The Observer (Kampala)
Shifa Mwesigye
8 July 2009
A new initiative to improve the health of pregnant women and their babies has been introduced under a pilot project in Western Uganda. The approach dubbed Healthy Baby aims to increase the number of women who deliver with the help of skilled birth attendants.
In the long run hopefully, the maternal and infant mortality rates will be reduced in Uganda.
According to the Ministry of Health, only 42% of women in Uganda deliver under the watch of a skilled birth attendant. And Uganda loses 6,100 women every year to pregnancy related complications. These include haemorrhage, infections, unsafe abortion, eclampsia (high blood pressure leading to seizures) and obstructed labour.
The Output Based Aid (OBA) project funded by KFW, a German government owned development bank, together with Global Partnership on Output Based Aid, realised the need to make safe motherhood affordable when the number of women giving birth with one leg in the grave was high.
Past experiences with development aid in Uganda showed that financing inputs like facilities and equipment, does not necessarily translate into improved health. Thus as a change, the OBA concept finances agreed outputs with pre-defined quality rather than predefined inputs by selling vouchers for health services at subsidised prices to expectant mothers.
So far antenatal visits in areas where the voucher system has been introduced have shot up from 95 in February to 578 in May.
The Government of Ugandan through the Ministry of Health and Kreditanstalt fur Wiederaufbau (KfW) appointed Marie Stopes International Uganda as a management agent of a one year OBA pilot project.
Already 5.4 million dollars has been sunk into the project with government offering technical support, monitoring and supervision.
The OBA project involves collaborating with already established and qualified health providers to deliver quality services through a voucher system. It is working with 16 private health centres where 60 service providers have been trained in safe motherhood and guidelines of OBA to provide service at their best. "When they enhance quality service, at the end of the day it's the women and their babies who benefit," Richard Ssemujju the project coordinator MSI says.
Service providers are reimbursed Shs 70,000 for normal delivery and up to Shs 109,000 for complicated deliveries.
The project is being tested in the districts of Mbarara, Kiruhura, Ibanda and Isingiro with private health centres because medical care in government hospitals is already free.
Western Uganda was chosen for the pilot project because of the thriving business in heath care compared to other regions that need this intervention. OBA works best where service providers are available.
Healthy Baby voucher is targeting to deliver 110,000 babies after three years. So far 169 children have been delivered. Before in Isingiro 15% of women delivered in a hospital and 30% delivered in (a hospital) Mbarara and only 10% in Kiruhura.
The card, which costs Shs 3,000, is given to only poor mothers after they have been assessed with a poverty grading tool.
Without a voucher a mother pays Shs 60,000 to 80,000 depending on the supplies and medicine used and which clinic they go to.
"Government facilities ask the mothers to buy gloves, medicine which they cannot afford, here just buy a voucher and get everything," says Fred Twinomugisha, the clinical officer at Ddembe Clinic in Kinoni Kazo sub-county Kiruhura district.
Medical officers in some of the health centres The Observer visited say the number of women giving birth in health centres is increasing. Kathe medical centre a health facility in Isingiro used to deliver barely five mothers a month but in May it delivered 18.
Rosemary Tukundana, 30, from Rwemondo in Ibanda is delivering for the first time in a health centre at Angella Domiciliary Clinic in Kashari Ibanda district using the OBA voucher card. This is Tukundana's fifth child.
Tukundana learnt of the Health Baby voucher when Bwebare was doing home visits.
Mothers can also purchase vouchers from pharmacies, clinics, drug shops, community organisations, women's groups, health committees, village health teams and religious institutions.
Bwebare however, says when she is doing home visits there are mothers who suggest that the card should be given to them free because they cannot afford the Shs, 3000. Other mothers buy, but live so far that they cannot make it to the clinic at the time of delivery. Bwebare sells about 20 cards every month fetching a profit of Shs 30,000.
Angela Ndahweje, the midwife at this health facility says since February 28 she has attended to 231 mothers.
With the card, mothers access assessment for risky conditions, the common complaints like Urinary Tract Infections, syphilis, and malaria.
And yet the biggest setback comes back to the Healthy Baby card. The card is called k'akadi k'omwaana wa'magara amarungi (healthy baby voucher) yet it doesn't provide for treatment of children born with diseases such as sepsis, asphyxia.
"The woman comes back with the baby and a voucher but it doesn't cater for children with complications yet it is called health baby voucher. They don't understand that postnatal stops six weeks from delivery."
Once the baby is delivered it is the concern of her parents who are still poor.
But Ssemujju says with time the programme will cater for babies too.
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