we extended the transport vouchers to the two control subcounties in 2016 for 3 more years, whereas, the baby kits were phased out.…”

Section: Methodsmentioning

confidence: 99%

“…Considering the barriers to accessing health services in Oyam District, in 2014, Doctors with Africa Collegio Universitario Aspiranti e Medici Missionari (CUAMM), hereafter referred to as CUAMM, implemented two demand-side incentive schemes—baby kits and transport vouchers—to improve the utilisation of institutional delivery services. A study on the effects of the interventions has been published 23. The present study examines the perceptions of the community members and other stakeholders on those incentive schemes.…”

Section: Introductionmentioning

confidence: 99%

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Community perceptions on demand-side incentives to promote institutional delivery in Oyam district, Uganda: a qualitative study

Massavon

Wilunda²,

Nannini

et al. 2019

BMJ Open

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ObjectiveTo examine the perceptions of community members and other stakeholders on the use of baby kits and transport vouchers to improve the utilisation of childbirth services.DesignA qualitative study.SettingOyam district, Uganda.ParticipantsWe conducted 10 focus group discussions with 59 women and 55 men, and 18 key informant interviews with local leaders, village health team members, health facility staff and district health management team members. We analysed the data using qualitative content analysis.ResultsFive broad themes emerged: (1) context, (2) community support for the interventions, (3) health-seeking behaviours postintervention, (4) undesirable effects of the interventions and (5) implementation issues and lessons learnt. Context regarded perceived long distances to health facilities and high transport costs. Regarding community support for the interventions, the schemes were perceived to be acceptable and helpful particularly to the most vulnerable. Transport vouchers were preferred over baby kits, although both interventions were perceived to be necessary. Health-seeking behaviours entailed perceived increased utilisation of maternal health services and ‘bypassing’, promotion of collaboration between traditional birth attendants and formal health workers, stimulation of men’s involvement in maternal health, and increased community awareness of maternal health. Undesirable effects of the interventions included increased workload for health workers, sustainability concerns and perceived encouragement to reproduce and dependency. Implementation issues included information gaps leading to confusion, mistrust and discontent, transport voucher scheme design; implementation; and payment problems, poor attitude of some health workers and poor quality of care, insecurity, and a shortage of baby kits. Community involvement was key to solving the challenges.ConclusionsThe study provides further insights into the implementation of incentive schemes to improve maternal health services utilisation. The findings are relevant for planning and implementing similar schemes in low-income countries.

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Section: Discussionsupporting

confidence: 82%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Community perceptions on demand-side incentives to promote institutional delivery in Oyam district, Uganda: a qualitative study

Massavon

Wilunda²,

Nannini

et al. 2019

BMJ Open

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Effect of Maternal and Newborn Care Service Package on Perinatal and Newborn Mortality

Ariff,

Jiwani,

Rizvi

et al. 2024

JAMA Netw Open

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ImportanceIn resource-constrained settings where the neonatal mortality rate (NMR) is high due to preventable causes and health systems are underused, community-based interventions can increase newborn survival by improving health care practices.ObjectivesTo develop and evaluate the effectiveness of a community-based maternal and newborn care services package to reduce perinatal and neonatal mortality in rural Pakistan.Design, Setting, and ParticipantsThis cluster randomized clinical trial was conducted between November 1, 2012, and December 31, 2013, in district Rahim Yar Khan in the province of Punjab. A cluster was defined as an administrative union council. Any consenting pregnant resident of the study area, regardless of gestational age, was enrolled. An ongoing pregnancy surveillance system identified 12 529 and 12 333 pregnancies in the intervention and control clusters, respectively; 9410 pregnancies were excluded from analysis due to continuation of pregnancy at the end of the study, loss to follow-up, or miscarriage. Participants were followed up until the 40th postpartum day. Statistical analysis was performed from January to May 2014.InterventionA maternal and newborn health pack, training for community- and facility-based health care professionals, and community mobilization through counseling and education sessions.Main Outcomes and MeasuresThe primary outcome was perinatal mortality, defined as stillbirths per 1000 births and neonatal death within 7 days per 1000 live births. The secondary outcome was neonatal mortality, defined as death within 28 days of life per 1000 live births. Systematic random sampling was used to allocate 10 clusters each to intervention and control groups. Analysis was conducted on a modified intention-to-treat basis.ResultsFor the control group vs the intervention group, the total number of households was 33 188 vs 34 315, the median number of households per cluster was 3092 (IQR, 3018-3467) vs 3469 (IQR, 3019-4075), the total population was 229 155 vs 234 674, the mean (SD) number of residents per household was 6.9 (9.5) vs 6.8 (9.6), the number of males per 100 females (ie, the sex ratio) was 104.2 vs 103.7, and the mean (SD) number of children younger than 5 years per household was 1.0 (4.2) vs 1.0 (4.3). Altogether, 7598 births from conrol clusters and 8017 births from intervention clusters were analyzed. There was no significant difference in perinatal mortality between the intervention and control clusters (rate ratio, 0.86; 95% CI, 0.69-1.08; P = .19). The NMR was lower among the intervention than the control clusters (39.2/1000 live births vs 52.2/1000 live births; rate ratio, 0.75; 95% CI, 0.58-0.95; P = .02). The frequencies of antenatal visits and facility births were similar between the 2 groups. However, clean delivery practices were higher among intervention clusters than control clusters (63.2% [2284 of 3616] vs 13.2% [455 of 3458]; P &lt; .001). Chlorhexidine use was also more common among intervention clusters than control clusters (55.9% [4271 of 7642] vs 0.3% [19 of 7203]; P &lt; .001).Conclusions and RelevanceThis pragmatic cluster randomized clinical trial demonstrated a reduction in NMR that occurred in the background of improved household intrapartum and newborn care practices. However, the effect of the intervention on antenatal visits, facility births, and perinatal mortality rates was inconclusive, highlighting areas requiring further research. Nevertheless, the improvement in NMR underscores the effectiveness of community-based programs in low-resource settings.Trial RegistrationClinicalTrials.gov Identifier: NCT01751945

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Trends in facility-based childbirth and barriers to care at a birth center and community hospital in rural Chiapas, Mexico: A mixed-methods study

Truong

Montaño²,

Sullivan³

et al. 2023

Midwifery

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Effects of demand-side incentives in improving the utilisation of delivery services in Oyam District in northern Uganda: a quasi-experimental study

Cited by 17 publications

References 34 publications

Community perceptions on demand-side incentives to promote institutional delivery in Oyam district, Uganda: a qualitative study

Community perceptions on demand-side incentives to promote institutional delivery in Oyam district, Uganda: a qualitative study

Effect of Maternal and Newborn Care Service Package on Perinatal and Newborn Mortality

Trends in facility-based childbirth and barriers to care at a birth center and community hospital in rural Chiapas, Mexico: A mixed-methods study

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