This document summarizes key findings from a study on gender dynamics and their impact on access to maternal health care in Uganda. The study utilized community dialogues and district consultations to understand: who has resources for maternal needs; who performs roles in care; who makes decisions; and who is valued and why. Key findings include that women still depend on men for financial support, men are slow to join savings groups for maternal needs, and decisions around delivery and family planning are often made by men and mothers-in-law. Transportation incentives for male boda boda drivers helped women access follow-up care. Overall, the study explored how gender norms influence utilization of maternal health services in the Ugandan context.

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