Accessing healthcare has never been as simple as leaving home and travelling to the nearest health facility for 34-year-old Robinah Nzyabake.

Robinah lives in Kasese District and uses a wheelchair for mobility. Kagando Hospital is nearly 10 kilometres from her home, making transport essential whenever she needs healthcare. But transport comes at a cost, and in the past, it was an expense she could not always afford.

During her first pregnancy, these financial and mobility challenges prevented Robinah from attending the recommended antenatal care visits. Without affordable transport to the hospital, she eventually gave birth with the assistance of a traditional birth attendant.

The experience was difficult. Robinah recalls challenges accessing appropriate care after delivery, while her baby frequently fell ill. For her, the experience highlighted how important it is for women, particularly women with disabilities, to have access to professional healthcare throughout pregnancy, childbirth and the postnatal period.

Her most recent pregnancy, however, was different.

Robinah is now a member of the St. Mbaga Caritas Village Savings and Loans Association (VSLA). Her journey towards saving specifically for healthcare began after she participated in a sensitisation session on Saving for Health and Community-Based Health Insurance (CBHI) conducted by Kagando Hospital, one of the health facilities implementing a CBHI scheme in Kasese District.

Following the session, Robinah enrolled in the health insurance scheme and began actively saving for healthcare through her VSLA. When she became pregnant again, these two decisions helped her better prepare for the costs associated with accessing maternal healthcare.

This time, Robinah attended all her antenatal care visits. Whenever she needed to travel to Kagando Hospital, she could borrow money from her VSLA to pay for a boda boda (a motorcycle taxi) to take her to and from the health facility. Her outpatient healthcare costs at the hospital were covered under her insurance package.

This made a significant difference for her. Instead of worrying about how she would raise money for both transport and healthcare whenever she needed medical attention, she had financial options available to help her access the services she needed.

When the time came to give birth, she was also able to access a mama kit containing essential supplies for childbirth, something she says she did not have during her previous delivery. Her most recent childbirth went well, without the major challenges she had experienced before. Robinah paid a subsidised fee of UGX 30,000, while the remaining eligible healthcare costs were covered under her insurance package.

Being able to plan for healthcare expenses is particularly important for Robinah. Persons with disabilities can face additional barriers to accessing healthcare, including the cost and availability of suitable transport. For women with disabilities, these challenges can become even more significant during pregnancy and childbirth.

Across Uganda, about 13% of people aged five years and above have a disability, with disability more prevalent among women of reproductive age than men, according to the Uganda Bureau of Statistics. Although the rights of persons with disabilities are recognised in Uganda’s Constitution, many continue to face barriers in accessing essential services, including healthcare.

Beyond saving for her health, Robinah is also working to strengthen her livelihood. She makes tablecloths and weaves craft baskets to earn an income. She continues to save for healthcare through her VSLA and currently has UGX 60,000 set aside for future health needs. The difference between her two childbirth experiences goes beyond the amount of money she was able to save.

Robinah’s experience reflects the broader objective of the Decent Work and Social Protection Project in Uganda to strengthen social protection and help communities become more resilient to health-related financial risks.

Through Kagando Hospital in Kasese District and Kitojo Integrated Development Action (KIDA) Hospital in Kabarole District, the project supports Community-Based Health Insurance schemes that enable households to contribute towards healthcare in advance and access services when they need them. So far, 3,148 community members have enrolled in the CBHI schemes implemented through the two hospitals.

Alongside health insurance, the project supports the Saving for Health initiative through Village Savings and Loans Associations (VSLAs) in the Rwenzori and Albertine regions. A total of 981 groups, comprising 30,591 members (18,772 female), have collectively saved UGX 2.67 billion (approximately EUR 652,366) for healthcare.

These initiatives are helping households prepare for healthcare costs, reduce the financial burden of seeking care, and strengthen access to essential health services, including maternal healthcare. For women like Robinah, this means that pregnancy and childbirth do not have to begin with the question of whether they can afford to seek care. Through health savings and CBHI, they can prepare to access the healthcare services they need.

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