Promoting equity in accessing skilled childbirth for the vulnerableTuesday, 24 Jul 2018
The transport subsidy scheme, implemented by the MANI project and funded by UKAid, promotes equity and ensures no one is left behind. Vouchers are distributed without discrimination by Community Health Volunteers (CHVs), who assess a woman’s need and issue a voucher if she qualifies, helping her to overcome financial barriers in accessing quality care.
Each CHV is in charge of 100 households, which s/he visits regularly to educate mothers and fathers on the importance of maternal and newborn health services. The subsidy allows the CHV to offer a transport solution (a boda-boda rider) for mothers who can’t afford to get to a facility.
This is the story of Josephine, married to Bernard and mother of three girls. Josephine and her family live in Kanduyi in Bungoma county.
Josephine was born without any physical disability but when she was 10 years old, her leg began to swell and became weak, leading to a permanent disability. Josephine is able to walk with a limp, although not for long distances, as this causes her pain. Josephine struggled to complete her education and dropped out of school when she was 10 years old due to financial constraits. At 12 years old she gave birth to her first child at home, followed by a second child a couple of years after. In November 2017, she had Cynthia, her third child. Throughout her pregnancy with Cynthia, Josephine was visited by a CHV who helped her understand the importance of antenatal visits, the risk of malaria during pregnancy (including giving her a free treated mosquito net), and advised her on nutrition and awareness of danger signs. During these visits, the CHV assessed that she was eligible for a transport voucher.
Unfortunately, Jospehine’s third pregnancy didn’t go smoothly; "When I started to feel labor pains at 1am, my husband went to the CHV and informed them of my labor pains. The CHV called a motorbike and immediately rushed me to nearest health facility, Mumbule dispensary." Josephine’s labour did not progress normally, and she was referred to Bungoma County Referral Hospital. When she got to the hospital she was taken for an emergency cesarean section.
"Without the transport voucher, I wouldn’t have managed to go to hospital at that time of the night; with my condition I would have died, since I arrived in Bungoma unconscious" she says.
Josephine’s husband, Bernard says; "I could not afford to take her to hospital at that time of the night; let alone finding a boda-boda."
Josephine benefited from quality care with no discrimination. Her husband and her relatives supported her during the entire period of pregnancy and delivery.
Bernard says of Josephine; "She is a demonstration of a deserving woman who benefited from the transport subsidy." The voucher scheme has helped her and her family overcome the lack of money that would have prevented her from accessing skilled birth attendance at the health facility.
Since 2015, MANI has distributed over 43,300 transport vouchers in Bungoma, of which 62% have been used. The chart below shows the steps involved in using a transport voucher. Through this approach, MANI has contributed to an increase in skilled birth attendance from 41% in 2014 to 67% in 2017, improving health outcomes for mothers and their babies.
The chart below shows the steps on transport voucher usage.