SP4PHC in Uganda

The Government of Uganda (GOU) is implementing reforms to improve how it purchases primary health care, as envisaged in the 2016 Health Financing Strategy. Key among these, following many years of implementing externally funded results-based financing (RBF) projects, is mainstreaming the RBF approach into its public financial management (PFM) systems. The ThinkWell SP4PHC team in Uganda supported the GOU to develop and refine its mainstreaming strategy by providing extensive guidance on the key considerations for implementation. The team commissioned relevant research with our local learning partner, the Makerere University School of Public Health (MakSPH), that focused on mechanisms for contracting and purchasing PHC services at the national and subnational levels and facilitated the policy-making process throughout governmental review and approval. Our current focus is on supporting the GOU to implement, refine, and evaluate its RBF mainstreaming policy.

ThinkWell’s accomplishments in Uganda

  • Assessed Uganda’s reproductive health voucher schemes and documented how the lessons learned can be applied to Uganda’s health financing system.
  • Provided embedded support to the RBF Unit in the MOH for the roll-out of the GFF-funded RBF mechanism, achieving nationwide coverage in April 2020.
  • Conducted a review of Uganda’s purchasing landscape and undertook operations research to explore issues like how funds flowed to facilities and how these funds were used.
  • Published a study on the use of RBF income by local governments and health facilities, which was was approved through formal MOH processes.
  • Supported the GOU to develop a strategy for integrating RBF into government PFM systems under the World Bank-funded Uganda Inter-Fiscal Transfer (UgIFT) program and facilitated the process for its approval by the Ministry of Finance.
  • Supported the Kampala Capital City Authority (KCCA) to analyze causes for congestion at high-volume public health centers, assessed the readiness of the private sector for contracting, and profiled the women accessing care in Kampala’s public facilities. This evidence informed the co-design of a prototype model for government purchasing PHC services from private providers.

Current Strategies and Activities

Strategy one: Support MOH to institutionalize RBF into government purchasing.

  • Retrospectively analyze the World Bank RBF project to further inform the design and implementation of GOU mainstreaming.
  • Document how RBF was mainstreamed into GOU PFM mechanisms, detailing the key considerations and tradeoffs.
  • Conduct a difference-in-difference analysis on the affect of RBF on service utilization and quality
  • Support GOU processes for RBF mainstreaming, including revision of PHC grant guidelines on how local governments and facilities will spend RBF funds.

Strategy two: Facilitate learning focusing on contracting for PHC services.

  • Partner with the Makerere School of Public Health to facilitate learning exchanges focusing on strategic purchasing, RBF, and private sector contracting.
  • At the request of MOH, support prototyping the NHIS implementation framework.
  • Build engagement around a prototype for KCCA to purchase PHC services from private providers.

More information about the SP4PHC project in Uganda can be found in this one-pager.

Country Factsheets

These three factsheets below serve as a reference and aim to visualize the latest data and trends on purchasing family planning, maternal, and 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                     Maternal, Newborn, and Child Health                Family Planning

Featured Learning Products

Results-Based Financing for Primary Health Care: How local governments and frontline facilities plan, use, and account for RBF funds

Starting in financial year 2018/19, the Ministry of Health (MOH) began implementing results-based financing (RBF) under the Uganda Reproductive, Maternal, and Child Health Improvement Project (URMCHIP). Building on more than 15 years of experience with related health financing approaches, the MOH introduced performance-linked payments to eligible public and private not-for-profit (PNFP) health facilities and hospitals, providing them with additional revenue based on their service outputs and quality. The aim was to increase utilization of selected primary health care (PHC) services, and providers were given discretion to use their additional revenue to enhance performance, including by distributing bonuses to health workers, procuring supplementary medicines and supplies, upgrading their facilities, and more. The MOH undertook this operational research study to inform development and implementation of its RBF mainstreaming strategy.

Documentation of the Kampala Capital City Authority’s experiences with private sector engagement for health services

The private sector supplies an important share of health services in Uganda, including for maternal and child health (MCH), especially in urban settings such as Kampala. The Kampala Capital City Authority (KCCA) is mandated to manage all health affairs in the city; however, of Kampala’s more than 1,500 health facilities, 98% are privately owned, while the KCCA only manages eight. Moreover, MCH services in KCCA facilities are heavily congested, undermining service quality and staff morale. This brief is intended for KCCA, the Ministry of Health (MOH), members of the private sector, development partners, and other stakeholders, including the ThinkWell team, to understand the current relationships and partnerships KCCA has had with respective private providers.

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 is below levels needed if Uganda is to achieve its universal health coverage goals.

Other Learning Products

SP4PHC aims to improve how governments purchase primary health care services, with a focus on family planning and maternal, newborn, and child health. SP4PHC is supported by a grant from the Bill & Melinda Gates Foundation.