REPRODUCTIVE HEALTH VOUCHERS IN WESTERN UGANDAImpact Evaluation<br />
INTRODUCTION<br /><ul><li>435 women die per 100,000 live births in Uganda.
Joan did not stop bleeding after giving birth, her husband left her with his mother-in-law to fetch a doctor. After 3 hours and twenty miles of biking in the dark under the pouring rain, he and the doctor reached Joan, but she had passed away.
That’s why we introduced the Health Voucher project: to help Mothers, like Joan, live…and we are convinced that this program can work.</li></ul>LAUNCH OF HEALTH VOUCHERS <br />
OVERVIEW<br /><ul><li>Review baseline survey of Uganda Reproductive Health OBA project
Where We Are: project’s current results, implementation gaps and challenges
US $4.3 million</li></li></ul><li>Reproductive Health Vouchers in Uganda(OBA project) <br />Targeting: Geographic (20 districts) and self-selection: all sexually active people with a particular focus on high risk groups and the poor (STD vouchers) and poor women (safe delivery vouchers)<br />Cost to beneficiaries: - Safe deliveryabout 1,500 Ushs per voucher. Originally estimated at US$1.70 decreased because of depreciation.- STD treatment at 3,000 Ushs (US$1.70) per pair of vouchers – no longer so because of depreciation.<br />OBA subsidy to accredited Medical Service Providers (MSPs) on real cost<br />Commission of approx. US$0.11 per voucher provided to voucher distributors<br />Incentives to VMU (Marie Stopes International-Uganda) to perform KfW-funded behavior-change campaign, marketing and training of MSPs<br />
KEY MESSAGE<br />In order to maximize the success of this program, we must use evaluation findings as we learn them to inform the implementation process.<br />The Uganda experience: <br />Learn the importance of using evaluation findings as we discover them, rather than waiting until the end of the project to learn.<br />
REVIEW OF PROJECT BASELINE<br />Baseline survey looked at: <br /><ul><li>Proportion of attended deliveries
Frequency of antenatal and post-natal services
3 kms from a road connecting them to facility</li></li></ul><li>INITIAL FINDINGS FROM SURVEY<br /><ul><li>No significant differences in use of facilities care: antenatal (ANC), delivery and postnatal (PNC)
Majority of respondents agreed on importance of visiting facility for all care
Each type of facility visit consistently lower than expected use</li></li></ul><li>INITIAL FINDINGS: ANC Visit<br /><ul><li>No differences between treatment and control groups</li></li></ul><li>INITIAL FINDINGS: Delivery<br /><ul><li>Insignificant difference in use of public facilities
Young, first-time mothers </li></li></ul><li>INITIAL FINDINGS:Postpartum Morbidity<br /><ul><li>No significant differences in complications during pregnancy</li></li></ul><li>INITIAL FINDINGS: Issues to Watch<br /><ul><li>Coincidentally, use of services already higher in treatment villages.
Follow-up survey - need to ensure large enough sample of vouchers and number of births
Some evaluation findings have to inform the implementation earlier in the process</li></li></ul><li>WHERE WE ARE<br /><ul><li>Greater use of vouchers for any of the first three ANC visits than PNC
Proportion of C-sections to normal deliveries remained constant within 9-17%, despite large numbers being registered</li></li></ul><li><ul><li>Healthy Baby client visits increased to 43,308 to date</li></ul>Project’s first healthy baby delivered in 2009<br />
led to constraints in quality service provision</li></li></ul><li>NEXT STEPS<br />Goal:<br />Learn How to Implement the Program Better<br />
NEXT STEPS: Improve Feedback Process <br /><ul><li>Include more real-time evaluation tools to understand results better and to adjust more promptly
Follow-up IE Survey in same villages: care was taken to select respondents with a five-year birth history
Qualitative Research – Focus Groups discussions </li></ul>Women<br />Values and beliefs around labor<br />Quality of care in service providers<br />Sensitive Issues: form focus groups of women who trust each other<br />
NEXT STEPS: Improve Feedback Process<br />Qualitative Research – Focus Groups discussions <br />Providers<br />Knowledge and awareness building around the voucher scheme<br />High turnover of medical staff<br />Problems specific to the target group<br />DHO’s<br />Constraints to taking ownership and leadership of the voucher schemes? How can these be increased?<br />User fees: quality of care; sense of ownership of beneficiaries<br />
CONCLUSION<br /><ul><li>There is hope for reproductive care for women in Uganda.
The voucher system can work…if implemented well.
We’ve learned so much from our initial studies.
We are looking forward to improving our evaluation process to learn how to implement most effectively.