How savings groups are helping women deliver in health facilities

Monday June 30 2014

Expectant mothers wait to be attended to at Mulago hospital’s maternity

Expectant mothers wait to be attended to at Mulago hospital’s maternity ward. Because of several factors including lack of money, many women prefer to deliver from home. FILE PHOTO 

By Agatha Ayebazibwe

Edisa Babaranda, a resident of Nawanende Village in Kamuli District, lost her child during labour as a result of a delay in accessing a health facility.
Babaranda knew that she would need money when time to deliver came, but she did not do anything about it. She was hoping her husband would provide the financial support she would need.

Unfortunately, when the labour pains started, her husband was not at home.

But hours later when he returned home, he was drunk and did not have any money to transport his wife to the health facility—about 10 kilometres away from their home.

Babaranda is a housewife with no source of income. At the time of delivery, her neighbour attempted to help her deliver from home, but hours of intense labour passed without success. And so a solution had to be found as soon as possible.

Role of VHTs
A Village Health Team (VHT) member was called to help. VHTs serve as the primary village-level health contact person for all villages across the country. The VHT member wrote a referral note, mobilised money and hired a motorcycle to take Babaranda to Nawanende Health Centre III. At this point, it was clear she had developed obstructed labour.

At the health centre, the only midwife on duty said she could not handle Babaranda’s case and advised she be taken to Kamuli District hospital. However, she did not have money to be moved to the hospital.


When Babaranda eventually got to the hospital, it was too late. That is when the baby died.

According to the World Health Organisation, most maternal deaths result from delays in making a decision on whether to seek care or not, previous bad experiences at health facilities, lack of money, long distances, and facilities that lack equipment and staff.

Put together, all these factors played a part in Babaranda’s predicament. And this situation is not unique to women in Kamuli District.

New innovation
To address the problem, researchers at Makerere University’s School of Public Health have designed a programme called MANIFEST. It encourages women to start saving money as soon as they find out they are pregnant.

The money is then used to pay for transport costs to the health facility and buy things such as clothes, as well as pay additional bills that may arise at the time of delivery.

According to the programme coordinator, Moses Tetui, this approach allows women in the communities to take charge of their health by saving money that they can use in the event of an emergency.

“The project does not only work to save mothers and their newborns, it also empowers communities. It offers a more friendly and sustainable way to address maternal and child health using the little resources we have,” says Tetui.

For instance, through the savings system, Tetui says a mother identifies a group, joins it, and then starts saving money. The amount deposited depends on how much she has at hand at any particular time.

So when an expectant mother goes into labour, she will be able to call a designated boda boda rider, who then takes her to the facility.

The nurse who receives the mother at the facility then signs on the members’ share passbook, which is taken back to the group’s executive for reimbursement.

What beneficiaries say
Betty Opolot : A leader of the Puti Puti Central money saving group in Pallisa District, where the project is also being implemented, says women are fast embracing it.

“We organised the women and talked to them about the benefits of preparing for delivery by saving with the group. So far, 21 women have joined and collected Shs500,000 since January,” says Opolot.

This, she says, has seen more women access services and increase delivery in health facilities.

“The women can now pay their own bills. They no longer rely on their husbands,” says Harriet Bagoote, a member of Esigwa Fesiraza Saving Group, in Kamuli District.

Christopher Bamulooba: A leader of the Kwagala Kwamukama Saving group, says so far, nine women have been transported since the programme started in his village in Kamuli.

Norah Tibesigwa: The in-charge of Bupadhengo Health Centre III, says deliveries at the facility have increased as a result of community awareness and birth preparedness of the expectant mothers.

“When I first came to this facility in 2012, we were getting three to five deliveries a month. People had abandoned the facility for fear of being asked to buy items that would be used to aid delivery. But now, we get between 20 and 35 deliveries every month,” Tibesigwa says.

Dinah Nakiganda: The district health officer for Kamuli, notes that because of the programme, a reduction in child and maternal mortality rates are being registered in those communities where the saving scheme is being implemented.

Government plans on maternal health

Cutting maternal deaths is one of the goals the United Nations set to be achieved by member countries by 2015.

But Uganda is still a distant call away from reaching these goals. According to the UN, countries must reduce by 75 per cent the number of mothers who die in childbirth by 2015.

This means Uganda will have to significantly reduce this figure from the current 435 to 131 per 100,000 live births by 2015. The government acknowledges this goal is unachievable in the remaining time.

Instead, according to Uganda’s MDG report, more focus is now going to be shifted on addressing bottlenecks in the delivery of emergency obstetric care, skilled attendance at birth, family planning and access to antenatal care-interventions which are crucially required to improve maternal health.

In its proposed plan, the government also says it will introduce cheap alternative transportation as an incentive for women to seek care promptly.