output-based healthcare

The growth of output-based aid (OBA) in the Ugandan health sector is based on the conviction that public health goals can be achieved with contracted incentives to healthcare providers. In Uganda the OBA  approach is built on a perfomance-based contract and patient vouchers that entitles the bearer to choose care from any contracted health center. Healthcare providers must meet accreditation standards and then compete to diagnose and treat patients in exchange for the voucher. The vouchers’ cost to the patient is heavily subsidized. The provider is reimbursed at a negotiated rate that reflects the cost of service provision and a reasonable profit. Service providers are reimbursed only after verification of contractually delivered services. The Uganda OBA programs are designed to give patients the economic power to demand high quality healthcare delivery, to target high risk or low income patients for critical services, to augment general population utilization rates, and to contain per-unit costs.

The OBA 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.

Microcare Insurance Limited is a leading health insurance and health management solutions company in Kampala. Microcare was licensed by the Uganda Insurance commission in 2004 to provide Health Insurance to both the formal and informal sectors. Microcare developed the OBA voucher database for Phase I. Due unforeseen constraints, a new vendor will be identified in Phase II.

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.