By Esther Nakkazi
After working in the public sector for over two decades, Grace Oling, a trained midwife decided to start her own business offering health services to the rural communities in Pader district located in northern Uganda.
The beginning was tough, the profits were minimal, she had a few staff, client flow was limited and she did not have most of the equipment that would make her run the health facility efficiently and offering quality services as she had dreamt.
In 2016, the U.S. Agency for International Development (USAID) Voucher Plus Activity project started to expand and improve access to quality maternal and newborn services. This was a year after Oling started her JAFO medical center and she qualified to become a service provider.
After Voucher Plus, Oling’s life changed and JAFO medical center started achieving its purpose – serving the rural poor women by providing them with quality maternal and newborn services. “My profits were only UGX 400,000 (USD $107) a month before becoming a voucher provider. After I joined the project my profits increased to UGX 2,000,000 (USD $540) a month and I have 13 staff from only 4,” says Oling.
JAFO medical center then got the much needed fresh coat of paint, medical beds, a proper waste management system, and an ambulance to ferry patients who would be referred to bigger health facilities.
“The facility is neat and clean, we bought a scan, new hospital beds, an incinerator and fridges to keep the vaccines for immunization,’ says Oling. This created a one-stop center for women to attend antenatal care, give birth and have their children immunized a service that was a reserve for government health facilities before.
The Voucher Plus Activity also carried out audits which means the participating facilities had to maintain the required level of standards – bookkeeping, training staff, cleanliness, timely referrals, and client care. In return, this increased the clientele for JAFO to become the first choice for most voucher holders in Pader.
“We deliver 60 babies a week from 10 before Voucher and most pregnant women attend all the four antenatal visits,” says Oling.
“The USAID Voucher Plus Activity was focused on ensuring that every poor pregnant woman in the regions it covered has access to high-quality maternal health care and family planning services,” says Christine Namayanja, Chief of Party.
The Voucher Plus Activity, a project of the USAID has expanded and improved access to quality maternal and newborn services in 35 districts in Northern and Eastern Uganda. As a result of the assistance from the American people, the activity enabled over 194,800 safe deliveries at 146 private health facilities.
It also enabled private-sector health providers like Oling to participate in a service that she is passionate about, save newborn babies and mothers’ lives and make business sense out of their investments.
By improving the quality of health services private providers that have participated have increased demand for safe motherhood services and facility-based deliveries to reduce maternal and neonatal morbidity and mortality, says Namayanja.
The way the voucher works:
A needy family buys a voucher from the USAID Voucher Plus Activity at a fee of UGX 4,000 (USD $1.7) which would enable a family to access a set package of maternal and newborn care services including four antenatal care visits, elimination of mother to child transmission of HIV, urinary tract infection and sexually transmitted diseases treatment, safe delivery, and referrals for complications, postnatal care, and post-partum family planning services.
The beneficiaries present a UGX 4,000 worth voucher to any accredited health care providing facility offering any of the services entitled and then later receives a reimbursement for the services. The staff in the accredited facilities also receive mentorship, capacity building, and supervision during service delivery. But they were also linked to the government system to input data into the national data system for planning.
Uganda’s health sector has two main actors the private and public sectors. Currently, the principal mechanism of funding health services in Uganda is through government general revenue tax financing, however, out of pocket payments and contributions by Health Development Partners contribute a substantial amount of financing for health care services. For various reasons, the out of pocket payments lead to financial hardships for many patients and their caretakers often leading to long term indebtedness or poverty.
Through supporting the private sector and linking it to the government through initiatives like Voucher Plus, you standardize services, improve data input for national planning which strengthens the health system and improves health outcomes across all facilities.
“If you support the private sector you change their mindset but also standardize the services. A nation cannot plan with half the data which in this case is from the government facilities,” says Dr. Dennis Buluma, the deputy chief of party USAID Voucher Plus Activity.
On September 3rd 2020, the Voucher Plus Activity ended after five years. Namayanja says after the project ends families and communities they targeted will be able to continue to access high-quality maternal care because they have addressed sustainability, says Namayanja. “The private sector will retain its skilled health workers and provide high-quality care for communities to thrive.”