In Uganda, voucher schemes improved access to family planning (FP) and maternal newborn health (MNH) services for poor women in rural areas. This was largely due to their targeted approach of improving access to high-quality services. On the national stage, voucher schemes demonstrated at scale the opportunities and challenges of implementing demand-side purchasing by generating methods, tools, and lessons that can inform future health financing reforms.
Uganda has more than a decade of experience with FP- and MNH-focused voucher schemes. The two latest large-scale voucher schemes in Uganda covered approximately half of the country, were implemented at nearly the same time and were completed by 2020. These included:
The Uganda Reproductive Health Voucher Project (URHVP-II), financed through the World Bank Global Partnership on Output-Based Aid, implemented by the Ministry of Health (MOH) with Marie Stopes Uganda (MSU) as the Voucher Management Agency (VMA).
The Uganda Voucher Plus Activity (UVPA), supported by the United States Agency for International Development (USAID) and implemented by a consortium of partners led by Abt Associates.
Together, the URHVP-II and UVPA schemes supported over 400,000 women to access safe delivery services and improved providers’ quality of care. A key measure of success in both projects was the number of safe deliveries accessed with voucher support. The URHVP-II exceeded its target of 156,400 safe deliveries by almost 50,000. The UVPA supported nearly 200,000 safe deliveries, short of their target of 250,000. Additionally, both projects successfully improved the quality of care provided by contracted providers, much of which was financed by providers investing in their facilities.
The MOH has made the decision to discontinue these efforts in “project mode” and instead integrate capacities and lessons produced by them into government purchasing arrangements. In collaboration with the MOH, ThinkWell undertook this study to document the lessons learned from the URHVP-II and UVPA voucher schemes for future purchasing reforms. Under the Strategic Purchasing for Primary Health Care (SP4PHC) project, supported by the Bill & Melinda Gates Foundation, ThinkWell works closely with the MOH to support improvements in the purchase of primary health care (PHC) services. In conducting this study, the joint ThinkWell and MOH research team reviewed literature, conducted qualitative key-informant interviews and focus group discussions, and analyzed voucher scheme data to assess performance.
ThinkWell produced this report under the Strategic Purchasing for Primary Health Care (SP4PHC) grant from the Bill & Melinda Gates Foundation.