Presentation given at the RinGs event in Cape Town.

1. Gender Dynamics
Underlying Voucher Schemes:
Experience From Broadening Access to
Maternal Health Care in Uganda
Elizabeth Ekirapa-Kiracho, Principal Investigator
Co-Investigators- Moses Tetui, Asha George
etc ,

2. MANIFEST study
• Action research to move beyond proof of concept
to support local ownership and promote
sustainability of intervention strategies

3. Context: 3 districts in Eastern Uganda
E.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

5. 30 Community level dialogues: women, men,
transporters, adolescent mothers

6. 6 District consultations

7. Makerere &
DHMT

8. Who has what?
• Affects Women’s access to services
o FP, delivery, ANC, PNC etc
• Women still depend on men for savings
omen have money, but spend it on
drinking
• Men slow at joining savings groups for
MNH
oLeaders of savings groups -Men

9. Who does what?
• Incentives for boda boda drivers (male)
oFollowing up women to ensure they
return for follow-up facility care
oJumping the queue at health centers
and ensuring that the women they
brought get attention
• Unintended consequences

10. Who decides?
• Still mostly men & mother-in-laws
o Place of delivery, number of children, spacing etc.
• Increasing role of boda boda riders
o Easier to create a linkage with transporters when
they are part of a savings group

11. Who is valued for what?
• Women valued for having children, but not while
pregnant
o 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.

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