Gender Dynamics Underlying Voucher Schemes:

Experience From Broadening Access to Maternal Health Care in Uganda

Elizabeth Ekirapa-Kiracho, Principal InvestigatorCo-Investigators- Moses Tetui, Asha George

etc ,

MANIFEST study• Action research to move beyond proof of concept

to support local ownership and promote sustainability of intervention strategies

Context: 3 districts in Eastern UgandaE.g. Kamuli district

•600,000 population•56 Health facilities

– 2 private hospitals, 2 HC IV (EmOC), 13HC III (with labs) 39 HC II (outpatient)

•50 % of health worker vacancies

30 Community level dialogues: women, men, transporters, adolescent mothers

6 District consultations

Makerere & DHMT

Who has what?• Affects Women’s access to services

o FP, delivery, ANC, PNC etc

• Women still depend on men for savingsomen have money, but spend it on

drinking• Men slow at joining savings groups for

MNHoLeaders of savings groups -Men

Who does what?

• Incentives for boda boda drivers (male)oFollowing up women to ensure they

return for follow-up facility careoJumping the queue at health centers

and ensuring that the women they brought get attention

• Unintended consequences

Who decides?

• Still mostly men & mother-in-lawso Place of delivery, number of children, spacing etc.

• Increasing role of boda boda riderso Easier to create a linkage with transporters when

they are part of a savings group

Who is valued for what?

• Women valued for having children, but not while pregnanto Husbands slow at accepting the use of contraception

o While some do not want to identify with pregnant women or be seen with them

• Women always pressured to prove fertility.o Men can get away with being infertile.

Acknowledgements

• Makerere University School of Public Health• DFID• Comic Relief • The conference organizers • SHAPES thematic group leadership