title: Lessons learnt during the process of setup and implementation of the voucher scheme in Eastern Uganda: a mixed methods study.
abstract: BACKGROUND
  In spite of the investments made by the Ugandan Government, the utilisation of maternal health services has remained low, resulting in a high maternal mortality (438 maternal deaths per 100,000 live births). Aiming to reduce poor women's constraints to the utilisation of services, an intervention consisting of a voucher scheme and health system strengthening was implemented. This paper presents the lessons learnt during the setup and implementation of the intervention in Eastern Uganda, in order to inform the design and scale up of similar future interventions.
  
  
  METHODS
  The key lessons were synthesised from a variety of project reports, as well as qualitative data drawn from six focus group discussions and four in-depth interviews conducted in the Buyende and Pallisa districts during the implementation phase of the voucher scheme.
  
  
  CONCLUSIONS
  To promote the successful implementation of interventions with demand and supply side initiatives, such as voucher schemes, the health system should be able to respond to the demand created by providing the additional required resources such as health workers, essential supplies and equipment. Involving a diverse, multi-sectoral group of stakeholders is important for addressing the different barriers experienced by women when seeking maternal health services. Voucher schemes should have a mechanism of detecting unintended consequences and mitigating them. Sustainability plans should be built into such interventions to maintain the gains achieved. Lastly, health policy planners can use this information to develop follow-up programmes to test modified versions that are more sustainable. Such programmes could use locally existing community structures for management and resource mobilisation for self-sustainment.
authors.affiliation: Department of Health Policy Planning and Management, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda. buanev@yahoo.com.
authors.forename: John
authors.initials: J
authors.lastname: Bua
authors.affiliation: Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. lpaina@jhu.edu.
authors.forename: Ligia
authors.initials: L
authors.lastname: Paina
authors.affiliation: Department of Health Policy Planning and Management, School of Public Health, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda. ekky@musph.ac.ug.
authors.forename: Elizabeth Ekirapa
authors.initials: EE
authors.lastname: Kiracho
mesh_terms: D005260:Female; D005380:Financing, Government / Q000458:organization & administration*; D017144:Focus Groups; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008427:Maternal Health Services / Q000458:organization & administration*; D016730:Program Development; D036301:Qualitative Research; D014454:Uganda