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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.

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.

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.

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

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

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

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