In January 2016, the Joint United Nations Programme on HIV/AIDS (UNAIDS), through the Uganda Voucher Plus Activity, launched a free health programme whereby vulnerable poor women in rural areas could access free maternal and newborn health care services in private facilities.
The project which has been running for five years has been able to cover 35 districts in northern and eastern Uganda operating in over 140 private health facilities in these areas and it operates on the basis of women purchasing vouchers at only Shs 4,000 from the village health teams and volunteers which they can use to access quality maternal health care services from private hospitals at no additional costs.
Using the vouchers, women can get access to services like four antenatal care visits, HIV testing and prevention of mother to child transmissions, delivery, postnatal care, emergency referral transport, newborn care and postpartum family planning. The service providers then submit their payment claims to the organization which reimburses them after ensuring that good quality health services where provided to the women.
As of January this year, the Voucher Plus Activity had sold over 304,017 vouchers, provided 185,360 deliveries with skilled providers, contributed to 32% of facility based deliveries in the 35 districts and supported almost 300,000 antenatal care visits.
Deborah Akijo a resident of Obule parish in Lira district says that had it not been for the voucher, she would be dead by now.
"I had a prolonged and painful labour after the doctors finding out that I had a haemorrhage which called for immediate caesarean section. My husband would not have been able to raise the money needed for the operation but the voucher was able to cater for the expenses," she says.
Akijo had about the voucher service when she was just two months pregnant through an announcement made at Pentecostal Assemblies of God Church and she decided to tend a neighbour's garden so as to raise the Shs 4,000 to pay for the voucher.
The project has not only benefited individual mothers but also has had a huge positive impact on the private health facilities it has operated from where over 500 health workers have been trained on implementing self-regulatory quality improvement services.
Robert Ojok, an administrator from Gift Life Medical Centre in Lira one of the Voucher plus service providers said that ever since their facility started associating with this USAID project, they have registered an increase in monthly maternal safe deliveries.
"Before the project came in, we used to attend to 10 to 15 mothers a month but when the project came, we started having an average of 250 mothers a month coming in to receive maternal health services," he said.
Ojok added that after accreditation by the Voucher Plus project, the facility got an opportunity to have a facelift like a fully functioning maternity ward and a modern theatre, increased staff of 3 full-time medical officers, 13 midwives and 12 nurses and also had a financial training which has enabled them manage the hospital's funds better.
PROVIDING SERVICES DURING COVID-19
This Covid-19 period has obviously posed a challenge to the project especially due to restriction of movement and curfew which has made it very difficult for expectant mothers to move from their rural areas to health centres in time but Dr Dennis Buluma, the deputy chief of party of the Uganda Voucher Plus Activity said that they have put in place some measures to ensure that women still access health care easily.
These measures include working with 600 LC 1 leaders to transverse their villages and encourage voucher clients to visit health facilities for all services provided in the voucher package. They are also running campaigns on local media to encourage expectant mothers to seek maternal care with confidence that they will be safe at health facilities despite the coronavirus scare.
The voucher service providers further obtained movement permits from RDCs and they use private vehicles for emergency transport to pick mothers from their homes, take them to hospitals and finally back home again.
Dr Buluma further adds that they have encouraged hospitals to provide holding spaces for women nearing delivery such that they do not have to experience hardships in rushing to hospitals when labour pains kick in.
Unfortunately despite its impressive impact, the project is set to come to an end in September this year as Dr Buluma says that it was only meant to be a stepping stone to long term health financing mechanisms by government.
"We need government to think about a more sustainable mechanism like the National Health Insurance because the tax base financing has proved not beneficial and our project has demonstrated that even the poor can actually be engaged in the national health insurance scheme if the package is well designed," he said.
He noted that even though some districts where the project was being implemented had health IIIs and IVs which offer maternal services, many women still chose to be part of the project where they would some little money to access health services because even in public facilities where services are meant to be for free they end up paying.
He however added that they are not leaving the women who have been on the programme hanging because they have mobilized and sensitized local communities on saving for health and consequently many of them have formed Community Health Insurance groups where members can pay for health care from pooled funds.
Dr Tonny Odong, the district health officer of Alebtong district says that as the overall seer of health activities in the district, he has mobilized members of the executive through the LC5s and sold them the innovative idea of community health insurance and fortunately they have all embraced it.
"Voucher Plus has worked closely with the district since inception which has enabled us to take an active part in the transition plan. Community members have gained more confidence in Community Health Insurance and it is a great way of ensuring that our people are able to equitably access quality health care services without facing financial hardships," Odong said.
They have also linked the project to other long term financing mechanisms like the Results Based Financing Mechanism where the ministry of Health will work closely with USAID to ensure that the voucher service providers are able to continue providing health services to women through those financing mechanisms.
Dr Buluma said that although they hope that local hospitals can take up this initiative even after it has ended, the National Health Insurance Scheme which could provide guidance on how community health insurance schemes could be run has not yet come out clear on this.
On June 24th 2019, the cabinet approved the National Health Insurance Scheme bill and sent to parliament for debate, recommended amendments and approval for enactment but it has not yet been discussed.