Leading the Uganda Voucher Plus Activity
- The poor need affordable health financing options to access quality health care.
- The project provides access to facility-based births with skilled attendants in the private sector.
- In the first two years, almost 60,000 births took place with skilled attendants.
The Ugandan Ministry of Health (MOH) is committed to ending preventable maternal and child deaths, and it recognizes that in order to achieve this, Uganda must increase the role of the private sector in expanding quality services for mothers and babies. The USAID Uganda Voucher Plus Activity (the Activity), led by Abt Associates, is designed to expand access to quality obstetric, newborn and postpartum family planning (PPFP) services for poor women through the private sector. The Activity provides facility-based deliveries with skilled attendants in 30 districts in the Northern and Eastern regions.
Using an output-based financing mechanism, service providers are accredited, contracted, and reimbursed to provide an explicit package of obstetric, newborn, and PPFP services. The service package includes four antenatal care visits, elimination of mother to child transmission of HIV, delivery with skilled attendants, referrals for complications, postnatal care, and PPFP services. Working with the Activity, selected Village Health Teams and other community agents sell vouchers to poor pregnant women at a subsidized rate of 4,000 UGX. VHTs also share maternal and child health information with pregnant women, men and youth. The Activity’s clinical staff provide training, technical assistance, and ongoing supervision and mentorship to the Voucher Service Providers.
In the first two and a half years of the Activity, the team distributed approximately 150,000 vouchers, leading to almost 70 percent attendance at the first antenatal care visit and 60,000 births with skilled attendants. The participating providers tested nearly 100 percent of mothers for HIV and guided them to treatment (some treated on-site, some referred).The Activity engaged local health officials in various activities to improve their understanding of output-based financing mechanisms and how they could support private providers.
The Activity has invested in continuous learning and adaptation to respond to challenges and adapt programming to improve outcomes. To this end, the Activity is preparing a series of knowledge and learning briefs on how output-based financing strategies can contribute to increased quality. The Activity also contributes evidence to the MOH’s results-based financing initiative, and supports the MOH as it improves access to quality health services.