- A UShs4,000 (US$1) voucher covers antenatal visits, delivery, and post-natal care
- Vouchers are intended for poorer women in two mostly rural regions of Uganda
- Even the cost of assisted births, such as Caesareans, are covered
KANUNGU, May 30, 2017 – Anna Katushabe’s daughter came into the world in early May by Caesarean-section delivery, and so both mother and daughter spent longer than expected in Rugyeyo Community Hospital. Ordinarily, the longer stay would have been a worry for the young mother; for Anna, however, her C-section delivery cost only UShs 4,000, just over US$1.
The secret to keeping safe childbirth cheap lies in an innovative voucher programme that gives pregnant women affordable, effective medical attention. When she was four months pregnant, Anna bought a reproductive health care voucher for UShs 4,000. This gave her access to a health facility throughout her pregnancy, and she knew it would cover the delivery and medical care for six weeks after her baby’s birth as well.
Rugyeyo hospital is in Kanungu District, 260 miles (420km) from Kampala on Uganda’s border with the Democratic Republic of the Congo. A normal (vaginal) birth usually costs UShs 46,000 (US$13) at the hospital, while Caesarean births cost UShs 316,000 (US$88).
Uganda was the first country in Eastern Africa to use these health vouchers, starting with a pilot programme in 2006.
Funded by KfW, the German Development Bank, the pilot project, Healthy Life, subsidised the cost of treating sexually transmitted infections. The scheme expanded in 2008, when KfW and the World Bank’s Global Partnership on Output-Based Aid gave it US$6.2 million to subsidize safe deliveries as well.
The program in south-western Uganda was very successful, helping with nearly 66,000 deliveries, 130% of its initial target. Uganda’s Ministry of Health then expanded it to other districts through its Reproductive Health Voucher Project, which was funded with US$13.3 million from the Swedish International Development Agency (SIDA) through the Global Partnership on Output Based Aid (GPOBA).
Giving birth in remoter rural areas
More than 200,000 vouchers have since been sold in 25 districts in south-western Uganda and central-eastern Uganda. Marie Stopes Uganda manages the distribution of vouchers, and a poverty-grading tool is designed to help the program reach the most vulnerable women.
The project’s objective is to increase the amount of access poorer women living in disadvantaged rural areas have to skilled medical care. It covers the cost of:
- four antenatal visits,
- a safe delivery under skilled supervision,
- one postnatal visit,
- the treatment and management of some pregnancy-related medical conditions and complications, including Caesarean-sections
- and emergency transport.
“This program started at our facility in May 2016,” Dr. Hadus Masereka, the medical superintendent at the hospital. “About 40 out of the 50 pregnant women who have ended-up delivering by C-section since, have had vouchers.” This saved the lives of women who would have been unable to afford this expensive, often emergency, procedure. Many Ugandan women deliver their babies in sometimes less-than-ideal conditions at home.
Such new health initiatives are helping reverse Uganda’s high rates of infant and maternal mortality, with maternal mortality falling from 438 to 336 deaths for 100,000 live births between 2011 and 2016, according to the Uganda Bureau of Statistics. Infant mortality has also fallen from 432 deaths to 54 per 1000 live births.
The voucher system shows that with a little money and innovation, the process of giving life does not have to be a matter of life and death for Ugandan mothers like Anna. By the end of March 2017, the project had provided help for more than 43,000 births, including 31,000 normal deliveries, 6,500 assisted deliveries, and 5,600 C-sections.
In some areas, the system has also reduced the burden public health care facilities face when it comes to childbirth care, because vouchers have made private, for-profit health centres accessible to women.
The Uganda Reproductive Health Voucher Project increases skilled medical care during pregnancy and delivery for poor women living in rural and disadvantaged areas.
By Rose Mahoro
Sexual Reproductive Health (SRH) is an essential component of the universal right to the highest attainable standard of physical and mental health, enshrined in the Universal Declaration of Human Rights and in other international human rights conventions, declarations, and consensus agreements.
Globally, most people become sexually active before their 20th birthday and according to the data from the Demographics and Health Survey, the median age of young people in Uganda having their first sexual experience is 16.4 years thus an alarming increase in teenage pregnancies and unsafe abortions. According to the data collected from Naguru Teenage Information Health Center, 64% of the clinical problems at the facility were related to STIs management. No wonder, early this year (2017), Uganda Aids Commission released a disquieting report saying 500 girls get HIV infection every week in Uganda.
This plague should be caused by scant knowledge about contraceptives and HIV and AIDS, increasing immorality among young people since social and cultural norms have largely prohibited teachers, parents and children from discussing sex, mistrust between the youth and the service providers which impairs access to youth friendly services.
The ministry of Gender, Labour and Social Development (MGLSD) tabled a shocking motion to ban comprehensive sexual education in schools which was a blow to activists who have been advocating for a more holistic sex education and a more open dialogue about sexual reproductive health that covers the psychological and emotional aspects of adolescents and helping them make more informed decisions.
Although this is happening, we shouldn’t forget Uganda’s successful response to HIV/AIDS and for this reason, it was held as a model for other countries. The government of Uganda also registered a tremendous achievement for young people in the field of SRHR by adopting policies that created an environment supportive of adolescent sexual and reproductive health. International and national organizations such as RHU, UHMG, Reach a Hand and Marie Stopes Uganda have come up with programs and interventions aimed at behavior change, advocacy and service delivery for adolescents.
Among the interventions, Marie Stopes Uganda launched SRH Ambassadors program for young people ages 18-25 years where they are trained on Sexual Reproductive Health and leadership roles to help them reach their fellow young people in and out of school who may be in need of SRH knowledge and information, refer them to appropriate facilities and empower them to make informed decisions.
In Addition, Marie Stopes Uganda runs a toll free line 0800220333. This helpline is adequately equipped to provide free and friendly counseling, information giving and referrals on SRH related matters to both female and male adolescents in a confidential manner.
Therefore, gender and human rights should be placed at the heart of sex education, service providers should be trained in providing youth friendly services, NGOs through the government should come up with interventions to increase access of free youth friendly services, stake holders, parents and children should as well work hand in hand to have a better Sexual Reproductive Health.
Ever sat down on the toilet and felt a searing, burning pain when you tried to urinate? It may also have felt like you couldn’t properly empty your bladder – hardly surprising when it feels like you’re pushing razor blades out of your urethra!
What you experienced was a urinary tract infection (UTI), and some experts say that as many as 50% of women will experience at least one UTI in her lifetime.
What is a UTI, what causes it and what are the symptoms?
A urinary tract infection is an infection in any part of the urinary system, or the urethra, bladder or kidneys. It’s usually caused by bacteria (like e-coli) from the large intestine travelling from the anus to the urethra. This is the primary reason women are taught to wipe from front to back, which limits the risk of contamination.
Once a UTI sets in, it can travel to the bladder and even the kidneys if left untreated, and it can cause serious damage if ignored.
The symptoms of a UTI include:
- A burning sensation when you urinate
- Increased urge to urinate, even though very little urine comes out when you go
- Dark, cloudy or strange-smelling urine
- Blood in the urine
- Nausea, vomiting and/or dizziness
- Pain or pressure in your back or lower abdomen
- Feeling tired or shaky
- Feeling fevery (which is a sign that the infection may have spread to your kidneys)
9 Ways to help prevent a UTI
Whether you’ve had one, none or countless UTIs, there are several things you can do to help reduce your chances of contracting an infection – even if you’re in a high-risk category (like if you’re diabetic or menopausal, for example).
You should always:
- Drink enough fluids to help flush out your bladder regularly (most UTIs are caused by bacteria that’s already in the bladder but allowed to multiply to unhealthy levels. Regular urination helps prevent this build-up).
- Always empty your bladder after sex, as sexual activity can cause harmful bacteria to travel into your urethra.
- Never hold it in if you need to urinate.
- Wipe from front to back after you’ve urinated.
- Avoid feminine hygiene products as these kill both good and bad bacteria. The good bacteria helps fight the germs that cause UTIs.
- If you’re prone to UTIs, avoid bathing – stick to showers instead.
- Wear cotton underwear.
- Include probiotics in your diet.
- Always change out of wet or sweaty underwear right away, like after swimming or exercising.
Visit Marie Stopes for your next women’s wellness check-up
Whether you suspect you may have a UTI or you simply want to make sure you’re in the best possible health, pop into your nearest Marie Stopes centre for your annual women’s wellness check up. And, if you have any of the symptoms listed above, get to your doctor, gynae or clinic right away.
Find your nearest Marie Stopes centre or call our toll free hotline 0800220333 now.
“I feel so happy that I was able to deliver my baby safely. I received good care and attention from the health workers here; my baby and I were in good hands,” says Alice Nalubwama from her bed in the maternity ward at Kamuli Mission Hospital in Eastern Uganda. “When I was referred here from the clinic I was worried because I felt my baby was in danger. But the doctors here helped me and I delivered safely.” The 24 year old delivered her fourth child by caesarean section. With her new born in her arms and her mother by her side, she smiles broadly as a midwife conducts a ward round checking on Nalubwama and other new mothers.
What may sound like a routine and ordinary event is often not the case for women like Nalubwama in many parts of Uganda. Even though the recently released Uganda Demographic and Health Survey (UDHS) shows that about 7 out of 10 women now deliver with the help of a skilled professional, there are still pockets of inequality especially in rural areas. There, having a baby is not always an easy journey and for many women the costs involved are a prohibitive factor; many end up delivering at home or with unqualified birth attendants who cannot handle complicated deliveries.
With her first three children, Nalubwama says she and her husband, who are peasant farmers, had to use up all their savings so that she could attend ante-natal care and deliver at a private clinic near her home.
As a way to address the challenges faced by women like Nalubwama, a new initiative, the Maternal Health Voucher Scheme was introduced. The Scheme is one component of the Reproductive Maternal Newborn and Child Health Country Engagement plan, implemented by UNFPA, WHO and UNICEF. One of the objectives is to ensure availability and utilization of high impact maternal health interventions at birth and during the postnatal period. The beneficiaries include women and men in 30 districts where maternal mortality is still high and access to good quality services for women during pregnancy and delivery is still a challenge.
In eight districts in Eastern Uganda, UNFPA supports partner Marie Stopes Uganda to implement the Maternal Health Voucher scheme. Rolled out in June 2016, the initiative is implemented in 100 public and private health facilities that are accredited by Marie Stopes to provide maternal health services. The scheme works through a network of 200 trained volunteer health workers (Village Health Teams) who are a critical link to the health system. The VHTS identify needy prospective mothers and sell them vouchers at 4,000 shillings. (About $1). They also provide information to pregnant women on the importance of attending at least four ante natal care visits and delivering at a health facility.
The voucher card allows the mother to access services throughout pregnancy and delivery, with just one single payment. Once a mother buys the voucher she is entitled to four ante-natal care visits, delivery under the care of a skilled health professional and post-natal care. For women who develop complications, an ambulance is available to ensure there are no delays in getting them to a higher level facility where they can receive more specialised care.
This is exactly what happened in Nalubwama’s case. At the Health Centre III where she was originally meant to have her baby, the health workers were concerned that her labour was not progressing well. “The midwife said that my contractions were weak and that I may not be able to push the baby out. I was so worried; I did not know what would happen next,” Nalubwama recalls.
Realising that she might need a caesarean section the health workers quickly referred her by ambulance to the bigger and better equipped Kamuli Mission Hospital where the caesarean section was performed. Ordinarily the operation would have cost about 500,000 shillings, not counting the cost of transport to the hospital. Nalubwama and her family paid nothing.
For Dr Andrew Muleledhu, the Medical Superintendent of Kamuli Mission Hospital, the fact that Nalubwama and others like her are able to access such services is testament to the power of the Voucher Scheme. “At the heart of it the voucher system is addressing poverty. That voucher is money in the hands of the mother. It is preventing this mother and her family from going into financial catastrophe simply because they are having a baby. That is universal health coverage at its best,” he says.
Sister Jane Nelima a midwife at Mayuge Health Centre III one of the facilities where the Voucher Scheme operates could not agree more. She explains that as a midwife she is happy that with the Voucher Scheme she is able to see more mothers coming to the ante natal care clinic and coming back to deliver at the facility.
To date, 1,939 women in the eight districts where the Voucher Scheme is implemented have been supported to deliver at a health facility, attended to by trained and skilled health workers. A total of 14,999 vouchers have been sold, meaning that many more mothers will be receiving critical maternal health care in months to come.
As for Nalubwama, the only thing that could top her experience of having a safe delivery was the thought of getting back home to her husband and other children and introducing the new addition to the family.
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The topic of pap smears, HPV and cervical cancer is relevant to any woman who is 21 or older, so if that’s you – or your partner, friends, siblings or the women in your community – listen up and help spread the word.
Cervical cancer is one of the most common and deadliest forms of the disease, but unlike other types of cancer, it can be detected early and treated –and in some cases, even prevented before it happens. That’s where pap smears come in.
What is a pap smear?
A pap smear is a quick, simple and relatively painless procedure that can safeguard you against cervical cancer. It’s a test that doctors perform to check for the presence of cancerous or pre-cancerous cells in the cervix. When performed regularly, it’s a form of preventative healthcare as it can detect the presence of unhealthy cells before they have the chance to develop into cancer.
Pap smears take just a couple of minutes and can be performed by your gynae, or at a clinic. They’re not particularly uncomfortable, though every woman experiences them differently. Some women feel nothing at all, and other women report a little discomfort.
If a pap smear detects abnormal cells, those cells can easily be removed from the cervix before they result in cancer.
Do I need a pap smear?
Yes, if you are a woman who is 21 years of age or older. All adult women should undergo regular pap smears.
How often should I have a pap smear?
If the results of your first pap smear are normal, it’s recommended you go every three years. For women who have abnormal results, more regular testing may be required. Your doctor, clinic or gynae will advise you on how often you should be having a pap smear.
What’s the link between HPV and cervical cancer?
In the vast majority of cases, cervical cancer is caused by high-risk strains of the human papillomavirus (HPV), a form of sexually transmitted infection (STI) that is extremely common.
In some women, this STI is contracted and then suppressed by the immune system, causing only temporary changes to the cells in the cervix. This explains why some women have abnormal pap smear results, but normal results six months or a year later.
In other cases, HPV can be persistent and eventually lead to pre-cancerous or cancerous cells. Pap smears will test for abnormal cells, and if follow-up pap smears still detect these abnormalities, a simple procedure can be performed to remove the threat.
Where can I go for a pap smear?
A pap smear can be performed by your gynae or at any Marie Stopes centre across Uganda. Visit your most convenient Marie Stopes centre, and you’ll also be able to chat to us about your contraceptive options, get screened for STIs and HIV, and get personalised sexual healthcare advice.
Find your closest Marie Stopes centre or call our toll free hotline 0800220333 now and speak to our trained counselors.
Demand side financing is a tool that is being utilized to improve the utilization of under used services among the poor and under-served populations by placing purchasing power as well as choice of provider directly in the hands of the recipients (World health Report 2010).
This is an important innovation in health care systems where access remains poor and therefore the utilization and uptake of services very low among those who would benefit most from these services, that is to say the poor and vulnerable sections of the populations.
This is especially true for services such as family planning, maternal health and child health.
Every year there are 1,600,000 pregnancies in Uganda and many of these pregnant women face the probability of living or dying while giving life. According to the World Health Statistics report 2015, maternal mortality is at 320/100,000
Matched with the poor health seeking behavior (less than half of Ugandan women deliver with a skilled attendant) the need for a demand side intervention that actively engages both the private and public sector is clear.
In Uganda various demand side financing interventions have been tried which involve the use of subsidies or vouchers.
Voucher schemes like the Uganda Reproductive Health Voucher project implemented by Ministry of Health with Marie Stopes Uganda as the voucher management agency, are designed for women of reproductive age living below the poverty line.
Community health workers sell the voucher to pregnant women that entitle poor women to attend to skilled care during pregnancy, delivery and post-natal period in South Western and Eastern Uganda.
In this case a voucher is a document that authorises payment of a health service; therefore, it is a token that can be exchanged for a pre-defined set of health services or products. The voucher enables public subsidies for services or products to follow the client rather than being tied to providers.
The voucher system which is aimed at boosting maternal health services in 240 health facilities is being implemented in 25 districts of south west and eastern parts of the country.
Since the project started in April 2016, 65,000 expectant mothers have benefited from the project.
Specifically a total of 32,000 babies have been delivered to women from a socio-economic group that had a very low rate of uptake of maternal health services prior to the project. The demand for the voucher continues to be very high often exciding supply.
Dr. Michael Bukenya (chairperson of the health committee of Parliament) says that the voucher project proves that health financing is possible and therefore provides good lessons and benchmarks for the National Health Insurance Scheme which has been under review for a long time.
In conclusion, demand side financing projects particularly vouchers have proved to be effective in enhancing people’s motivation to seek for health services, improving health system performance and boosting facility deliverables as well as skilled birth attendance thereby contributing to the reduction of maternal mortality.
These services should be widely available to pregnant women in low resource settings. Therefore, as we mark International women’s day, It is critical that every pregnant woman and new-born has access to and receives good quality care and life saving interventions around the time of birth.
The writer is the head of communications and public relations at the Marie Stopes Uganda
#Beboldforchange is a tagline for International Women’s day which is marked every year on March 8. This theme gears us to all be responsive and responsible leaders in creating a more gender inclusive world where women and girls have quality education, health care, decent work, access and ownership rights over property and technology and equal participation in political and economic decision making.
According World Economic Forum, gender gap won’t close entirely until 2186. This gender disparity is due to some factors like women being underrepresented in the government, they are the minority in the booming tech sector yet still shoulder more in the household burden and having a greater risk of rape and domestic violence. Are we therefore going to seat, cross our arms and wait for a decade and yet many women in Uganda face a wide range of challenges like discrimination and lack of economic self-sufficiency which has led to gender based violence, limited access to health care and family planning leading to maternal and neonatal mortality and limited resources for the girl child to be in school.
To address these gaps, we need to learn from and replicate projects that have worked well to empower women; these include but are not limited to subsides for women, investment income generating activities, supporting girls stay in school among others.
One such project that Maries Stopes is implementing is the Uganda Reproductive Health Voucher Program. This is a 4 year Ministry of Health project aimed at increasing access to skilled care among poor women living in rural and disadvantaged areas during pregnancy and delivery. This project has empowered many less privileged mothers in Uganda to uptake antenatal care and safe delivery services thus strengthening institutional capacity to deliver reproductive health services to women and girls.
Therefore, to have more girls and women at the table, we must commit to advancing women and bring about change that is directly and aggressive reaching out to other women through coaching programs and initiatives; we need to identify the right forums which empower women socially, economically and also their health. We need to strengthen investments in service provision and advocacy more especially to health and family planning contraceptives, and a right to education for the girl child.
By. Mahoro Rose, Sexual Reproductive Counselor, Marie Stopes Uganda
Be the Choice!
Are you are young person between the ages of 18-25 years? Do you have interest in advancing Sexual Reproductive Health(SRH) within your community? If yes, Marie Stopes Uganda has a new exciting volunteering program for you.
Send us your application at firstname.lastname@example.org including a brief biography, contact information, name of university/ institution, district/region of your university and year of study. The application should have your motivation/application letter.
The letter should be addressed to the Head of Communications and Public Relations
In addition send us a two page write up about;
- any Sexual Reproductive Health challenges faced by youth in your community/school
- why you would like to be an SRH ambassador.
- You could also share how you would solve those challenges.
For the start, we are currently rolling out the program in the following districts below namely; Kampala, Wakiso, Jinja, Tororo, Mbale, Soroti, Masaka, Mbarara, Kabale, Hoima, Fortportal, Arua, Gulu, Lira. Youth in these areas are encouraged to apply.
Applications sent on email should be marked with the subject “SRH Ambassador” and sent to email@example.com
Deadline for applications is 20th March 2017
Note: This is a volunteer opportunity and its not full time.
For more details, refer to our website (http://www.mariestopes.or.ug/) or you call 0800220333 toll free.
Marie Stopes Uganda in partnership with the Ministry of Health was honoured to organise an information sharing meeting for all stake holders from the 25 districts where the (Uganda Reproductive Heatlth Voucher Project (URHVP) project is being implemented, Health Development partners and other agencies implementing results based financing programs to review progress of project implementation at Lake Victoria Serena Lweza on Tuesday 28th February, 2017.
This project is aimed at increasing access to skilled care among poor women living in rural and disadvantaged areas during pregnancy and delivery. The project is supported by the Swedish Government, the World Bank Group and UNFPA.
The project has been implemented since September 2015 and has managed to expand skilled care among poor pregnant women in the project districts.
To date, over 65,000 women have so far benefited from this project.