Audit showed a decline in infant mortality in Uganda
Christian Andersson helped performance auditors at the Office of the Auditor General of Uganda audit an initiative to increase vulnerable women’s access to maternity care. Through extensive interviewing, they were able to collect data that showed that the project reduced infant mortality by 65 percent.
The audit added new knowledge about infant mortality and the results have been published in the scientific journal Reproductive Health.
Christian Andersson normally spends his days examining the effectiveness and efficiency of central government initiatives in Sweden. As an expert in quantitative investigation methods, he was called upon to support his peers in Uganda. This cooperation formed part of the Swedish National Audit Office’s development cooperation efforts, in which we give peer-to-peer support in building professional and effective supreme audit institutions.
Christian Andersson, Audit Director
What did you audit?
"A central government project, supported by development funds from the Swedish International Development Cooperation Agency (SIDA), in which poor pregnant women could purchase vouchers for approximately USD 1 for access to maternity care services at local health centres. It was part of the Ugandan government’s efforts to attempt to reduce a high infant mortality rate."
How did you examine the impact of the project?
"There was not enough data to study the impact of the project, so the first challenge was to determine whether they could collect information that could reflect the impact."
"The project had used a clearly defined poverty score to determine who would be eligible to purchase a voucher. This made it easy to establish a control group of women with the same conditions, but who did not have the opportunity to purchase the voucher. The interesting part was to find out if more children survived in the treatment group than among pregnant women with otherwise similar conditions."
"The Ugandan performance auditors conducted extensive field work, sending out people to interview women in the villages where the project had been carried out. Nearly 1 500 women were interviewed in total."
"During the course of the audit, a couple of other Swedish colleagues and I provided support in questions such as: How should we design the audit? What data is available? Can we collect the data we need? How should we evaluate the data we collect? What software do we need?"
What is the major difference compared with working on similar audits in Sweden?
"The greatest challenge for my colleagues in Uganda is the ability to devote any time and resources at all to this type of audit. An important factor for success in this cooperation was that the Ugandan auditors could dedicate more time than in other audits."
"They also needed to be more inventive in their data collection. Sending surveys to these poverty-stricken villages, where many people are illiterate, isn’t effective. Instead, they created a special app for the questionnaire and hired people to carry out interviews. The Uganda Bureau of Statistics helped them to upload the statistics for analysis."
What did it feel like to see the results of the audit?
"It was very exciting when we understood that the project had led to the survival of more children. By selling a voucher for USD 1, women were given access to healthcare services equalling USD 60. We made a rough estimate that if the project had been implemented throughout Uganda, between 10 000 and 30 000 children per year could have been saved and that the cost of helping an additional child survive was around a mere USD 1 000."
Knowledge that can help more children survive
The auditing team concluded that the focus on more accessible maternity care really worked. The shortcomings they identified included the fact that the project had not been properly managed in some parts of the country and that the results had not been used on a larger scale.
The audit provided new knowledge about what can lead to lower infant mortality. The results have now been published in the scientific journal Reproductive Health.
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