This article is part of the supplement: An innovative approach to building capacity at an African university to improve health outcomes

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Exploring new health markets: experiences from informal providers of transport for maternal health services in Eastern Uganda

George W Pariyo1, Chrispus Mayora1*, Olico Okui1, Freddie Ssengooba1, David H Peters2, David Serwadda3, Henry Lucas4, Gerald Bloom4, M Hafizur Rahman2 and Elizabeth Ekirapa-Kiracho1

Author Affiliations

1 Department of Health Policy, Planning and Management, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda

2 Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA

3 Department of Disease Control and Environmental Health, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda

4 Institute of Development Studies, at the University of Sussex, Brighton, BN1 9RE, UK

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BMC International Health and Human Rights 2011, 11(Suppl 1):S10  doi:10.1186/1472-698X-11-S1-S10

Published: 9 March 2011



Although a number of intermediate transport initiatives have been used in some developing countries, available evidence reveals a dearth of local knowledge on the effect of these rural informal transport mechanisms on access to maternal health care services, the cost of implementing such schemes and their scalability. This paper, attempts to provide insights into the functioning of the informal transport markets in facilitating access to maternal health care. It also demonstrates the role that higher institutions of learning can play in designing projects that can increase the utilization of maternal health services.


To explore the use of intermediate transport mechanisms to improve access to maternal health services, with emphasis on the benefits and unintended consequences of the transport scheme, as well as challenges in the implementation of the scheme.


This paper is based on the pilot phase to inform a quasi experimental study aimed at increasing access to maternal health services using demand and supply side incentives. The data collection for this paper included qualitative and quantitative methods that included focus group interviews, review of project documents and facility level data.


There was a marked increase in attendance of antenatal, and delivery care services, with the contracted transporters playing a leading role in mobilizing mothers to attend services. The project also had economic spill-over effects to the transport providers, their families and community generally. However, some challenges were faced including difficulty in setting prices for paying transporters, and poor enforcement of existing traffic regulations.

Conclusions and implications

The findings indicate that locally existing resources such as motorcycle riders, also known as “boda boda” can be used innovatively to reduce challenges caused by geographical inaccessibility and a poor transport network with resultant increases in the utilization of maternal health services. However, care must be taken to mobilize the resources needed and to ensure that there is enforcement of laws that will ensure the safety of clients and the transport providers themselves.