The promise of Mama Kits: Perceptions of in-kind goods as incentives for facility deliveries in Uganda

ABSTRACT

There is growing interest in the use of incentives to increase the utilisation of maternal health services globally, including the use of in-kind goods. As part of the Saving Mothers, Giving Life (SMGL) programme, pregnant women in three districts in Uganda were incentivised to deliver in a facility by the promise of ‘Mama Kits’ – clean delivery kits augmented with goods for newborns. We collected and analysed qualitative data from 18 focus groups (130 women) who had a recent home (N = 9) or facility delivery (N = 9 groups) to understand their overall perceptions of the SMGL programme, and, in particular, the Mama Kit. There was a high level of awareness of Mama Kits among women who delivered in a health facility and a moderate awareness among women who delivered at home. When available, kits positively affected women's perceptions of facility delivery because they associated availability of kits with affordability of care. When not available, women's perceptions of their actual or expected delivery experience were negatively affected. When well implemented, in-kind goods can be important complements in broader efforts to incentivise facility delivery. Inconsistent implementation and an underestimation of their influence on care-seeking can undermine efforts to reduce maternal mortality and morbidity.

KEYWORDS:

• Mama kits
• in-kind goods
• maternal health
• perceptions
• Uganda
• facility delivery

Acknowledgements

M.E.K. developed the original concept for the evaluation of SMGL with input from K.A.G. K.A.-E. developed the concept for this paper, and wrote the first draft. All other co-authors contributed to reviewing and finalising the text. M.E.K. and K.A.G. oversaw instrument development and data collection. L.A. trained data collectors and oversaw data collection in Uganda. K.A.-E. and E.S. assisted with data collection in Uganda. K.A.-E., E.S., and D.G. conducted data analysis. The corresponding author had full access to all of the data in the study and had final responsibility for the decision to submit for publication.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Karen A. Grépin http://orcid.org/0000-0003-4368-0045

Additional information

Funding

This project was funded by a grant from Merck through its Merck for Mothers Programme to Drs Margaret E. Kruk and Sandro Galea. Neither the sponsors of the study nor other members of the SMGL leadership group played any role in study design, data analysis, data interpretation, writing of the report, or submission for publication.