Power of the Maternal Health Voucher
USAID helps poor pregnant women in Uganda have quality maternal care and deliveries
In the village of Okalis in Soroti district in Eastern Uganda, 20-year-old Lucy Akello looks at her baby and smiles. This is her first child, and when the baby smiles back she cannot hide her joy.
“I am glad I can smile and have my child in my arms. I did not think it was possible. The nine months that led to the birth of my baby were tough,” Lucy recounts. “We had not planned to have a child yet. We were struggling financially, we had nothing. Going to hospital to have our baby would have been impossible without the voucher.”
In Uganda, maternal health indicators have seen substantial improvements in recent decades, however inequities still exist. The maternal death rate remains high and the number of newborn deaths has not changed for the last 15 years. Access to government-owned health facilities is often difficult with the majority of people living as far as eight to 10 kilometers away, yet private health care facilities are often too expensive for poor women and children to access.
Recognizing the challenge, the USAID/Uganda Voucher Plus Activity is helping poor women in rural Uganda access quality maternal health services while assisting private health actors to provide options for sustainable health financing.
“My local church announced that there were village community-based distributors searching for poor pregnant women,” says Lucy. “I asked for more information and soon got the opportunity to interact with the voucher distributor.”
Community volunteers, including village health teams, sell vouchers to eligible women for as little as 4,000 Ugandan shillings, or around $1. The vouchers enable the women to have access to safe maternal care and deliveries.
USAID identifies private health service providers who can deliver a package of services including four antenatal care visits; HIV transmission prevention services; delivery with a skilled birth attendant; postnatal care; newborn care; and postpartum family planning. The providers are reimbursed after quality services provided to the mother and baby are verified using the voucher the mother presents.
“To raise enough money to buy the voucher, I cleared an elderly woman’s garden and helped her plant maize,” Lucy explains. “When I got the voucher, I was very happy, but I had little faith. I wondered if it is possible to get everything I was told, at just 4,000 shillings.”
A maternity package, like the one offered to Lucy, would normally cost over 200,000 shillings — about $54.
Rose Nekesa owns the Kyaterekera Domiciliary Clinic that accepts the vouchers, which helped her dramatically expand the number of patients she sees and made her facility become more financially secure.
“When the Voucher Plus project approached me about their need to invest in the facility to help pregnant women, I was delighted,” she said. “The first time I got money from vouchers it was 1,000,000 shillings. I could not believe it. I had never touched this kind of money.”
Through the voucher reimbursements, Rose has been able to renovate her facility, purchase equipment and enroll three midwives. “Voucher Plus has made me experience my dream. I now conduct in a day the number of deliveries I used to conduct in a month. This project has greatly reduced maternal deaths.”
Dr. Jonathan Wangisi, the Mbale district health officer, explains that making private health care suppliers accessible to a broader population has helped his district improve health coverage for people living within 5 kilometer radius of a health facility to about 80 percent.
As of June 2019, three years after the program started, 311,078 vouchers were sold to eligible women and 159,603 deliveries with skilled health providers have been recorded. This amounts to 24 percent of all facility-based deliveries in the districts where the project is implemented.
Through the program, USAID is partnering with private health facility providers to expand access to quality maternal and newborn health services in Uganda, while allowing more women like Lucy the joy of smiling at their healthy babies.
About the Author
Betty Kagoro is a communications specialist at USAID’s mission in Uganda.
