The first delivery on the new HealthyBaby vouchers took place the morning of February 28th (see Melissa’s post).The delivery took place at Angella’s Domicillary in Rubindi trading center. Mother and baby are both doing well.

The program was launched in September in Mbarara and then issues ranging from reimbursement rates to database development took [...]]]>

First HealthyBaby birth

The first delivery on the new HealthyBaby vouchers took place the morning of February 28th (see Melissa’s post).The delivery took place at Angella’s Domicillary in Rubindi trading center. Mother and baby are both doing well.

The program was launched in September in Mbarara and then issues ranging from reimbursement rates to database development took longer to resolve than initially anticipated, but the program is up and running now. It’s being rolled out in two stages. 11 facilities in the areas within an hour’s drive of Mbarara town are contracted now and 15 voucher community-based distributors do door-to-door selling of vouchers to poor women in rural communities. By May a second phase of 60 providers and many new voucher distributors will be confirmed in districts to the north and west – up to four hours from Mbarara in some cases. In the end, a population of 7-8 million will be covered with an anticipated 110,000 deliveries in the next three years.

In the HealthyBaby program the mother purchases a voucher for 3000 USh (approximately 1.50 USD). A peal-off sticker from the voucher is then submitted with a claim form on each visit. Four antenatal visits are covered by the program as well as the delivery, including any surgery needed then, and postnatal care.

After each visit, the facility submits the claim form with the voucher to the management agency, Marie Stopes International Uganda, which then pays the hospital for the cost of the visit – labs, any prescriptions given, the consultation fee, etc. The attending nurse usually completes the paper form and the mother signs or puts her thumbprint on it. Filling out the forms can be tedious and error prone. The same seems to be true too of much of the government clinic data reported to district health offices and up to the Ministry of Health in Kampala. Record keeping can be improved. Melissa is working to develop digital systems that can help improve communications between the clinics and the management agency, and also decrease the cost and burden of claims administration. More on that later.

Nov 12 update:  I wanted to post this newsletter (KenPop vol 2 issue 3, 1.9MB PDF) with more detail on [...]]]> The Kenya and Uganda OBA programs were both financed by the German KfW Development Bank and launched in mid-2006.  Recently a film was made about the Kenyan “voucher babies” highlighting one expectant mother in the Kenya program.

Nov 12 update:  I wanted to post this newsletter (KenPop vol 2 issue 3, 1.9MB PDF) with more detail on the Kenya OBA program which sells vouchers for safe delivery, long term family planning products and services, and a rape response service.  Between June 2006 and January 2008, over 73,000 vouchers were distributed in the 5 project sites.  Safe motherhood vouchers made up more than two-thirds of the vouchers sold.

Competitive voucher schemes are one of many demand-side financing approaches to health care, which links public funding to delivery of basic health services. The schemes have the potential to target specific segments of the population [...]]]> Anna Gorter is giving a talk next Thursday at the University of Bristol about vouchers in health. The synopsis follows here:

Competitive voucher schemes are one of many demand-side financing approaches to health care, which links public funding to delivery of basic health services. The schemes have the potential to target specific segments of the population effectively and provide them with priority services such as treatment of sexually transmitted infections (STI), HIV-AIDS services, family planning, safe motherhood and gender violence recovery services. When a voucher scheme is built on the principle of competition, it may not only further empower clients by allowing them to bring their business to the provider of their choice (be it public, private-non-profit or private-for-profit) but also give incentives for service providers to be innovative, cost effective, and responsive to the clients. Vouchers also encourage the use of specific health services because they provide information about the existence of the services and guide potential users to where these can be obtained, contributing to the potential ability of vouchers to reach underserved and/or vulnerable population groups.

In this talk we will introduce competitive voucher schemes as a demand side financing approach, describe their strengths and when, where and how these schemes work best. We will present the short history of competitive voucher schemes in the health field and illustrate this with relevant experiences from Nicaragua, Asia and Africa: a Nicaraguan scheme providing STI and HIV-AIDS services to sex workers, their clients, and glue-sniffing youth; schemes in Uganda and Kenya providing sexual and reproductive health services to disadvantaged populations; schemes providing safe motherhood services to the poor in Cambodia, India and Bangladesh; and other programmes. We will conclude with a discussion on the relevance of competitive voucher programmes in improving the provision of health care to underserved and/or vulnerable population groups.

The main work-aids for the output-based STI voucher are a [...]]]> I was in Uganda this past week following up the data cleaning from our October-November population survey.  On Wednesday I heard from the people at HLSP.org about their Gates funded work to document low-cost “work aids” and their interest in what the Uganda OBA project may use.

The main work-aids for the output-based STI voucher are a provider manual (pdf link) and wall-mounted algorithm for STI lab diagnosis and treatment.  Marie Stopes provides the manual and algorithm to contracted providers, who generally operate small and independently run facilities with space for the simplest lab diagnostics.  The private sector health workers in the OBA project are a mix of medical doctors, nurses, lab techs, and a few informally trained community health workers.  The algorithm was designed for use by the clinician as a memory aid setting out the program’s diagnostic and treatment objectives.

WASHINGTON, October 24, 2007– KfW Entwicklungsbank, a German government-owned development bank, yesterday signed a US$ 4.3 million grant to be administered by The World Bank, for the treatment of sexually transmitted diseases, and reduction of maternal and infant mortality [...]]]> Posted originally on the GPOBA website in October.

WASHINGTON, October 24, 2007– KfW Entwicklungsbank, a German government-owned development bank, yesterday signed a US$ 4.3 million grant to be administered by The World Bank, for the treatment of sexually transmitted diseases, and reduction of maternal and infant mortality amongst poor people in Uganda.

The grant is to be managed under the World Bank’s Global Partnership on Output-Based Aid (GPOBA) as a performance-based subsidy, which is designed to create incentives for efficiency and the long term success of development projects. The Output Based Aid (OBA) grant complements German cooperation funds of US$2.4 million that will develop local systems and capacity.

Following the signing, KfW’s Board member, Wolfgang Kroh said: “German financial cooperation aims at strengthening sustainable systems of social protection for the poor. Let us jointly support this new conceptual approach to pro-poor service delivery as well as to health financing under private sector participation and share the evidence with our partners globally.”

An innovative voucher program, which allows patients to choose among participating service providers, was introduced in Uganda in 2006 for patients with sexually transmitted diseases (STDs) seeking treatment. The program, funded by German financial cooperation, has shown to be successful, so that the grant signed yesterday will allow for the project to be extended by a further four years. The project extension will not only allow for more STD patients to be treated, but will also allow the provision of safe child delivery packages including 4 ante-natal visits, delivery attended by a trained medical professional and one post-natal visit.

“This is the first health project for GPOBA and it demonstrates the potential of OBA designs to contribute to the cost-effective use of public funds in the health sector. The project is a good example of the donor cooperation, working together to reach common goals. The project is results-based, and helps develop local capacity as well as the local market for private small scale medical service providers.” stated Patricia Veevers-Carter, Program Manager for GPOBA.

The two project components are expected to benefit up to 255,000 poor people in Western Uganda – 110,000 mothers and their children as well as 35,000 patients suffering from STDs. Use of local doctors and midwifes for the project will increase local capacity for providing affordable health care services for the poor. Given the output-based nature of the project, the medical service providers will only be reimbursed after service provision (the “output”). In return, the project will provide them with a secure income stream if they are able to provide quality service and attract patients.

The Global Partnership on Output-Based Aid (GPOBA) is a global partnership administered by the World Bank to develop output based aid (OBA) approaches across a variety of sectors including infrastructure, health and education. GPOBA’s current donors are the UK’s Department of International Development (DFID), the International Finance Corporation (IFC), which is a member of the World Bank Group, the Directorate-General for International Cooperation of the Dutch Ministry of Foreign Affairs (DGIS), and AusAid of Australia. The grant agreement signed yesterday was funded out of IFC’s contribution to GPOBA.

KfW Press Release: Weltbank und KfW Entwicklungsbank finanzieren Gesundheitsprojekt in Afrika

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