Transcript Namayanja Christine - Vouchers for Services and Supplies

Improving Access to Health Services for the
Poor through Output Based Aid:
“Vouchers for Services and Supplies”
Christine Namayanja, Programme Director , Marie Stopes International Uganda
28th May| Reproductive Health Supplies Coalition Meeting| Kampala Uganda
Purpose
• Highlight the impact of private sector in
reaching out to get a market that otherwise
would not take up the services.
• Describe how the OBA approach improves
RH commodity security-ensures supplies
are always available.
What is Output Based Aid
• Output Based Aid (OBA)
is a results based
financing mechanism that
ties the disbursement of
subsidies to clearly
specified outputs that
directly support improved
access to basic services.
At the Heart of OBA
1. Contracting out of service provision to an
already existing service provider (third party)
2. Bridging of the financing gap between what the
target group are able to pay for basic health
services and the required cost for providing
services.
Contrast of a traditional input based
approach to OBA approach
Traditional input-based approach
Output-based
Inputs
(such as materials)
approach
Inputs
(such as materials)
Private
finance
Private financing
mobilized by
service providers
Service
Provider
Service
Provider
Public
finance
Reimbursement
for outputs
delivered
Service recipient
Service recipient
Source: Output-Based Aid Lessons Learned and best Practices
Uganda OBA Programme Overview
•
The Uganda OBA Project finances the
provision of quality healthcare for safe
deliveries and STD management by
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selling vouchers to clients at
highly subsidised prices and by
reimbursing the costs to the
accredited private service provider for the
actual services provided.
General mechanism of the OBA Programme
Donor
KfW / GPOBA
$
report
MSIU
Distributor
$
Private Provider
(pharmacy, drug shop, CBD)
$
Service
Voucher recipient
Service Package
Safe Delivery
STD Management
Voucher benefits
(services covered)
Safe delivery: 4ANCs,
Basic & EMOC, PNC
STD Management
Eligible recipients
Poor women
Sexually active people,
focus on poor and high
risk
Geographic area
covered
20 districts
6 districts
60,000 deliveries
35,000 cases
Beneficiaries
Voucher Distribution
Safe Delivery
STD Management
Coverage
Mainly rural based
Semi-rural based
Eligibility criteria
Use of Poverty Grading
Tool & home visits for
qualification of poor
mothers
No specific qualification
criteria-all sexually
active
Distribution system
Use of trained CBDs
Pharmacies & drug
shops
$2
$1
Voucher selling price
Management of Service Provision
•Mapping, selection and approval-participating clinics
•Defined service protocols and guidelines• Cost of services agreed
•Training & orientation of service providers in OBA and
service package.
•Claims processing & management
•Reimbursement/payment of providers
Contract management
−External periodic facility Quality Assessments for service quality,
fraud detection, right targeting etc
Quality services means:- good counseling and client care, constant
availability of qualified personnel, adequate stocks of medicines, vaccines,
consumables/medical supplies, equipment
−Client M&E for right cost, good client care, fraud detection.
Good client care:- in addition to professional treatment of clients, health
providers should ensure that get all the required drugs and are not
charged for supplies
−Renewal or termination of contracts.
Key Lessons: Targeting New Populations
Recipient strategy- targeted approach as opposed to a universal
approach (difficult-to-reach groups, poor, high risk).
Benefits
Potential draw backs
•
Lowest wealth quintile in rural
communities of south and western
Uganda reached.
•
Vouchers aimed at disadvantaged
groups may leak directly or
indirectly to less disadvantaged
•
Equitable distribution of resources
as vouchers are distributed to
disadvantaged and poor women
•
Voucher recipients may lack
reliable information to choose vouchers can be stigmatizing
•
Removing cost and quality
barriers has improved uptake of
services
•
Relies on availability of extra
capacity-existence of providers
•
Client satisfaction leads positive
health seeking behaviour-clients
asking for other services
Key Lessons: Quality Improvements
Increased engagement of private sector capital and
expertise by encouraging the private sector to serve
poor customers they would otherwise disregard.
VSPs have hired skilled staff to provide
services to voucher clients
Key Lessons: Quality Improvements
Benefits
Potential draw backs
• Voucher Service Providers
have made infrastructure
improvements
•
Access to finance- if cost of prefinancing the outputs would place
undue burden to the provider.
• Improved & expanded
facilities
•
Security of funding- swift
disbursement when outputs have
been achieved
• Increased stocks of drugs
& ensured availability (no
stock outs)
• Purchase of relevant
equipment
• Purchase of cars or
motorcycles for
emergency transport
Key Lessons: Quality Improvements
Benefits
•
Increased accountability by
shifting performance risk to
service by paying them only
after delivering “agreed” outputs
– Record keeping has improvedmonitoring for results made
possible
– Monitoring of distribution on
behalf of the management
agency by reporting and
repulsing wrong clients.
•
Produces the most tangible cost
of delivering services.
Potential draw backs
•
Services may become fragmented
•
Administration and monitoring
system costs may be high