Article Text
Abstract
Objective To 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.
Design A qualitative study.
Setting Oyam district, Uganda.
Participants We 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.
Results Five 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.
Conclusions The 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.
- baby kits
- incentives
- transport vouchers
- maternal health
- Maternal medicine
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Footnotes
Correction notice This article has been corrected since it was published. The article title has been updated.
Contributors WM conceived and designed the study, contributed to the data collection, participated in the data analysis, drafted the manuscript and participated in the interpretation of the findings and revision of the manuscript. CW drafted the abstract, reviewed the Methods section, contributed to the data analysis, interpretation of the findings and revision of the manuscript. EDV, MN, JBO and SA contributed to the data collection, interpretation of findings and revision of the manuscript. CA participated in the editing of the manuscript and interpretation of findings. PL and GP contributed to the interpretation of the findings and revision of the manuscript. All authors read and approved the final version of the manuscript.
Funding This study was funded by Doctors with Africa CUAMM, Italy.
Disclaimer The views expressed in this document are solely the responsibility of the authors and do not necessarily represent the views of Doctors with Africa CUAMM.
Competing interests CW, MN, CA, JBO and SA have no competing interests to declare. At the time of this study, WM, EDV, PL and GP were employees of Doctors with Africa CUAMM.
Patient consent for publication Not required.
Ethics approval This study was approved by Lacor Hospital Research and Ethical Review Committee and registered by the Uganda National Council for Science and Technology (UNCST filed Ref #: SS 4252). The study was also approved by the local authorities in Oyam district.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request.