SP4PHC in Uganda
The Government of Uganda (GOU) continues to push forward on key health financing reforms to improve the purchase of primary health care. Building from the 2016 Health Financing Strategy and following extensive implementation of results-based financing schemes, the GOU has developed a strategy to mainstream a supply-side results-based financing (RBF) approach into its public financial management systems. Additionally, Uganda has continued to pursue a plan to establish a national health insurance scheme to support improved access and financing of the health system. ThinkWell has directly supported these efforts through close working relationships with the Ministry of Health (MOH), Ministry of Finance, and our learning partner Makerere University School of Public Health. These efforts began with the secondment of staff to the MOH to support the effort to achieve nationwide coverage of the Uganda Reproductive Maternal and Child improvement (URMCHIP) project World Bank-financed RBF project. The team has also contributed to national policy discussions by conducting primary research on public facility autonomy, the COVID-19 response, provider use of RBF income, the experience of large-scale reproductive, maternal, newborn, and child health voucher programs that engaged both public and private health providers, and the interaction of decentralization, public financial management, and the health system. The culmination of these efforts has been direct support to the MOH formulating a strategy to mainstream RBF into government PHC purchasing systems as the URMCHIP RBF comes to the end of its project cycle. Furthermore, the team provided close support to MOH efforts in the design of a national health insurance scheme through direct technical assistance and research on national health insurance experiences in sub-Saharan Africa.
For more information, view our Uganda overview presentation and one-pager. To see how our SP4PHC team in Uganda has helped its government respond to COVID-19, view our COVID-19 response page.
Our Strategies
SP4PHC has two key strategies to strengthen primary health care access and quality in Uganda.
Strategy 1: Harmonize and strengthen purchasing arrangements
SP4PHC is supporting the MoH to harmonize and strengthen purchasing arrangement as per the 2016 Health Financing Strategy. This is done in part through evaluation of existing purchasing schemes (including both results-based financing and voucher programs) to build consensus around approaches to make purchasing more strategic. Through facilitating dialogue and collaboration, SP4PHC is bringing the priorities of maternal, newborn, and child health and family planning to the forefront and is generating support for harmonization of these disparate purchasing schemes to move towards universal health coverage.
Strategy 2: Support the development of an approach for GOU through the Kampala Capital City Authority to effectively purchase FP and MNCH services from private providers
In many urban settings, public sector infrastructure is limited and there is an abundance of largely disconnected private providers. Public facilities offering services are overburdened and service delivery is highly congested. The Kampala Capital City Authority (KCCA) aims to bring together and leverage these private providers to make PHC and RBF purchasing more strategic. The SP4PHC team is facilitating dialogue between the MoH, KCCA and other key stakeholders to formalize existing initiatives through a public-private hybrid network in order to more efficiently purchase PHC services, with a focus on MCH and FP.
Factsheets
These three factsheets below serve as a reference and aim to visualize the latest data and trends on purchasing family planning, maternal & newborn health services, and a broader overview of purchasing in Uganda. Each factsheet also highlights some of the activities the SP4PHC country team is working on with local stakeholders within that topic area. These factsheets are updated annually (latest in May 2021).
Health Purchasing Factsheet Maternal, Newborn and Child Health Factsheet Family Planning Factsheet
Featured Learning Products
Pilot Model for KCCA to Purchase Health Services from Private Providers
The nature of service congestion in the Kampala Capital City Authority (KCCA) public health facilities (1% of all facilities in Kampala) is not exclusive of what also happens in other government health facilities. Working with KCCA’s Directorate of Public Health and Environment, ThinkWell facilitated the design of a ‘K-CARE’ pilot model aimed at supporting efforts to decongest its facilities by enabling timely, affordable access to high-quality maternal health services working with the private sector.
Results-Based Financing for Primary Health Care: A Review of Uganda Local Government and Health Facility Revenue, Expenditure, Service Trends, and Implementation Experiences
Starting in FY 2018-19, the Uganda Ministry of Health began implementing results-based financing (RBF) under the Uganda Reproductive, Maternal, and Child Health Improvement Project. The MOH and ThinkWell undertook this operational research study to understand how facilities and Local Governments planned for and used their RBF revenue, to inform development of its RBF mainstreaming strategy.
Uganda Reproductive, Maternal, and Child Health Services Improvement Project: An Overview of the Results-Based Financing Component
As part of its efforts to improve reproductive, maternal, infant, adolescent, and child health services, the Government of Uganda is implementing the Uganda Reproductive, Maternal, and Child Health Services Improvement Project with the support of the World Bank, Global Financing Facility, and Swedish International Development Cooperation Agency. This brief, published in July 2022, provides an overview of the operational structure of the project’s results-based financing component.
A Profile of Women Seeking Maternal, Newborn, and Child Health Services in Public Facilities in Kampala
Uganda continues to suffer from high maternal and under-5 mortality rates, with levels surpassing the averages of neighboring countries. This study, conducted in partnership with the Kampala Capital City Authority (KCCA), examines behaviors and sociodemographic factors associated with women seeking maternal, newborn, and child health and family planning services at the KCCA facilities. The study, published in July 2022, also offers recommendations and key learnings to inform KCCA’s strategic purchasing to bridge the gap between supply of and demand for high-quality healthcare.
Private Provider Readiness Assessment in Kampala – April 2022
The Kampala Capital City Authority (KCCA) manages just eight out of the more than 1,500 health facilities in Kampala. In two of the KCCA’s largest health centers, maternal, neonatal, and child health and family planning services are congested, undermining service quality and staff morale. This presentation, prepared by Thinkwell in partnership with the KCCA, explored the readiness of private providers to deliver essential services and help to decongest KCCA’s facilities.
Magnitude and Consequences of Service Congestion in KCCA Public Health Facilities
Public health facilities in Kampala are congested, impeding service access and quality. This presentation prepared by the Kampala Capital City Authority’s Department of Public Health and Environment, with support from ThinkWell, aims to validate and update common understandings about service congestion in Kampala’s public facilities–which hinders equitable access to maternal, neonatal, and child health and family planning services. The presentation also describes specific actions that facilities and the city can take to overcome this challenge.
National Health Insurance in sub-Saharan Africa: Insights for Uganda
Following advances of the 2019 National Health Insurance Scheme (NHIS) Bill through Parliament in early 2021, Uganda is now pushing forward on the design of the scheme to support progress towards Universal Health Coverage. This study draws on the experiences of six sub-Saharan African (SSA) countries that have achieved the highest levels of population coverage—namely Rwanda, Ghana, Gabon, Tanzania, Ethiopia, and Kenya—to highlight insights and lessons learned for Uganda in the core areas of enrollment, benefits package design, financing, and implementation sequencing for the NHIS.
An Overview of Health Financing Flows in Uganda
This report documents the nature and magnitude of financial flows to Uganda’s health sector and the purchase of primary health care services. Against international benchmark estimates that $86 per person is required to deliver essential health services in low- and middle-income countries, this study documents that the current level of government funding to primary health care services are below levels needed if Uganda is to achieve its universal health coverage goals.
Reproductive Health Voucher Schemes in Uganda: How They Worked and Lessons for the Future
Uganda has more than a decade of experience working with voucher schemes to improve reproductive and child health services. With the Government of Uganda actively engaged in moving forward with strategic purchasing reforms, ThinkWell and the Ugandan Ministry of Health partnered to document the experiences and lessons learned from the most recent large-scale voucher projects that include the Second Uganda Reproductive Health Voucher Project and the Uganda Voucher Plus Activity. The team’s poster from the 6th Global Symposium on Health Systems Research can be viewed here. The findings of this effort are summarized in this report published in February 2021. To read a blog our team recently published in P4H that summarizes the key findings and implications from this voucher analysis, please click here.
How Primary Health Care Services are Financed in Uganda: A Review of the Purchasing Landscape
An in-depth landscape of Uganda’s health purchasing policies and practices. This report answers the key questions: Who purchasers health services, and from whom? What mechanisms are used to purchase services? and What services are purchased? Insights from this landscape, published in September 2020, inform the project’s ongoing work to support strategic purchasing reforms in the country.
Uganda’s Emergency Response to the COVID-19 Pandemic: A Case Study
A review of Uganda’s initial institutional, financial, and operational responses to the COVID-19 pandemic. The case study, published in September 2020, provides insights to the priorities and investments made early in the outbreak that inform the current response and potential long-term reforms that can improve the health system.
Related resources
Uganda Reproductive, Maternal, and Child Health Services Improvement Project: A Review of the Results-Based Financing Component A brief that provides an overview of the results-based financing component of the Uganda Reproductive, Maternal, and Child Health Services Improvement Project.