Accredited private sector services coupled with affordable vouchers increase access to and quality of care: The healthy mothers, healthy babies voucher program

While Uganda has made strides to reduce poverty and progress towards the MDGs, reproductive health challenges remain. Maternal mortality remains high at 310 per 100,000 live births. While 42 percent of women deliver with the assistance of skilled medical personnel, inequities among wealth quintiles persist. The USAID-funded SHOPS (Strengthening Health Outcomes through the Private Sector) project works to meet the comprehensive obstetric care needs of poor women in Western Uganda. The healthy baby voucher program enables women to access the complete range of obstetric care – antenatal care (ANC), safe delivery, referrals, transportation, postnatal care (PNC), immunization, and postpartum family planning – for 3,000 Ugandan Shillings (about $1.20). Targeted behavior change communication (BCC) provides information on reproductive health and safe delivery, and community-based voucher distributors bring vouchers, information, and follow-up to clients. The program has already nearly met or surpassed its program goals, including: 10,887 sold vouchers (target: 10,888); 9,646 first ANC visits (target: 9,799); 5,910 safe deliveries (target: 6,533); and 2,400 PNC visits (target: 2,613). The voucher program has improved obstetric care quality in the private health sector through facilities accreditation, provider training, and regular monitoring and evaluation. High demand encouraged by frequent, well-received BCC, accessible facilities, transportation vouchers, and targeted community outreach have contributed to high uptake of services far exceeding expectations. The private sector offers an opportunity to provide high-quality obstetric services. Coupling private sector providers with low-cost vouchers and quality assurance mechanisms strengthens the health system and supports a reduction in maternal morbidity and mortality.