Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study

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Background: Rural populations in Uganda have limited access to formal financial Institutions, but a growing majority belong to saving groups. These saving groups could have the potential to improve household income and access to health services. Objective: To understand organizational characteristics, benefits and challenges, of savings groups in rural Uganda. Methods: This was a cross-sectional descriptive study that employed both quantitative and qualitative data collection techniques. Data on the characteristics of community-based savings groups (CBSGs) were collected from 247 CBSG leaders in the districts of Kamuli, Kibukuand Pallisa using self-administered open-ended questionnaires. To triangulate the findings, we conducted in-depth interviews with seven CBSG leaders. Descriptive quantitative and content analysis for qualitative data was undertaken respectively. Results: Almost a quarter of the savings groups had 5–14 members and slightly more than half of the saving groups had 15–30 members. Ninety-three percent of the CBSGs indicated electing their management committees democratically to select the group leaders and held meetings at least once a week. Eighty-nine percent of the CBSGs had used metallic boxes to keep their money, while 10% of the CBSGs kept their money using mobile money and banks,respectively. The main reasons for the formation of CBSGs were to increase household income, developing the community and saving for emergencies. The most common challenges associated with CBSG management included high illiteracy (35%) among the leaders,irregular attendance of meetings (22%), and lack of training on management and leadership(19%). The qualitative findings agreed with the quantitative findings and served to triangulate the main results. Conclusions: Saving groups in Uganda have the basic required structures; however, challenges exist in relation to training and management of the groups and their assets. The government and development partners should work together to provide technical support to the groups.

Section: Paper Contextmentioning

confidence: 99%

Characteristics of community savings groups in rural Eastern Uganda: opportunities for improving access to maternal health services

Mutebi

Kananura

Ekirapa-Kiracho

et al. 2017

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“…This was partly due to weaknesses in the health system, limited health financing and inadequacy of resources to cater for its growing population. Utilization of maternal health services is constrained by demand-side factors, such as: inadequate birth preparedness, lack of affordable transport to facilities, financial inaccessibility to cover care costs, preference for alternative traditional providers for prenatal or delivery care services, and negative attitudes towards health facilities [1–3]. Supply-side factors such as inadequate health staffing levels, hostile attitudes of health workers towards clients and suboptimal availability of medicines and equipment further compromise the quality and utilization of health services in Uganda [4,5].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Both SDS and UNEST had positive effects on increasing access to care and improvement in the care practices and survival of newborns, respectively [1,2]. The SDS used service and transport vouchers in Kamuli and Pallisa districts to increase access to quality maternal health services using a quasi-experimental study design [1]. While UNEST used community health workers (CHWs), also known as village health teams (VHTs), to encourage households to prepare for birth using birth plans and to promote newborn survival for low birthweight babies using the kangaroo mother care strategy, in addition, it strengthened the quality of services by providing refresher training, support supervision and purchasing equipment and supplies to complement what existed at the facility [2].…”

Section: Introductionmentioning

confidence: 99%

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Maternal and neonatal implementation for equitable systems. A study design paper

Ekirapa-Kiracho

Tetui

Bua

et al. 2017

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Background: Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability. Objectives: The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach. Methods: The study consisted of a quasi-experimental design, with a participatory action research approach to implementation in three rural districts (Pallisa, Kibuku and Kamuli) in Eastern Uganda. The intervention had two main components; namely, community empowerment for comprehensive birth preparedness, and health provider and management capacity-building. We collected data using both quantitative and qualitative methods using household and facility-level structured surveys, record reviews, key informant interviews and focus group discussions. We purposively selected the participants for the qualitative data collection, while for the surveys we interviewed all eligible participants in the sampled households and health facilities. Descriptive statistics were used to describe the data, while the difference in difference analysis was used to measure the effect of the intervention. Qualitative data were analysed using thematic analysis. Conclusions: This study was implemented to generate evidence on how to increase access to quality maternal and newborn health services in a sustainable manner using a multisectoral participatory approach.

“…[5,6] The PAR approach, as noted above, offers opportunities of making health systems more responsive by building local capacity. [7] Participation of all relevant stakeholders in making a contribution towards improving health outcomes is increasingly advocated for, especially among vulnerable populations.…”

Section: Introductionmentioning

confidence: 99%

Experiences of using a participatory action research approach to strengthen district local capacity in Eastern Uganda

Tetui

Coe

Hurtig

et al. 2017

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Background: To achieve a sustained improvement in health outcomes, the way health interventions are designed and implemented is critical. A participatory action research approach is applauded for building local capacity such as health management. Thereby increasing the chances of sustaining health interventions. Objective: This study explored stakeholder experiences of using PAR to implement an intervention meant to strengthen the local district capacity. Methods: This was a qualitative study featuring 18 informant interviews and a focus group discussion. Respondents included politicians, administrators, health managers and external researchers in three rural districts of eastern Uganda where PAR was used. Qualitative content analysis was used to explore stakeholders’ experiences. Results: ‘Being awakened’ emerged as an overarching category capturing stakeholder experiences of using PAR. This was described in four interrelated and sequential categories, which included: stakeholder involvement, being invigorated, the risk of wide stakeholder engagement and balancing the risk of wide stakeholder engagement. In terms of involvement, the stakeholders felt engaged, a sense of ownership, felt valued and responsible during the implementation of the project. Being invigorated meant being awakened, inspired and supported. On the other hand, risks such as conflict, stress and uncertainty were reported, and finally these risks were balanced through tolerance, risk-awareness and collaboration. Conclusions: The PAR approach was desirable because it created opportunities for building local capacity and enhancing continuity of interventions. Stakeholders were awakened by the approach, as it made them more responsive to systems challenges and possible local solutions. Nonetheless, the use of PAR should be considered in full knowledge of the undesirable and complex experiences, such as uncertainty, conflict and stress. This will enable adequate preparation and management of stakeholder expectations to maximize the benefits of the approach.