Incentives for Mothers, Health Workers and “Boda-Boda” Riders to Improve Community-Based Referral Process and Deliveries in the Rural Community: A Case of Busoga Region in Uganda

Abstract

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.