Effectiveness of the Box Savings Initiative for Transport Costs on Health Facility- Based Deliveries:

Abstract

Introduction: Access to maternal healthcare is crucial for reducing maternal and neonatal mortality, especially in rural areas where barriers such as transport costs limit facility-based deliveries. This study explores the effectiveness of Mothers' Box Savings Initiative on transport costs and its influence on health facility-based deliveries in the Busoga region of Uganda. Franchisor-franchisee transport model is important in building bond between mothers and local transporters. Mothers' Box Savings Initiative is a community-based saving scheme where expectant mothers save small amounts regularly to afford transportation to health facilities during delivery and when develop complications. Methods: this was an interventional study with mixed-methods approach employed for 6 months. The franchisor- franchisee model was aimed at bringing local transporters closer to pregnant mothers. However, the Box Savings Initiative was required for mothers to afford transport costs to health centres for deliveries and treatment of maternal related complications in the Busoga region. Results: After the initiation of box savings for transport costs affordability to health centres, deliveries in the intervention arm drastically increased to 70.5 percent and lethargically to 51.2 percent in the control arm. There was statistically significant change effect with the intervention (change average value at 0.314 and p-value at 0.000). The findings indicate that women involved in Mothers' Box Savings and can afford to meet transport costs are significantly more likely to have health facility-based deliveries (AOR=0.117; p-value=0.009; CI= 0.135 – 2.374 and AOR=2.290; p-value=0.011; CI=1.001 – 5.216 respectively). Conclusion: This suggests that the financial empowerment provided by savings initiatives directly contributes to improved maternal health outcomes by reducing barriers to accessing skilled birth attendants. The study underscores the importance of community savings mechanisms as a cost-effective strategy for enhancing maternal healthcare accessibility in low-resource settings.