output-based healthcare

More than 18000 patients have been seen for complaints of sexually transmitted infections in the first 18 months of the Uganda output-based aid program.  Marie Stopes International and Microcare Limited have worked closely to build a network of healthcare providers in Ibanda, Isingiro, Kiruhura, and Mbarara districts. Moving beyond the WHO-recommended STI syndromic management used in many developing countries, OBA clinics offer two important improvements: use of low cost lab technologies (wet mount and a microscrope) and a healthcare subsidy for partner referral. A contractual relationship ensures that a financial mechanism is constantly in place to induce compliance with quality lab and management standards.

Clinic selection and accreditation

In OBA programs, service providers are reimbursed only after verification of contractually delivered services. Following a baseline survey of providers, rigorous lab training and a second review of the facilities, twenty providers were invited to sign contracts with MSI. Eighteen clinics joined in the weeks before the launch on July 29, 2006.

Behavior change communication

Marketing the vouchers, educating communities about STIs and the STI treatment services and the importance of partner referral are all important elements in stimulating a healthy demand for the OBA STI services.

Health information system

The focus of output-based systems is by its nature on the measureable output - the numbers of patients treated and cured. That simple output is only measureable when supported by an efficient database management system and data collection methods. Microcare’s unique experience in Uganda has been the innovative implmentation of efficient and cost-effective insurance systems for low-income populations, building when possible from local social savings institutions (see Engozi societies). The Voucher Management Unit System is detailed in this early report on database design (625kb, PDF).