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Background: Saving groups are increasingly being used to save in many developing countries. However, there is limited literature about how they can be exploited to improve maternal and newborn health. Objectives: This paper describes saving practices, factors that encourage and constrain saving with saving groups, and lessons learnt while supporting communities to save through saving groups. Methods: This qualitative study was done in three districts in Eastern Uganda. Saving groups were identified and provided with support to enhance members’ access to maternal and newborn health. Fifteen focus group discussions (FGDs) and 18 key informant interviews (KIIs) were conducted to elicit members’ views about saving practices. Document review was undertaken to identify key lessons for supporting saving groups. Qualitative data are presented thematically. Results: Awareness of the importance of saving, safe custody of money saved, flexible saving arrangements and easy access to loans for personal needs including transport during obstetric emergencies increased willingness to save with saving groups. Saving groups therefore provided a safety net for the poor during emergencies. Poor management of saving groups and detrimental economic practices like gambling constrained saving. Efficient running of saving groups requires that they have a clear management structure, which is legally registered with relevant authorities and that it is governed by a constitution. Conclusions: Saving groups were considered a useful form of saving that enabled easy acess to cash for birth preparedness and transportation during emergencies. They are like ‘a sprouting bud that needs to be nurtured rather than uprooted’, as they appear to have the potential to act as a safety net for poor communities that have no health insurance. Local governments should therefore strengthen the management capacity of saving groups so as to ensure their efficient running through partnerships with non-governmental organizations that can provide support to such groups.
This was a qualitative study comprising focus group discussions (FGDs), key informant interviews (KIIs) and review of project documents and meeting notes. It was conducted across three districts (kamuli, Kibuku and Pallisa). The section below describes how we worked with saving groups to enhance saving for maternal health. The process of engaging with savings groups was achieved through five main activities that have been summarized in Figure 1. The activities were repeated every quarter except for the orientation which was done only once at the beginning of the study. Process of setting up maternal health component in existing and new saving groups. The activities included the following: Saving groups with maternal and child health accounts and transport agreements. Eighteen key informant interviews (KIIs) and 15 Focus Group Discussions (FGDs) were held in the intervention and comparison areas in the three districts. The 18 key informants (12 in the intervention arm and six in the comparison arm) were selected purposively, either because they were involved in the implementation of the study and therefore knowledgeable about the study (three CDOs, one super village health team member (VHT), four chairpersons and treasurers of saving groups, two subcounty chiefs, three health assistants) or because they were local opinion leaders (three local council chairpersons and two secretaries for health) and were, therefore, in position to share their observations and perceptions about the savings component of the project and its influence on the community. Nine FGDs were done in the intervention and six in the control areas. Six focus groups were held with men of reproductive age and nine were held with women of reproductive age. Each focus group had six to 12 participants. The focus group participants were selected with the help of the local council chairperson, who is a gatekeeper in the community. The members of the female focus groups were women of reproductive age who had given birth within one year prior to the data collection period, while participants for the male focus groups were men whose wives had given birth within one year prior to the data collection. A key informant guide and FGD guide was used to collect data from the key informants and the focus group participants. The information collected focused on issues such as saving practices for maternal health, the experiences of the respondents with saving groups, benefits of joining saving groups, male involvement in saving groups, challenges encountered in saving groups and perceptions about the savings component of the project (with a focus on areas where it worked well and where challenges were noted, as well as suggestions for improvement). The FGDs and KIIs were conducted by a total of four facilitators who had experience in collecting qualitative data. Data extraction guides were used to extract data from the project reports and meeting notes. The interviews were recorded using a digital recorder and then later transcribed verbatim and reconciled with the notes taken during the interviews. The analysis was done manually using thematic analysis. The transcripts were first read and re-read to allow familiarization with the data. A coding frame was then developed in line with the research questions. The transcripts were then coded and both deductive and inductive coding approaches were utilized. The deductive approach to coding was based on the key issues that we sought to answer in relation to our study objectives, while the inductive approach allowed us to include new issues that emerged as we read the data. After that, categories were derived and themes generated from the data. The categories that were identified when looking at saving practices included individual saving methods and group saving methods. The categories that emerged when looking at factors that facilitate or constrain saving included individual factors, benefits of joining saving groups and management-related factors. When looking at lessons learnt, we used the five stages as categories and then identified themes within each of them. Interpretations and arguments were then drawn from the data in relation to the objectives and presented as text. The project documents were reviewed and key lessons were synthesized out of them and used to draw key lessons which were presented as text and a matrix. Written informed consent was obtained from all key informants, while verbal informed consent was sought from focus group participants. Ethical approval was provided by the Makerere University School of Public Health Higher Degrees Research and Ethics Committee (HDREC-152) and the National Council of Science and technology (UNCST-HS1399).
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