Utilization of obstetrics services in rural areas of Uganda

I am working on a project aiming to increase financial access to quality obstetrics services for the women in reporoductive ages in one district in Uganda. On this project, the expected outputs should be increased utilization of ANC and medical services, increased institutional deliveries and increased utilization of PNC services. Immunization of the newborns is expected to increase as well.

Our approach is to get the community take the lead in making sure the women access the services. We have therefore designed and are promoting community health insurance schemes to which the communities pay premiums and the women in the paid up community automatically benefit from the scheme by accessing obstetrics services when they need them. The package is comprehensive. In addition to the obstetrics services, the women are provided with transort. In case of death the dead body is transported as well.

It has been two years now. What are we seeing?

1. A steady increase in utilization of services
2. Some resistance from culturalists. Cultural barriers making the utilization of TBAs still common
3. Data collection a challenge because some women deliver from communities as well as immunizations. Even cases of maternal death occuring from home are not easy to truck

Our biggest challenge is monitoring. How to collect data from the community? Institutional data is ok to collect but it accounts for only 60% of all the cases untill now.

Are there experiences to learn from?