For mothers-to-be in remote vil­lages of Uganda bring­ing a baby to the world can be very dif­fi­cult. Walks can be long to any hos­pi­tal, so the thought of receiv­ing any pre­na­tal care is out of the ques­tion, let alone going to the hos­pi­tal for the deliv­ery itself. Besides, who could afford any of the care or sup­plies the hos­pi­tal would charge you?

An arti­cle in All Africa today exam­ines a new voucher pro­gram that gives full preg­nancy care at a reduced cost. The funds for the voucher pro­gram are put up by the World Bank and the Ger­man Devel­op­ment Bank. How­ever, the draw­back to the card pro­gram is not every­one can afford it, even with the reduced cost.

New Vision writer Irene Nabu­soba exam­ines the voucher program.

EVERY preg­nant woman has one foot in the grave,” goes an African adage. This may sound crude today but it is the real­ity for many rural poverty-stricken women like Con­so­lata Kebikali, 38. She has sur­vived death nine times dur­ing child­birth, but has traded her luck for four of the babies she was try­ing to give life.

With a small plot just enough for their two-roomed house in Kibale vil­lage, Ndei­jja sub-county in Mbarara dis­trict, Kebikali had never known the inside of a health facil­ity or a gloved hand of a mid­wife dur­ing childbirth.

Her labour suite had always been the banana plan­ta­tion, under the instruc­tion of an elderly neigh­bour and at some extremes by her­self. What with the near­est gov­ern­ment health facil­ity — Itojo Hos­pi­tal, 25 miles away?

Besides, she could not afford sh35,000 — sh50,000 charged by Kathe Med­ical Care Clinic located on Kabale Road (17 miles from her home). Thus from con­cep­tion, through preg­nancy to child­birth, every­thing is ‘up to God to see her through’.

But thanks to the health baby vouch­ers under the Out-put Based Aid (OBA) project, Kebikali’s last-born baby, now aged two months, was born in hos­pi­tal, guar­an­tee­ing it a safe arrival.

She says: “I went to Kathe Clinic ear­lier than nec­es­sary because of false labour. I was referred to Mbarara Hos­pi­tal where I was told my baby was okay after a scan. All expenses were paid cour­tesy of the card.”

What is ‘the card’?

The Ger­man Devel­op­ment Bank (KfW) and the Global Part­ner­ship on Out­put Based Aid (GPOBA), a World Bank-managed trust fund, are jointly financ­ing a three-year Repro­duc­tive Health Voucher project for the man­age­ment of sex­u­ally trans­mit­ted infec­tions (STIs) and pro­vi­sion of safe deliv­ery ser­vices in Mbarara, Kiruhura, Isin­giro and Ibanda districts.

Under the project man­aged by Marie Stopes Inter­na­tional, a UK-based health and social mar­ket­ing organ­i­sa­tion that advo­cates for qual­ity repro­duc­tive health care, patients buy a card at sh3,000 to access STI screen­ing and treat­ment (health life vouch­ers) or med­ical care dur­ing preg­nancy and deliv­ery (health baby vouch­ers), at accred­ited health facilities.

“The card enti­tles a mother to four ante­na­tal vis­its, malaria screen­ing and pro­phy­laxis, STI and HIV screen­ing, deliv­ery (nor­mal and C-section), trans­porta­tion for refer­ral in case of emer­gency and post-natal care within six weeks after deliv­ery,” says Richard Semu­jju, the project coordinator.

He says only 15% of moth­ers in Isin­giro give birth at health units, about 20% in Kiruhura, 30% in Mbarara, while Ibanda hardly has any sta­tis­tics on skilled deliv­er­ies. Nation­ally, 42% of moth­ers deliver in health units under skilled care.

Angela Mbah­we­jje, a mid­wife and pro­pri­etor of Angela Domi­cil­iary Clinic in Kashari sub-county, who has par­tic­i­pated in the project since its incep­tion in 2006 with the STI vouch­ers, says: “So far, we have attended to 231 mothers.

We have had 43 deliv­er­ies, three emer­gency deliv­er­ies which were refer­rals to Mbarara Hos­pi­tal and three moth­ers return­ing for post-natal care.”