USAID UGANDA VOUCHER PLUS ACTIVITY "Supporting poor pregnant women to access safe, facility-based maternal, newborn health services"

The USAID Uganda Voucher Plus Activity focused on increasing high quality maternal, newborn, and child health and family planning services through the private sector using the voucher mechanism. Simultaneously, the Activity built local capacity of the public and private sector and communities to develop, manage, and participate in long-term health financing options.

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View the Project Documentary

We improved access to health services for poor mothers.

The Uganda Ministry of Health is committed to ending preventable maternal and child deaths, and recognizes that Uganda must increase the role of the private sector in expanding quality services for mothers and babies. USAID supported Abt Associates to implement the Voucher Plus Activity, to address this need by contracting private providers, training them and linking them to government-supported health facilities to deliver quality maternal and newborn services to poor mothers in 36 districts in Northern and Eastern Uganda. We worked with PricewaterhouseCoopers (PwC), BDO East Africa, and Communication for Development Foundation Uganda(CDFU).

The Activity technical approach focused on six key pillars.

Pillar 1: Equity: Expanding the reach of the health system to serve the poorest, hardest-to-reach populations through partnering with remote service providers.

The poor mothers in the remotest locations were able to access maternal child and health services in the nearest private facilities.

Equity in access means that everyone who needs a service is able to access that service, regardless of ability to pay (WHO 2019). Equity in access to health services has three dimensions: physical accessibility, financial affordability, and acceptability. Read the project technical brief

Using a Poverty Grading Tool in Rural Uganda: Lessons Learned in Identifying Poor Mothers for Subsidized Maternal Health Services. Read the technical brief.

View video: Mothers share their life-changing stories

Pillar 2: Financial protection: Vouchers offered financial protection to very poor women to avoid catastrophic out-of-pocket payments.

A voucher cost UGX 4,000 (approximately USD 1) and entitled mothers to a range of maternal services including four antenatal care visits, delivery and post-natal care, EMTCT and postpartum family planning.

The Activity protected women from high out-of-pocket costs related to pregnancy and childbirth by covering the costs of safe, facility-based deliveries. This allowed them to obtain a quality package of MNCH and FP services without being exposed to financial hardship. Read the project technical brief

View video: Supporting poor mothers to access vouchers for MNCH services

Pillar 3: Quality: The Activity improved the quality of RMNCH services in the private sector.

Facilities were able to invest voucher reimbursements to invest in health to improve quality of care for the poor population

According to the WHO’s vision of quality of care for pregnant women and newborns, quality of care encompasses the provision of care and the experience of care. The Activity strengthened the capacity of participating private providers through training, on-site clinical mentorship, supportive supervision, and annual clinical audits to improve service quality. Read the project technical brief on quality of care.

Read the project brief: Provider mapping and accreditation for contracting

View video: DHO's testimony to increased access to MNCH by the Voucher Activity

View video: Experiences from a participating facility

Pillar 4: Public-private partnerships: The Activity stimulated public-private partnerships for health at the district level to strengthen the health system

Private facilities were able to leverage partnerships with government facilities to access drug supplies, equipment and medical service training.

Public private partnerships for health (PPPH) allow the public and private sectors to work together to leverage each other’s resources, experience and intellectual assets for better service delivery. PPPH is recognized in the National Health Development Plan as an important strategy for strengthening health systems in Uganda.

The Voucher Plus Activity was successful in forging several health partnerships to increase the impact of the program.

View video:The Activity's approach to fostering PPPH

View video: PPH perspectives from a private facility owner

View video: Government stewardship in improving EMTCT linkages

Pillar 5: Sustainable financing: The Activity empowered the private sector to contract with long-term health financing mechanisms

Before (l) and after (r): Heaven of Peace health facility, Lira District, was one of the facilities that partnered with the Activity. Many facilities were able to use voucher reimbursements to improve quality of care including hiring qualified human resource, ensuring availability of drugs, purchase of relevant equipment and invest in adequate, appropriate infrastructure for health care service.

The Activity increased health facilities' readiness to engage with sustainable financing mechanisms such as Community-Based Health Insurance (CBHI) and the national results-based financing (RBF) programs to enable poor families continue to access affordable quality MNCH services within their communities. At least 42 facilities have enrolled into the RBF while 18 facilities enrolled members into CBHI.

View video: District leadership commitment to collaborate with the private sector

View video: Sustainability strategies adopted by the Activity

Pillar 6: Evidence to action: The Activity generated and used evidence to adapt the implementation approach and inform other implementers and development partners

Engaging district leadership to share best practices on sustainable health financing options to garner their support for community health insurance

The Activity gathered data and information to generate evidence that drove decisions and informed stakeholders to adopt and implement lessons learned from the project.

The final Voucher Plus virtual dissemination meeting, was attended by various stakeholders including USAID, other development partners, Ministry of Health, district health officials, other district leaders, USAID and other health implementing partners and voucher service providers. Lessons will support planning for health financing in collaboration with the private sector.

Strategic media outreach to share the Activity lessons




“The project changed the attitude of the community and enabled the mothers realize the importance of delivering in health facilities.” Opit Joseph Okojo, Chairman LCV, Serere District
"I believe I gave birth successfully because I went to the clinic from the start of my pregnancy."
"Vouchers brought more women to the clinic because they could now afford the service". Robert Ojok, Administrator Gift Life clinic.
Thank you USAID for saving the lives of mothers and babies.