IFGH 2012: Changing Incentives for Health Workers Through a Voucher Scheme for Maternal Health Services

January 30, 2012

Posted by Irish Forum for Global Health | Conference Abstracts


Authors:Ekirapa- Kiracho E.1, Kiwanuka SN.1, Brugha R.2, Sengooba F.1, Thomas S.3

Author Affiliations:1Makerere University School of Public Health, Uganda, 2Royal College of Surgeons, Ireland,3Trinity College Dublin, Ireland.

Option 1– Scientific / Empirical Research Findings Presented as – Oral Presentation


A voucher scheme in Eastern Uganda was implemented to facilitate access to maternal health services. The scheme also aimed at altering incentives for providers so as to improve their motivation, performance and hence the quality of maternal health services delivered. The intention of this study was to explore changes in the incentives for providers and their influence on the behaviour of providers.


The study was conducted using a case study design. The study population included health workers and women of reproductive age. Data was collected using key informant interviews (health workers) and focus group discussions (women of reproductive age). Thematic analysis was employed.


The health workers reported that they felt more motivated to perform their duties. This increased interest in their work was attributed to allowances provided by the scheme, the increased availability of the resources required at work, increased job enrichment and acquisition of skills as a result of the increased diversity and number of clients. The focus group discussions revealed that the health workers were perceived to be more available and responsive towards client needs. Their attitudes towards clients had also improved remarkably. One of the challenges reported was a high workload especially in understaffed facilities.


One of the reasons for absenteeism of health workers in Uganda has been the need to supplement their meagresalary. Financial incentives from the program provided additional income, so the health workers dedicated more time to their work. Positive changes in the work environment provided a more conducive environment for health workers hence they enjoyed their work. The increased numbers and diversity of clients led to the acquisition of new skills and job enrichment. These changes together with their internal drive to serve patients had a positive influence on the behaviour of the health workers.



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