MSD for Ugandan Mothers Programme FINAL PROGRAMMATIC REPORT Improving the availability of affordable transport as a means to overcoming the constraints to accessing maternal health services September 2015 1 Table of Contents 1. Acknowledgement .............................................................................................................................. 4 2. Abbreviations/Acronyms .................................................................................................................... 5 3. Executive Summary ............................................................................................................................. 6 4. Introduction ........................................................................................................................................ 8 4.1 The MUM Programme .................................................................................................................. 9 4.2 Transaid ....................................................................................................................................... 10 4.3 Terms of Reference ..................................................................................................................... 12 4.4 Background/Context ................................................................................................................... 13 5. Methodology ..................................................................................................................................... 16 5.1 Target Areas ................................................................................................................................ 16 5.2 Formative Assessment ................................................................................................................ 19 5.2.1 Facility-Based Interviews ..................................................................................................... 19 5.2.2 Community-Based Focus Group Discussions ....................................................................... 21 5.2.3 Findings ................................................................................................................................ 22 5.3 Project Design ............................................................................................................................. 25 5.3.1 Emergency Transport Scheme ............................................................................................. 26 5.3.2 Participant Motivation ......................................................................................................... 27 5.3.3 Project Promotion ................................................................................................................ 28 5.4 Implementation .......................................................................................................................... 29 5.4.1 ProFam Ambassador Sensitisation ....................................................................................... 29 5.4.2 Boda Boda Rider Sensitisation ............................................................................................. 30 5.4.2 Placement of Boda Boda Ambulance Trailers ...................................................................... 34 5.5 Data Collection/Monitoring ........................................................................................................ 34 5.5.1 Monthly Data Collection ...................................................................................................... 35 5.5.2 Data Collection via ‘Focal Riders’ ......................................................................................... 36 5.5.3 Rural Assessments to Evaluate the Effectiveness of the Scheme ........................................ 36 6. Findings ............................................................................................................................................. 38 6.1 Feedback from ETS Riders ........................................................................................................... 38 6.2 Monthly Monitoring .................................................................................................................... 39 6.2.1 ETS Rider Retention ............................................................................................................. 39 6.2.2 Number of Women Transported ......................................................................................... 42 2 6.2.3 Ante-Natal, Delivery or Illness ............................................................................................. 46 6.2.4 Uptake of Maternal Health Services by Type....................................................................... 47 6.2.5 Length of Journey by ETS ..................................................................................................... 49 6.2.7 Cost Reduction per Journey ................................................................................................. 50 6.2.8 Costs Before and After Project Intervention........................................................................ 51 6.3 Cross Referencing Data ............................................................................................................... 52 6.3.1 Rural Assessments ............................................................................................................... 52 6.3.2 Estimated ‘Actual’ Birth Rates ............................................................................................. 56 7. Conclusion ......................................................................................................................................... 61 8. References ........................................................................................................................................ 62 9. Annexes ............................................................................................................................................. 63 9.1 Annex 1: ProFam Clinic assessment tool for Facility-based interviews ...................................... 63 9.2 Annex 2: Community-based assessment tool for focus group discussions ................................ 65 9.3 Annex 3: ETS Riders ..................................................................................................................... 69 9.3.1 Mubende District ................................................................................................................. 69 9.3.3 Ibanda District ...................................................................................................................... 74 9.3.4 Lira District ........................................................................................................................... 81 9.3.5 Alebtong District .................................................................................................................. 86 9.4 Annex 4: ProFam Ambassador Sensitisation .............................................................................. 87 9.5 Annex 5: ETS Rider Data Collection Tool ..................................................................................... 88 9.6 Annex 6: Nominated ‘Focal Riders’ ............................................................................................. 89 9.6.1 Mubende District ................................................................................................................. 89 9.6.2 Ibanda District ...................................................................................................................... 92 9.6.3 Lira District ........................................................................................................................... 98 9.6.4 Alebtong District ................................................................................................................ 102 9.7 Annex 7: Rural Assessment Tool ............................................................................................... 103 9.8 Annex 8: ETS Rider Feedback during monitoring ...................................................................... 107 3 1. Acknowledgement On behalf of Transaid, the project team wishes to express its appreciation to the following groups for their invaluable contributions towards the successful execution of this assignment: . The staff at PACE headquarters in Kampala for their advice and support throughout. The Northern, Central and Western Regional PACE Teams for being very generous with their local knowledge and their incredible interpretation skills. All CBOs affiliated with the ProFam Clinics within Transaid’s target districts. The staff at all of the ProFam Clinics which supported the project and were very candid at times. All of the ETS riders with whom it was a pleasure and an inspiration to work with. All the community members that have either used the service or participated in one of the project team’s many focus groups or interviews that the project team have carried out. The ProFam Ambassadors whose energy levels impressed. Patrick Ntandi and his colleagues at Connex for providing safe transport to the project team throughout the project. MSD for the opportunity to collaborate with the MSD for Mothers (MSD’s 10-year $500 million initiative to help create a world where no woman dies giving life). MSD for Mothers is an initiative of Merck & Co., Incl., Kenilworth, N.J., U.S.A. 4 2. Abbreviations/Acronyms ANC Ante-natal Care