When the Uganda Reproductive Health Voucher Project (URHVP) was introduced in 2014, the objective was to increase access to skilled care among poor women living in rural and disadvantaged areas during pregnancy and delivery. As the five-year $17m project nears completion, ZURAH NAKABUGO assesses the impact of URHVP on pregnant rural women.
Jennifer Nyaketcho, 32, of Namungalo village, Iganga district cannot forget how the URHVP saved her life a year ago at New Hope hospital in Iganga.
The mother of 10 was introduced to the voucher project at her ninth pregnancy after developing complications and wasn’t able to foot the hospital bills. Her husband died when she was three months pregnant and in the aftermath, she started getting pregnancy complications.
When she went to Namungalo hospital in Iganga, doctors advised her to go for a scan for proper assessment of the pregnancy since she was carrying twins.
“I didn’t have any money on me but the nurse at the hospital advised me to look for Shs 4,000 and register for the health voucher. I was told it was a requirement in order to get free medical services, including the scan,” Nyaketcho says.
She says the nurse connected her to the Village Health Team (VHT) that gave her the health voucher card that she used at Namungalo hospital to get scan services and antenatal visits.
“However, during antenatal visits, the nurses advised me that I won’t be able to deliver normally…they referred me to New Hope hospital in Iganga where I delivered my twins through caesarean Section,” Nyaketcho says.
“I cannot believe I delivered my twins after spending only Shs 4,000. The nurses and doctors gave me good care during the four days I was admitted.”
Nyaketcho is just one of a projected 156,400 pregnant women to benefit from URVHP’s services by gaining access to safe delivery services from contracted private and public providers, which are expected to provide the specific services and submit claims along with the appropriate voucher coupons to a Voucher Management Agency (VMA) for settlement on the basis of the negotiated fees.
Meanwhile, Oliver Nabirye, 16, is also among many teenage girls who have benefited from the health voucher project after enduring complications during pregnancy. According to Nabirye, when she got pregnant in primary seven, her parents chased her from home and she went to her sister’s place, who also gave her marching orders after she started getting pregnancy complications.
When her sickness worsened, she went to Kamuli general hospital where doctors diagnosed her with anemia and, therefore, she needed blood.
“I didn’t have any penny yet my parents and sister had chased me away. My friends collected Shs 4,000 and got me a health voucher which I used during my pregnancy,” she says.
After getting the voucher, Kamuli General hospital referred Nabirye to Kamuli Mission hospital where she got the much-needed blood transfusion.
“I was operated on during childbirth since I had hypertension but I’m glad I delivered safely without paying anything since I had the voucher,” she says.
Hellen Aguti and Martha Nanyonjo, both 16-year-olds, also got pregnant while in primary seven but managed to do exams and passed. They are now in senior one.
“I learnt of the health voucher project through the VHT that was sensitizing people in the village. It helped me to get free antenatal care and deliver my child in hospital, with good care at free cost,” she says.
NEED FOR EXTENSION
Looking at the success of URVHP, members of parliament have called for the extension of its services. Robina Ssekitoleko, the Kyotera Woman MP, says the World Bank and the ministry of Health that fund the health voucher project should extend the project countrywide since almost all mothers are poor and it is one way of preventing maternal deaths.
“When this project extends countrywide for all women to benefit, there will be a decrease in maternal deaths,” she says.
Meanwhile, Mary Mugenyi, the Butaleja Woman MP, expresses worry at the high rate of teenage pregnancies.
“Butaleja district has the youngest grandmother in the world. We support the voucher project and we request the World Bank to organise sessions in schools to sensitise young girls about the dangers of teenage pregnancy,” she says.
Dr John Sengendo, the URHVP coordinator, notes that the health voucher project was at first sabotaged by people in eastern Uganda who were calling it a project aiming at kidnapping their newborn children.
“We had a lot of difficulties when we had just started the voucher project since most people in eastern region were associating it to Illuminati, claiming that the project coordinators want to kidnap the newborn babies,” he says.
“We had to use District Health Officers (DHOs) and District Education Officers (DEOs) to sensitize the public about the benefits of health vouchers.”
Dr Charles Olaro, an official from the ministry of Health, says neonatal deaths are still high but there is a slight improvement in child maternal deaths.
“The voucher project is gaining more demand and it has assisted us to reduce maternal deaths,” he says.
URHVP is funded by World Bank, SIDA and UNFPA and is projected to end in December this year, if the contract is not renewed by funders.
URVHP’s second component has the goal of supporting project management functions and building national capacity to mainstream and scale up implementation of the safe delivery voucher scheme in the health sector.
In that regard, Dr Carole Sekimpi, the country director, Marie Stopes Uganda, says the project aims at increasing access to skilled health care among poor women living in rural areas during pregnancy and delivery.
“The project targets to reach women in 25 districts in the east and southwestern Uganda,” she says.
Dr Asuman Basembeza, the officer in charge of Kityerera health centre III in Mayuge district, says the project has helped women in the hard-to-reach areas by reducing on maternal deaths after providing safe delivery services.
“It has improved customer care relationship between the patients and the doctors and the quality of service. In our district, safe deliveries have increased from 65 to 120 per month, since the project started in 2016,” he said.