Background This study set out to investigate how incentives for mothers, health workers and boda–boda riders can improve the community-based referral process and deliveries in the rural community of Busoga region in Uganda. Both the monetary and non-monetary incentives have been instrumental in the improvement of deliveries at health centres. Methods The study was a 2 arm cluster non-randomized control trial study design; with intervention and control groups of mothers, health workers and boba–boda (commercial motor-cycle) riders from selected health centres and communities in Busoga region. Among the study interventions was the provision of incentives to mothers, health workers (midwives and VHTs) and boda–boda riders for a duration of 6 months. Monetary and non-monetary incentives were applied in this study, namely; provision of training, training allowances, refreshments during the training, payment of transport fares by mothers to boda–boda riders, free telephone calls through establishment of a pre-paid Closed Caller User Group (CUG) and provision of bonus airtime to all registered CUG participants and rewards to best performers. The study used a mixed methods design. Descriptive statistical analysis was computed using STATA version 14 for the quantitative data and thematic analysis for qualitative data. Results Findings revealed that incentives improved community-based referrals and health facility deliveries in the rural community of Busoga. The proportion of mothers who delivered from health centres and used boda–boda transport were 70.5% in the intervention arm and only 51.2% in the control arm. Of the mothers who delivered from the health centres, majority (69.4%) were transported by trained boda–boda riders while only 30.6% were transported by un-trained boda–boda riders. And of the mothers transported by the boda boda riders, 21.3% in the intervention arm reported that the riders responded to their calls within 20 min, an improvement from 4.3% before the intervention. Mothers who were responded to between 21–30 min increased from 31.4% to 69.6% in the intervention arm while in the control arm, it only increased from 37.1% to a dismal 40.3%. Interestingly, as the time interval increased, the number of boda–boda riders who delayed to respond to mothers’ calls reduced. In the intervention arm, only 6.2% of the mothers stated that boda–boda riders took as many as 31–60 min’ time interval to respond to their calls in post intervention compared to a whopping 54.9% in the pre intervention time. There was little change in the control arm from 53.2% in the pre intervention to 41.2% in the post intervention. Conclusion Incentives along the maternal health chain are key and the initiative of incentivising the categories of stakeholders (mothers, midwives, the VHTs and the boda–boda riders) has demonstrated that partnerships are very critical in achieving better maternal outcomes (health facility-based deliveries) as a result of proper referral processes.

Evidence on how intra-urban inequalities could steer the use of modern family planning (mFP) services remains elusive. In this study, we examined the role of residence, socio-economic, family, and individual factors in shaping access to mFP use in Iganga Municipality and Jinja city, in central eastern Uganda. We used cross-sectional household survey data that were collected between November-December 2021 from 1023 women aged 15-49 years. We used logistic regression to assess the factors associated with mFP use and Stata user written command – iop, to assess the inequality in mFP due to different factors. We considered unfair circumstances as socio-economic status (wealth quartile, education level, and working level), place of residence, age, religion affiliation, and authority. The time of sexual intercourse was considered as fair circumstance. Overall mFP use was estimated at 48.8%, with close to 60% using long-term acting reversible methods. Overall, 24% of all heterogeneity in modern FP use was due to the observed circumstances and 18% was due to differential in unfair circumstances. An increase in age was inversely associated with mFP use [adjusted Odds Ratio (aOR) [95% Confidence Interval (95%CI)] =0.976[0.966-0.986]), while an increase in parity was positively associated with mFP use (aOR [95%CI]=1.404[1.249-1.578]). Compared to mainland non-slum and landing site residents, mainland slum residents were two-fold (aOR[95%CI]=2.065[1.735-2.458]) and three-fold (aOR[95%CI]=2.631[1.96-3.531]) more likely to use mFP, respectively. Whereas the odds of using mFP increased with the wealth status (Middle: aOR[95%CI]=1.832[1.52-2.209] and Better: aOR[95%CI]=5.276[4.082-6.819]), an interaction between the place of residence and wealth index showed that wealth index mattered only in non-slum mainland areas. Women with secondary or higher level of education and whose decisions to use mFP were independent of other authorities were more likely to use mFP.  Lastly, there were region affiliation and type of work differential in the use of mFP. In conclusion, about one-fifth of all heterogeneity in mFP use was   due to differentials in unfair circumstances. The findings highlight the need for intervention that are tailored to the different groups of urban residents. For instance, the package of interventions should consider the places of work and places of residences regardless of socioeconomic status.

Background: This study set out to investigate how incentives for mothers, health workers and boda-boda riders can improve the community-based referral process and deliveries in the rural community of Busoga region in Uganda.Methods: The study was a 2-arm cluster non-randomized control trial study design; with intervention and control groups from selected health centres and communities as the units of non-randomization. The study interventions involved the provision of incentives for mothers, health workers and boda-boda riders for duration of six months. The study used a mixed methods research design with both quantitative and qualitative approaches. Descriptive statistical analysis was computed using STATA version 14 for the quantitative data and thematic analysis for qualitative data. Results: Findings revealed that incentives strongly improved community-based referrals and health facility deliveries in the study area. Mothers who delivered from health centres and transported by boda-boda transport were 70.5% in the intervention arm and only 51.2% in the control arm. Of the 70.5% of the mothers above, 69.4% were transported by trained boda-boda riders and only 30.6% were transported by un-trained boda-boda riders. The 69.4% mothers transported by trained boda-boda riders to health centres stated that boda-boda riders’ response to their calls for transport improved from 4.3% to 21.3% in the 5 – 20 minutes interval. For the 21 – 30 minutes interval, the response improved from 31.4% to 69.6% in the intervention arm compared to 37.1% to 40.3% in the control arm. As the time interval increased, the boda-boda riders who delayed to respond to mothers’ calls reduced. In the intervention arm, only 6.2% of the mothers stated that boda-boda riders’ response took 31 – 60 minutes time interval after the intervention compared to 54.9% before the intervention. There was little change in the control arm from 53.2% pre intervention to 41.2% post intervention. Similarly, the boda-boda riders’ response to mothers’ calls for transport reduced for the time interval of 60 minutes and above. Conclusion: Incentives and creation of partnerships are very critical in achieving better health facility-based deliveries as a result of proper referral processes.