1) The document discusses a reproductive health voucher program in Uganda aimed at improving access to safe delivery and STD treatment. Initial findings from a baseline survey found no significant differences in care between treatment and control groups. 2) Challenges included lower than expected use of antenatal and postnatal care, and a poor road network limiting access to facilities. 3) Next steps discussed using real-time evaluation to provide feedback and adjustments to better implement the program, through additional surveys, focus groups, and improving the feedback process.

1. REPRODUCTIVE HEALTH VOUCHERS IN WESTERN UGANDAImpact Evaluation

3. 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.

4. That’s why we introduced the Health Voucher project: to help Mothers, like Joan, live…and we are convinced that this program can work.LAUNCH OF HEALTH VOUCHERS

6. Where We Are: project’s current results, implementation gaps and challenges

7. Outline next steps for evaluation:

8. Improve the use evaluation findings

10. 1) To provide safe delivery packages,

11. 2) to provide non-stigmatizing treatment for STDs

12. Output:

13. Safe Delivery Packages

14. 4 ante-natal visits

15. Delivery

16. 1 post-natal visit

17. GPOBA Grant Amount:

19. Structure of Uganda OBA Project

20. KEY MESSAGE In order to maximize the success of this program, we must use evaluation findings as we learn them to inform the implementation process. The Uganda experience: Learn the importance of using evaluation findings as we discover them, rather than waiting until the end of the project to learn.

22. Frequency of antenatal and post-natal services

23. Prevalence of Caesarian delivery

25. Voucher Distributors assigned to two Groups:

26. Treatment group - in early 2009

27. Control group -- wait 2 years

28. Target population: Women and men

29. Age 15-49

30. Pregnant or pregnant partner past 12 months

32. Clusters selected randomly out of adjacent villages

34. Within each cluster, look for change in attitudes and use of facilities for maternal deliveries

35. Treatment and Control groups have similar access to transportation & contracted facilities

36. 5-10 kms from 13 contracted facilities

38. Majority of respondents agreed on importance of visiting facility for all care

40. Reasons for not using facility: Home births

41. Distance - 24%,

42. High cost of care - 22%

43. Unnecessary to deliver at a facility - 17%

44. Facility births more common with

45. Higher household assets

46. Higher education

48. Follow-up survey - need to ensure large enough sample of vouchers and number of births

53. RESULTS FROM INCEPTION: MID-2009 - SEPTEMBER 2010 23,075 healthy babies delivered (target: 50,456) 29, 675 cases of STD treatments (target: 35,000)

55. Poor road network & limited access to transport --

56. hampers referral system

57. High turnover of medical staff --

60. Follow-up IE Survey in same villages: care was taken to select respondents with a five-year birth history

61. Qualitative Research – Focus Groups discussions Women Values and beliefs around labor Quality of care in service providers Sensitive Issues: form focus groups of women who trust each other

62. NEXT STEPS: Improve Feedback Process Qualitative Research – Focus Groups discussions Providers Knowledge and awareness building around the voucher scheme High turnover of medical staff Problems specific to the target group DHO’s Constraints to taking ownership and leadership of the voucher schemes? How can these be increased? User fees: quality of care; sense of ownership of beneficiaries

64. The voucher system can work…if implemented well.

65. We’ve learned so much from our initial studies.

66. We are looking forward to improving our evaluation process to learn how to implement most effectively.

67. We will fine-tune and adjust the program.

68. We all want fewer tragedies like Joan’s…and more planned successes like Anita and baby…don’t we?Happy mother and baby!

70. Transaction Adviser and IE Team Leader: Leslie Villegas, GPOBA

71. Principal Investigators:

72. Ben Bellows, PhD

73. Matt Hamilton, Ms MPH

74. Baseline Survey Report available upon request