UPDATE ON THE UGANDA REPRODUCTIVE HEALTH VOUCHER PROJECT (URHVP)

URHVP is a follow up to the successful maternal health voucher scheme (Healthy life and Healthy baby) implemented in Western Uganda from 2008-2012. The project finances the demand side through use of vouchers to reduce the likelihood of out-of-pocket payment for deliveries among women in communities served by the program. The four year Ministry of Health (MOH) project kicked off in September 2015 .It is funded by the Swedish Development Agency (SIDA) ,World Bank ,United Nations Population Fund (UNFPA). It is implemented by Marie Stopes Uganda (MSU) as the Voucher Management Agency (VMA) while BDO is the Independent Verification and Evaluation Agent (IVEA).

URHVP is  implemented in 12 districts of South Western Uganda (Mbarara, Kabale, Kanungu, Ntungamo Kiruhura, Sheema, Buhweju, Mitooma, Ibanda, Isingiro, Bushenyi, Rubirizi) and 13 districts of East and Central Uganda (Jinja, Bugiri Kamuli, Buyende, Kaliro, Luuka, Mayuge, Iganga, Namutumba, Kibuku, Tororo, Namayingo and Busia). The primary beneficiaries are the poor and vulnerable pregnant mothers resident within the catchment areas of the contracted health facilities. The contracted Voucher Service Providers (VSPs) and surrounding communities are the secondary beneficiaries.

The project overall aim is to increase access to skilled care among poor women living in rural and disadvantaged areas during pregnancy and delivery.

The project targets 3 key outputs;

  1. Support 142,400 pregnant women to deliver under skilled attendance;
  2. Out of all the vouchers purchased by pregnant women,70% are redeemed to support deliveries in a health facility;
  3. 90% of pregnant women enrolled under the project attend at least one ante natal care visit (ANC 1).

The project comprises of two components.

  • Package of Safe Delivery Services to Poor Pregnant Women.
  • Capacity Building and Project Management

The package of services consists of: four antenatal visits, safe delivery, one postnatal visit, Family Planning ,treatment and management of selected pregnancy-related medical conditions and complications (including caesarean sections), and emergency transport. The package also includes services for Elimination of HIV transmission from mother to child (eMTCT) as part of antenatal care. The VMA takes lead in implementing component one. The specified services are provided by the contracted VSPs that later submit reimbursement claims together with the appropriate voucher coupons to the VMA for settlement at the negotiated and agreed fees.

The pregnant mothers purchase vouchers at Uganda shillings (UGX) 4,000 (US$1.60) from members of Village Health Teams (VHTs) in their areas of residence. A combination of geographical targeting (based on poverty mapping) and a customized poverty grading tool is used to select eligible beneficiaries.

As at March 2017 a total of 247 health facilities were identified, assessed and contracted from both Public, Private not For Profit (PNFP) and Private for Profit (PFP) as illustrated below.

South  Western Region Eastern Region
Service Type Private (PFP/PNFP) Public Total Service Type Private (PFP/PNFP) Public Total
BEmOC 80 12 92 BEmOC 42 74 116
CEmOC 12 18 30 CEmOC 4 5 9
Total 92(75%) 30(25%) 122 Total 46(37%) 79(63%) 125

Component two supports project management functions including building national capacity to mainstream and scale up implementation of safe delivery voucher scheme in the health sector.

With the direct supervision and guidance from MoH, MSU has trained service providers (midwives) on the Basic Emergency Obstetric Care (BEmOC) package (ALARM) and Post-Partum Family planning (PPFP). The project has also trained Doctors and Anaesthetic officers in Comprehensive Emergency Obstetric Care (CEmOC) services.

MOH Permanent Secretary visits URHVP

MOH Permanent Secretary visits URHVP

 The Permanent Secretary Dr Diana Atwiine (4th right), MD Marie Stopes Dr Carole Sekimpi (2nd left) in a group photo with the URHVP team.

The Permanent Secretary Dr Diana Atwiine (4th right), MD Marie Stopes Dr Carole Sekimpi (2nd left) in a group photo with the URHVP team.

The Uganda Reproductive Health Voucher Project (URHVP) recently conducted a field visit with a high powered delegation led by the new MoH Permanent Secretary Dr Diana Atwiine. It was a great platform to discuss how best results based financing can be operationalized to get out puts out of both public and private players in Uganda’s health sector. The team visited a number of centres in the East that are supported by the URHVP program.

The Uganda Reproductive Health Voucher Project (URHVP) is a Ministry of Health program being implemented in partnership with Marie Stopes Uganda (MSU) with support from the World Bank. The overarching goal of the URHVP is to reduce maternal and perinatal mortality and morbidity through increased access to skilled care (Voucher Based Services) during pregnancy, delivery and postnatal period.

Uganda has high maternal mortality ratio of 438/100,000 live births, 435/100,000 live births in 2006 and 524/100,000 live births in 2000. A perinatal mortality rate of 27/1000 pregnancies in 2011, 46/1000 pregnancies in 2006 and 55/1000 pregnancies in 2000.

This four years project is currently being implemented in the South- Western and Eastern districts of  Uganda in Mbarara, Kabale, Kanungu, Ntungamo Kiruhura, Sheema, Buhweju, Mitooma, Ibanda, Isingiro, Bushenyi ,Rubirizi, Rakai, Sembabule, Masaka, Jinja, Kamuli, Buyende, Kaliro,  Luuka, Mayuge, Iganga, Namutumba, Kibuku, Tororo,  and Namayingo.