Launched in July 2006, more than 19000 patients were seen for complaints of sexually transmitted infections  (STIs) in the first 20 months of the Uganda voucher program.  Marie Stopes International and Microcare Limited have worked closely to build a network of healthcare providers in Ibanda, Isingiro, Kiruhura, and Mbarara districts. Moving beyond the WHO-recommended STI syndromic management used in many developing countries, OBA clinics offer two important improvements: use of low cost lab technologies (wet mount and a microscrope) and a healthcare subsidy for partner referral. A contractual relationship ensures that a financial mechanism is constantly in place to induce compliance with quality lab and management standards.

The voucher program in Uganda is coordinated by the following organizations:

Marie Stopes International-Uganda manages the voucher distribution, claims and processing, fraud control, quality assurance and provider accreditation. Marie Stopes International-Uganda initially selected twenty clinics and distributes voucher through drug shops, pharmacies and targeted behavior change campaigns in areas known to be frequented by the poor at risk of STIs.

Venture Strategies for Health and Development is a nonprofit that uses market forces to improve the health of people in resource-poor settings. Working closely with KfW, University of California, Berkeley technical advisers from VSHD have provided policy and operational recommendations for the evaluation of innovative Kenyan and Ugandan voucher programs delivering targeted cost-effective reproductive health services.

Since 1989, the Mbarara University of Science and Technology, Department of Community Health (DOCH), has provided training in public health to undergraduate and graduate medical and nursing students. In the OBA project, MUST coordinates the external evaluation, fielding staff for the baseline and follow-up household surveys on district healthcare utilization and STI prevalence.

KfW Development Bank supports a number of OBA pilot projects on behalf of the German federal government. The projects finance health services for safe motherhood and childbirth, family planning, diagnosis and treatment of sexually transmitted infections (STI) and sexual violence. In Uganda, KfW is funding the OBA voucher scheme for high-quality cost-effective lab diagnosis and STI treatment with free partner referral in a private provider network.

The Uganda Ministry of Health, AIDS Control Program, is a leading unit in the Ministry with strong leadership engaging private sector partners and market mechanisms to further national public health priorities. Also within the Ministry of Health the STD Unit at Mulago Hospital established the lab diagnostic algorithm and assisted MSI-U with provider accreditation.

View Uganda clinics in a larger map

Clinic selection and accreditation

In OBA programs, service providers are reimbursed only after verification of contractually delivered services. Following a baseline survey of providers, rigorous lab training and a second review of the facilities, twenty providers were invited to sign contracts with MSI. Eighteen clinics joined in the weeks before the launch on July 29, 2006.

Behavior change communication

Marketing the vouchers, educating communities about STIs and the STI treatment services and the importance of partner referral are all important elements in stimulating a healthy demand for the OBA STI services.

Health information system

The focus of output-based systems is by its nature on the measureable output – the numbers of patients treated and cured. That simple output is only measureable when supported by an efficient database management system and data collection methods. Microcare’s unique experience in Uganda has been the innovative implmentation of efficient and cost-effective insurance systems for low-income populations, building when possible from local social savings institutions (see Engozi societies). The Voucher Management Unit System is detailed in this early report on database design (625kb, PDF).