OBA Webinar Series

REPRODUCTIVE HEALTH VOUCHERS IN WESTERN UGANDA

Scaling Up OBA Projects March 27, 2014

www.gpoba.org/webinars

Presentation Outline

• Uganda RH OBA Project Overview

• Project Outputs at a glance

• Knowing a successful project

• Lessons for Scaling UP

• Challenges

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Uganda RH OBA Project Overview

• Partnership between GPOBA, KfW, World Bank and MoH to improve safe delivery services and management of STDs by introducing use of vouchers.

• Through contracted private providers. • Project Financing:

– Total Project Cost -US$6,814,000: – GPOBA (IFC)$4,300,000 ($3,810,000 Subsidy; $100,000 IVA; and $390,000 FA Fee) – KfW $2,400,000 - Voucher Management Agency – User Contribution of $114,000

• Voucher Management Agency – MSI

• Fiduciary Agent – KfW

• Independent Verification Agent – PWC

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Service Package

Safe Delivery STD Mgt

Voucher benefits 4 ANCs, Basic & EMOC,

Transport and PNC

Diagnosis & Mgt of 7

Common Syndromes

Target 50,456 deliveries

(Contracted Amount $70)

35,000 cases

(Contracted Amount $10)

Recipients Poor rural women Sexually active people in

urban and semi urban

Eligibility Criteria Use of Poverty Grading Tool + geographical targeting

No specific qualification criteria

Distribution System

Use of trained Community Based Distributors

Pharmacies & drug shops

Voucher Price Shs. 3,000 ($1.30) Shs. 1,500 ($0.65)

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Project Outputs At A Glance

1. Babies Delivered - 65,590 (130% of Target)

2. Treated STD clients - 31,660 (90% of target)

3. Enrolled private providers – over 120

4. Weighted Average Reimbursement Cost: – Safe delivery - $49.55 – Normal delivery - $25.00 – Complicated delivery - $79.00 – STI - $11

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Knowing a Successful Project

• Project Evaluation Findings:

– Targeted women from poorest quintiles to access services compared to those from the richer quintiles.

– increased deliveries in health facilities with significant reductions in home-based births.

– significant reductions in the likelihood of out-of-pocket payment for deliveries among communities.

• Heightened interest to scale up safe delivery scheme :

– DFID and USAID:– Introduced a FP voucher scheme.

– USAID:- RH Voucher Scheme in four project districts

– Sida:- $13.3 M for scale up through GPOBA

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Uganda RH OBA Project - Lessons for Scaling UP

• Communication and Dissemination Strategy – Evaluation Findings – Sensitize key stakeholders on the program by demonstrating what works – Steer away from championing one form of RBF/OBA/PBF against another – People know when a project is successful

• Ensure buy-in of Devt Partners including the World Bank – Encourage partners to visit the project site; – Support partners interested to start similar programs; – Develop the program to accommodate interested parties; e.g. different entry

times

• Address perceived problems:- high overhead and management costs – Be transparent about costs, – Challenge the other programs to provide their costs; – Focus on the results to speak for themselves

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Uganda RH OBA Project - Lessons for Scaling UP (2)

• Government Leadership. – Govt should be ready to tell partners to finance the program;

– Building support of Local Leaders

– Buy-in of Public Service Providers;

– Steering Committee

• Plan to mainstream OBA – Sector plans e.g. Health Financing Strategy;

– Arrange training of key stakeholders on RBF/OBA

• Strong and Credible VMA – With robust systems

– Open to share findings and provide TA to interested parties

– Manage similar programs by other partners

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Challenges

• Diverse Interests of the Development Partners

• Suspicion about the World Bank intentions

• Unhealthy competition

• Concerns about sustainability

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