Maternal health in Uganda

The fifth Millennium Development Goal aims at reducing maternal mortality by 75%. Available evidence however indicates that it may not be easy for developing countries like Uganda to achieve this goal since over the last two decades maternal morality has not declined significantly (527 in 1995, 507 in 2001 and 435 in 2005. The sampling errors around these estimates have been large so the results are not significantly different).

The main causes of maternal mortality in Uganda have been reported to include haemorrhage, obstructed labour, ruptured uterus, sepsis and hypertensive disorders (Ebanyat et al 2002). There is evidence to show that attendance of delivery by skilled health personnel reduces maternal mortality (Graham et al, 2001). However in Uganda, according to the Uganda Demographic and Health Survey, the proportion of mothers delivering in health facilities has been persistently low (38% in 1995, 37% in 2001 and 42% in 2006). Inequities in institutional delivery have also been noted with the women in the lowest quintile less likely to deliver in health facilities than those in the highest quintile.

Most of the attempts that have been made in Uganda so far to increase institutional delivery focus on influencing the supply side of delivery. Few interventions have been directed at the demand side. The Future Health Systems study intends to apply a demand side intervention using vouchers. The intention is to assess the effectiveness of the use of a voucher system to increase delivery in health units. The information obtained will be useful for guiding decisions geared at promoting the attainment of the 5th MDG.