Uganda Voucher Plus Activity Quarterly Report Year 2, Quarter 2 report January 1 – March 31, 2017 Submitted: 30th April 2017 The Uganda Voucher Plus Activity produced this document for review by the United States Agency for International Development. Abt Associates prepared this document with significant input from partners. Activity No: AID-617-LA-16-00001 Submitted to: Rhobbinah Ssempebwa, Agreement Officer’s Representative USAID Uganda Prepared by: Abt Associates In collaboration and partnership with: Baylor College of Medicine Children’s Foundation Uganda (Baylor-Uganda) Communication for Development Foundation Uganda (CDFU) PricewaterhouseCoopers (pwc) DISCLAIMER The author’s views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government Table of Contents Table of Contents .............................................................................................................. 2 Acronyms............................................................................................................................ 3 Executive Summary .......................................................................................................... 5 1. Introduction ................................................................................................................... 7 1.1 Overview of the Results Framework for the Uganda Voucher Plus Activity ................... 7 1.2 Stakeholder Coordination and Collaboration .......................................................................... 8 2. Voucher Management Agency Activities .................................................................. 10 3. Activities by Intermediate Result (IR)....................................................................... 12 3.1 IR1: Increased Utilization of High-Quality Voucher-Covered MNCH and FP Services in Designated Program Districts .......................................................................................................... 12 3.2 IR 2: Increased Capacity of Uganda’s Public and Private Sectors to Develop Longer Term Health Financing Options ...................................................................................................... 26 4. Program Management ................................................................................................ 27 5. Activity Monitoring, Evaluation, and Learning ......................................................... 27 6. Quarter 3, Year 2 Planned Activities ........................................................................ 29 Annex 1: Voucher Plus Best Practices, Lessons Learned, and Emerging Issues ...... 30 Best Practices and Lessons Learned ............................................................................................... 30 Emerging issues ................................................................................................................................... 30 Annex 2: Voucher Plus Success Stories ........................................................................ 32 Annex 3: Voucher Plus Progress Against the AMELP ................................................. 35 Uganda Voucher Plus Activity Page 2 Acronyms ACP AIDS Control Program AIDS Acquired Immunodeficiency Syndrome AMELP Activity Monitoring Evaluation and Learning Plan ANC Antenatal Care ART Antiretroviral Therapy Baylor-Uganda Baylor College of Medicine Children’s Foundation Uganda BCC Behavior Change Communication BEmONC Basic Emergency Obstetric and Newborn Care CEmONC Comprehensive Emergency Obstetric and Newborn Care CDFU Communication for Development Foundation Uganda CHC Communication for Healthy Communities DHGS Director General of Health Services DHO District Health Office DHT District Health Teams EmONC Emergency Obstetric and Neonatal Care eMTCT Elimination of Mother to Child Transmission FP Family Planning GOU Government of Uganda HA Health Assistant HC Health Center HIV Human Immunodeficiency Virus HMIS Health Management Information System IEC Information, Education, Communication IP Implementing Partner IR Intermediate Result IVEA Independent Verification and Evaluation Agency LC Local Council M&E Monitoring and Evaluation MCH Maternal and Child Health METS Monitoring and Evaluation Technical Support Program MNCH Maternal, Neonatal and Child Health MOH Ministry of Health MOU Memorandum of Understanding PGT Poverty Grading Tool PHSP Private Health Support Program PMTCT Prevention of Mother to Child Transmission PNC Postnatal Care PNFP Private Not For Profit PPFP Postpartum Family Planning PWC PricewaterhouseCoopers QED QED Group LLC RBF Results Based Financing RH Reproductive Health Uganda Voucher Plus Activity Page 3 RMNH Reproductive, Maternal, and Neonatal Health RMNCH Reproductive, Maternal, Neonatal, and Child Health SBCCO Social Behavior Change Communications Officer UGX Ugandan Shilling UHF Uganda Healthcare Federation USAID United States Agency for International Development USG United States Government UTI Urinary Tract Infection VCBD Voucher Community Based Distributor VHT Village Health Team VMA Voucher Management Agency VMIS Voucher Management Information System VSP Voucher Service Provider WB World Bank Uganda Voucher Plus Activity Page 4 Executive Summary The Uganda Voucher Plus Activity is designed to increase health services for pregnant women by promoting safe, facility-based deliveries to reduce maternal and neonatal morbidity and mortality. The Activity improves access to quality maternal and neonatal health services by recruiting private sector providers and building their technical capacity to deliver quality services to pregnant women and to process payments for services rendered. The Uganda Voucher Plus Activity comprises the following partners: Abt Associates is the prime contractor, responsible for activity management and sequencing, oversight, monitoring and evaluation (M&E), and learning to inform the Government of Uganda (GOU) on health financing schemes. With Abt Associates oversite, Baylor College of Medicine Children’s Foundation Uganda (Baylor-Uganda) is the training, quality assurance and accreditation agency for private providers. Communication for Development Foundation Uganda (CDFU) is the community engagement agency to mobilize communities and utilize village health teams (VHTs) to distribute vouchers as Voucher Community Based Distributors (VCBDs). PricewaterhouseCoopers (pwc) is the voucher management agency (VMA) that is managing provider claims and the reimbursement processes. On December 7, 2016, Abt Associates submitted a request for approval of the independent verification and evaluation agency (IVEA) that will audit and ensure accountability in the voucher activity to USAID. We responded to questions from USAID in February and March 2017, and we are now waiting for the approval before we contract the IVEA. Summary of Year 2, Quarter 2 Activities The Activity increased voucher distribution and service delivery resulting in a cumulative sale of 45,114 vouchers since October 2016. By 31 March 2017, the Activity registered 8,321 deliveries and a 70 percent redemption rate for at least 1 service of the voucher benefits package. The Activity reimbursed UGX 713,150,670 to accredited private providers for services provided since October 2016. Uganda Voucher Plus Activity Page 5 The Activity expanded to the northern region, and by 31 March 2017, 157 private providers were actively providing RMNCH services to voucher-holders in both east and norther Uganda. Stakeholder collaboration continues to be extremely important to take advantage of all opportunities for synergy with other implementing partners, and ensure the appropriate learning agenda. The Activity addressed quality of care deficiencies identified by the team in private providers performing RMNCH voucher-redeemable services. The team identified a number of private providers who were not actually qualified to participate in the voucher activity. This discovery prompted the Activity team to undertake a rigorous validation exercise, conduct thorough district based key stakeholder meetings, and provide intensive technical supportive supervision. By end of quarter 2, the validation exercise was completed in northern Uganda and voucher distribution in communities surrounding 12 providers were suspended to allow proprietors of the affected facilities fix the gaps identified in their facilities or risk being terminated. The validation exercise will now take place in eastern Uganda. In quarter 3, the Activity will review the field-based capacity and re-organize management of activities to ensure robust support for continuous quality improvement. Uganda Voucher Plus Activity Page 6 1. Introduction The Uganda Voucher Plus Activity is designed to increase health services for pregnant women by promoting safe, facility-based deliveries to reduce maternal and neonatal morbidity and mortality. 1.1 Overview of the Results Framework for the Uganda Voucher Plus Activity The Results Framework presented in the revised Activity Monitoring and Evaluation Plan (AMELP) of April 2017 follows in Figure 1 below. This is provisionary until USAID approves it. Figure 1: Results Framework for the Voucher Plus Activity Critical Development Objective 3: Improved health and nutritional status in focus areas and Assumptions 1. Stable political population groups environment with no civil unrest, climatic shock or conflict such that demand generation Strategic Objective: and service