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BMC Pregnancy Childbirth. 2017 Dec 19;17(1):431. doi: 10.1186/s12884-017-1623-y.

Effects of demand-side incentives in improving the utilisation of delivery services in Oyam District in northern Uganda: a quasi-experimental study.

Author information

Doctors with Africa CUAMM, Aber Hospital, P. O. Box 130, Lira, Uganda.
Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshida Konoecho, Sakyoku, Kyoto, Kyoto, 606-8501, Japan.
Doctors with Africa CUAMM, Via San Francisco 126, 35121, Padua, Italy.
School of Economics and Development, University of Florence, Via delle Pandette, 32, (50127), Florence, Italy.
Doctors with Africa CUAMM, Aber Hospital, P. O. Box 130, Lira, Uganda.
Kampala Capital City Authority, Plot 1-3 Kyagwe Road, P.O. Box 7010, Kampala, Uganda.
District Health Office, Oyam District Local Government, P. O. Box 30 Loro, Oyam Town Council, Oyam, Uganda.
Doctors with Africa CUAMM, Plot 3297 Church Road, P.O. Box 7214, Kampala, Uganda.
Institute of Tropical Medicine, Nationalestraat 155, 2000, Antwerp, Belgium.



We evaluated the effects and financial costs of two interventions with respect to utilisation of institutional deliveries and other maternal health services in Oyam District in Uganda.


We conducted a quasi-experimental study involving intervention and comparable/control sub-counties in Oyam District for 12 months (January-December 2014). Participants were women receiving antenatal care, delivery and postnatal care services. We evaluated two interventions: the provision of (1) transport vouchers to women receiving antenatal care and delivering at two health centres (level II) in Acaba sub-county, and (2) baby kits to women who delivered at Ngai Health Centre (level III) in Ngai sub-county. The study outcomes included service coverage of institutional deliveries, four antenatal care visits, postnatal care, and the percentage of women 'bypassing' maternal health services inside their resident sub-counties. We calculated the effect of each intervention on study outcomes using the difference in differences analysis. We calculated the cost per institutional delivery and the cost per unit increment in institutional deliveries for each intervention.


Overall, transport vouchers had greater effects on all four outcomes, whereas baby kits mainly influenced institutional deliveries. The absolute increase in institutional deliveries attributable to vouchers was 42.9%; the equivalent for baby kits was 30.0%. Additionally, transport vouchers increased the coverage of four antenatal care visits and postnatal care service coverage by 60.0% and 49.2%, respectively. 'Bypassing' was mainly related to transport vouchers and ranged from 7.2% for postnatal care to 11.9% for deliveries. The financial cost of institutional delivery was US$9.4 per transport voucher provided, and US$10.5 per baby kit. The incremental cost per unit increment in institutional deliveries in the transport-voucher system was US$15.9; the equivalent for the baby kit was US$30.6.


The transport voucher scheme effectively increased utilisation of maternal health services whereas the baby-kit scheme was only effective in increasing institutional deliveries. The transport vouchers were less costly than the baby kits in the promotion of institutional deliveries. Such incentives can be sustainable if the Ministry of Health integrates them in the health system.


Baby kit; Demand-side; Incentives; Maternal and newborn health; Oyam District; Transport vouchers; Uganda

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