Making Health Systems Work for the Poor A DfID funded research programme Collaborating institutions: Uganda - Makerere University Institute of Public Health Nigeria - University of Ibadan Bangladesh - ICDDRB China - Chinese Health Economics Institute India - Indian Institute of Health Management Research Johns Hopkins University, Baltimore, MD, USA Institute of Development Studies, Sussex, UK

Making Health Systems Work for the Poor Increasing Access to Institutional Deliveries Using Demand and Supply Side Incentives [Uganda]

Aim To contribute in reducing maternal mortality (MDG 5) in Uganda and the regional countries by increasing institutional delivery through an innovative demand and supply side intervention Promote the implementation of evidence based strategies

To contribute in reducing maternal mortality (MDG 5) in Uganda and the regional countries by increasing institutional delivery through an innovative demand and supply side intervention

Promote the implementation of evidence based strategies

[Uganda]

Objectives Identify the demand side factors that influence delivery at health facilities Assess the effectiveness of a voucher system for services and transport in increasing deliveries at public, PNFP and PFP health facilities Assess the effectiveness of a voucher system in increasing deliveries among the poor at public, PNFP and PFP health facilities [Uganda]

Identify the demand side factors that influence delivery at health facilities

Assess the effectiveness of a voucher system for services and transport in increasing deliveries at public, PNFP and PFP health facilities

Assess the effectiveness of a voucher system in increasing deliveries among the poor at public, PNFP and PFP health facilities

Objectives Identify the appropriate pathways through which vouchers influence delivery care services at public, PNFP and PFP health facilities Estimate the incremental cost of implementing a voucher system for increasing deliveries at health facilities [Uganda]

Identify the appropriate pathways through which vouchers influence delivery care services at public, PNFP and PFP health facilities

Estimate the incremental cost of implementing a voucher system for increasing deliveries at health facilities

Methodology Design: Cluster randomized trial Study site: 4 sub-districts (2 intervention and 2 control) will be randomly selected from 2 randomly selected districts in eastern Uganda Intervention: Voucher for transport and maternity services

Design: Cluster randomized trial

Study site: 4 sub-districts (2 intervention and 2 control) will be randomly selected from 2 randomly selected districts in eastern Uganda

Intervention: Voucher for transport and maternity services

Methodology Primary outcome: % change in the proportion of women delivering in the intervention and control areas Secondary Outcomes: Birth Outcome Attendance of ANC Attendance of PNC Analytical method: Difference in differences analysis

Primary outcome: % change in the proportion of women delivering in the intervention and control areas

Secondary Outcomes:

Birth Outcome

Attendance of ANC

Attendance of PNC

Analytical method: Difference in differences analysis

[Uganda]

Innovations in the project Transport scheme that uses locally available transport Performance based method of payment Inclusion of public and private facilities [Uganda]

Transport scheme that uses locally available transport

Performance based method of payment

Inclusion of public and private facilities

Actors Makerere University School of Public Health Ministry of Health District health system Donors Health consumer organizations Consumers United Nations agencies Bilateral agencies Politicians Other academic institutions [Uganda]

Makerere University School of Public Health

Ministry of Health

District health system

Donors

Health consumer organizations

Consumers

United Nations agencies

Bilateral agencies

Politicians

Other academic institutions

[Uganda]