Incentives for Mothers, Health Workers and “Boda–Boda” Riders to Improve Community-Based Referral Process and Deliveries in the Rural Community, a Case of Busoga Region in Uganda
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Date
2022
Authors
Muluya, Kharim Mwebaza
Mugisha, John Francis
Kithuka, Peter
Kibaara, Kenneth Rucha
Muwanguzi, David Gangu
Ochieng, Otieno George
Yitambe, Andre
Wananda, Irene
Journal Title
Journal ISSN
Volume Title
Publisher
Springer Link
Abstract
Background: This study set out to investigate how incentives for mothers, health workers and boda–boda riders can
improve the community-based referral process and deliveries in the rural community of Busoga region in Uganda.
Both the monetary and non-monetary incentives have been instrumental in the improvement of deliveries at health
centres.
Methods: The study was a 2 arm cluster non-randomized control trial study design; with intervention and control
groups of mothers, health workers and boba–boda (commercial motor-cycle) riders from selected health centres and
communities in Busoga region. Among the study interventions was the provision of incentives to mothers, health
workers (midwives and VHTs) and boda–boda riders for a duration of 6 months. Monetary and non-monetary incentives were applied in this study, namely; provision of training, training allowances, refreshments during the training,
payment of transport fares by mothers to boda–boda riders, free telephone calls through establishment of a pre-paid
Closed Caller User Group (CUG) and provision of bonus airtime to all registered CUG participants and rewards to best
performers. The study used a mixed methods design. Descriptive statistical analysis was computed using STATA version 14 for the quantitative data and thematic analysis for qualitative data.
Results: Findings revealed that incentives improved community-based referrals and health facility deliveries in the
rural community of Busoga. The proportion of mothers who delivered from health centres and used boda–boda
transport were 70.5% in the intervention arm and only 51.2% in the control arm. Of the mothers who delivered from
the health centres, majority (69.4%) were transported by trained boda–boda riders while only 30.6% were transported
by un-trained boda–boda riders. And of the mothers transported by the boda boda riders, 21.3% in the intervention
arm reported that the riders responded to their calls within 20 min, an improvement from 4.3% before the intervention. Mothers who were responded to between 21–30 min increased from 31.4% to 69.6% in the intervention arm
while in the control arm, it only increased from 37.1% to a dismal 40.3%. Interestingly, as the time interval increased, the number of boda–boda riders who delayed to respond to mothers’ calls reduced. In the intervention arm, only
6.2% of the mothers stated that boda–boda riders took as many as 31–60 min’ time interval to respond to their calls in
post intervention compared to a whopping 54.9% in the pre intervention time. There was little change in the control
arm from 53.2% in the pre intervention to 41.2% in the post intervention.
Conclusion: Incentives along the maternal health chain are key and the initiative of incentivising the categories of
stakeholders (mothers, midwives, the VHTs and the boda–boda riders) has demonstrated that partnerships are very
critical in achieving better maternal outcomes (health facility-based deliveries) as a result of proper referral processes.
Plain English Summary: Maternal and child health has become a priority area of focus among health policy makers and planners. Several interventions are being tried in an efort to increase deliveries in health facilities in order to
realise better health outcomes. This study focused on how incentives for mothers, health workers and boda–boda
riders can improve the community-based referral process and deliveries in the rural community of Busoga region in
Uganda.
Two groups of boda–boda riders, mothers and health workers were followed up. One group was given incentives
while the other was not. The incentives included training and training allowances, refreshments during training, payment of transport fares by mothers to boda–boda riders, free telephone calls and provision of bonus airtime to all
registered CUG participants and rewards to best performers.
The results of this study showed that incentives help to boost deliveries from health facilities hence improving
maternal outcomes. In intervention group, 70.5% of mothers who deliveries from health facilities were transported by
boda–boda riders whereas this was only 51.2% in the control group. The response time of boda–boda risers to calls
for transport by expecting mothers improved tremendously in the intervention group when compared to the control
group. All the targeted parties—boda–boda riders, mothers, midwives and Village Health Teams were more active and
motivated to work towards improving maternal health of the mothers
Description
Article
Keywords
Incentives, Health workers, Boda–boda riders, Community-based referrals, Health facility-based deliveries
Citation
Muluya, K. M., Mugisha, J. F., Kithuka, P., Kibaara, K. R., Muwanguzi, D. G., Ochieng, O. G., ... & Wananda, I. (2022). Incentives for mothers, health workers and “boda–boda” riders to improve community-based referral process and deliveries in the rural community: a case of Busoga Region in Uganda. Reproductive Health, 19(1), 24.