Mobile Lotteries for Safe Births: Accelerating Scale up of the Demand Driven Safe Motherhood Voucher Program in Uganda

In this decade, maternal and reproductive health voucher programs have contributed to reduced maternal and infant mortality and morbidity. The Uganda program is considered a key success. The administrative cost of supporting these safe births is approximately 32% of total program costs. If we can scale the Ugandan voucher program by a factor of 10, an estimated 1,820 deaths and 2,400 stillbirths would be averted annually. But, voucher programs face challenges scaling nationally because of: 1) inefficient distribution and claims systems, 2) suboptimal information management processes, 3) weak demand-side incentives for voucher distribution and utilization, and 4) high administrative overhead. To address these scale challenges in Uganda, we propose the targeted use of incentives to mothers and their families, and community-based voucher distributors (CBDs). Mothers will be enrolled in routine lotteries for modest cash prizes after using the voucher to access antenatal care (ANC), safe delivery and postnatal care (PNC). CBDs will receive fixed incentive payments after the mother's first ANC visit, after the mother's delivery and after the final PNC visit. The lotteries and incentive payments can only be realized with improved voucher tracking, which will rely on an interactive SMS (short message service) system for voucher activation by CBDs and voucher verification by voucher service providers (VSPs). The system does not require mothers to own phones. However, vouchers will no longer have cash value until activated at the point of sale.  This simple change reduces the administrative capacity needed to manage vouchers.