“Vouchers for Services and Supplies”

Christine Namayanja, Programme Director , Marie Stopes International Uganda28th May| Reproductive Health Supplies Coalition Meeting| Kampala Uganda

Purpose

• Highlight the impact of private sector in reaching out to get a market that otherwise would not take up the services.

• Describe how the OBA approach improves RH commodity security-ensures supplies are always available.

• Output Based Aid (OBA) is a results based financing mechanism that ties the disbursement of subsidies to clearly specified outputs that directly support improved access to basic services.

What is Output Based Aid

At the Heart of OBA

1. Contracting out of service provision to an already existing service provider (third party)

2. Bridging of the financing gap between what the target group are able to pay for basic health services and the required cost for providing services.

Contrast of a traditional input based approach to OBA approach

Inputs(such as materials)

Private finance

Public finance

Service recipient

Service Provider

Private financing mobilized by

service providers

Reimbursement for outputs delivered

Traditional input-based approach Output-based approach

Service Provider

Service recipient

Inputs(such as materials)

Source: Output-Based Aid Lessons Learned and best Practices

Uganda OBA Programme Overview

• The Uganda OBA Project finances the provision of quality healthcare for safe deliveries and STD management by

− selling vouchers to clients at − highly subsidised prices and by − reimbursing the costs to the − accredited private service provider for the − actual services provided.

General mechanism of the OBA Programme

DonorKfW / GPOBA

MSIU

Distributor (pharmacy, drug shop, CBD)

Private Provider

Voucher recipient

$

Service

$

$ report

Service PackageSafe Delivery STD Management

Voucher benefits (services covered)

Safe delivery: 4ANCs, Basic & EMOC, PNC

STD Management

Eligible recipients Poor women Sexually active people, focus on poor and high

risk

Geographic area covered

20 districts 6 districts

Beneficiaries 60,000 deliveries 35,000 cases

Voucher DistributionSafe Delivery STD Management

Coverage Mainly rural based Semi-rural based

Eligibility criteria Use of Poverty Grading Tool & home visits for qualification of poor mothers

No specific qualification criteria-all sexually active

Distribution system Use of trained CBDs Pharmacies & drug shops

Voucher selling price $ 2 $1

Management of Service Provision

•Mapping, selection and approval-participating clinics

•Defined service protocols and guidelines-

• Cost of services agreed

•Training & orientation of service providers in OBA and

service package.

•Claims processing & management

•Reimbursement/payment of providers

Contract management−External periodic facility Quality Assessments for service quality, fraud detection, right targeting etc

Quality services means:- good counseling and client care, constant availability of qualified personnel, adequate stocks of medicines, vaccines, consumables/medical supplies, equipment

−Client M&E for right cost, good client care, fraud detection.Good client care:- in addition to professional treatment of clients, health providers should ensure that get all the required drugs and are not charged for supplies

−Renewal or termination of contracts.

Key Lessons: Targeting New PopulationsRecipient strategy- targeted approach as opposed to a universal

approach (difficult-to-reach groups, poor, high risk).

Benefits• Lowest wealth quintile in rural

communities of south and western Uganda reached.

• Equitable distribution of resources as vouchers are distributed to disadvantaged and poor women

• Removing cost and quality barriers has improved uptake of services

• Client satisfaction leads positive health seeking behaviour-clients asking for other services

Potential draw backs• Vouchers aimed at disadvantaged

groups may leak directly or indirectly to less disadvantaged

• Voucher recipients may lack reliable information to choose - vouchers can be stigmatizing

• Relies on availability of extra capacity-existence of providers

Key Lessons: Quality ImprovementsIncreased engagement of private sector capital and expertise by encouraging the private sector to serve poor customers they would otherwise disregard.

VSPs have hired skilled staff to provide services to voucher clients

Key Lessons: Quality Improvements

Benefits• Voucher Service Providers

have made infrastructure improvements

• Improved & expanded facilities

• Increased stocks of drugs & ensured availability (no stock outs)

• Purchase of relevant equipment

• Purchase of cars or motorcycles for emergency transport

Potential draw backs• Access to finance- if cost of pre-

financing the outputs would place undue burden to the provider.

• Security of funding- swift disbursement when outputs have been achieved

Key Lessons: Quality Improvements

Benefits• Increased accountability by shifting performance risk to service by paying them only after delivering “agreed” outputs

– Record keeping has improved-monitoring for results made possible

– Monitoring of distribution on behalf of the management agency by reporting and repulsing wrong clients.

• Produces the most tangible cost of delivering services.

Potential draw backs• Services may become fragmented

• Administration and monitoring system costs may be high