{"id":228,"date":"2013-03-04T17:45:52","date_gmt":"2013-03-04T16:45:52","guid":{"rendered":"http:\/\/www.sina-health.com\/?page_id=228"},"modified":"2019-02-02T00:23:08","modified_gmt":"2019-02-01T23:23:08","slug":"uganda","status":"publish","type":"page","link":"https:\/\/www.sina-health.com\/?page_id=228","title":{"rendered":"Uganda"},"content":{"rendered":"<p><span style=\"color: #000000;\"><strong>Start: <\/strong>2003<\/span><br \/>\n<span style=\"color: #000000;\"><strong>Phase: <\/strong>WB performance-based contracting programme 2003-2005,\u00a0<\/span><span style=\"color: #000000;\">New Cordaid financed pilot since 2009, other pilots such as from DFID and demand side voucher programs<\/span><br \/>\n<span style=\"color: #000000;\"><strong>Coverage Estimate: <\/strong>60%<\/span><br \/>\n<span style=\"color: #000000;\"><strong>Feasibility: <\/strong>42%<\/span><br \/>\n<span style=\"color: #000000;\"><strong>Supported by: <\/strong>Government, WB, USAID, DFID, SIDA,\u00a0Cordaid<\/span><\/p>\n<p><strong>Budget :<\/strong> WB $ 68 million 2016-2020<\/p>\n<p><span style=\"color: #000000;\"><strong>Description: <\/strong>The World Bank-financed RBF project 2003-2006 (Performance-Based Contracting) had many imperfections and consequently failed to deliver desired results. New pilots have been started by faith-based organizations financed through Cordaid and USAID.\u00a0<strong><br \/>\n<\/strong><\/span><\/p>\n<p><span style=\"color: #000000;\">A new framework has been developed in 2018 for the implementation of RBF in two third of the country. Yet the team in Mombasa scored the feasibility of the current design with 42% and they identified several points for improvement:<\/span><\/p>\n<ul>\n<li><span style=\"color: #000000;\">The per capita budget for PBF is only USD 2.50, while at least USD 4.00 is considered necessary for a well-designed holistic PBF programme;<\/span><\/li>\n<li><span style=\"color: #000000;\">The number of indicators is only 10 with a vertical orientation towards reproductive health care, while a minimum of 25 is recommended.<\/span><\/li>\n<li><span style=\"color: #000000;\">The current package does not contain community PBF indicators;<\/span><\/li>\n<li><span style=\"color: #000000;\">Government health facility managers are not allowed to spend their locally generated revenues from cost-sharing at the point of collection;<\/span><\/li>\n<li><span style=\"color: #000000;\">Health facilities do not have a right to decide where to buy their inputs. They depend on the central distribution for inputs such as essential drugs and equipment;<\/span><\/li>\n<li><span style=\"color: #000000;\">The verification agency is the DHMT, which is also the regulatory authority at the local government level. This violates the RBF principle of separating functions. Thus, there is a need to create an independent CDV agency.<\/span><\/li>\n<li><span style=\"color: #000000;\">There are no geographic and\/or facility-specific equity bonuses<\/span><\/li>\n<li><span style=\"color: #000000;\">There are no equity bonuses for vulnerable people. Instead, there is generalized free health care that is inefficient and produces a poor quality of care.<\/span><\/li>\n<li><span style=\"color: #000000;\">The National RBF program data management system is still manual and not linked to the DHIS 2<\/span><\/li>\n<li><span style=\"color: #000000;\">There are no output indicators at the national and regional RBF Units<strong style=\"font-size: 1rem;\">\u00a0<\/strong><\/span><\/li>\n<\/ul>\n<p><span style=\"color: #000000;\"><strong>Recommendations<\/strong><\/span><\/p>\n<p><span style=\"color: #000000;\">Given the discrepancies between the PBF best practices and the currently proposed RBF National Framework design, the Uganda team proposes:<\/span><\/p>\n<ul>\n<li><span style=\"color: #000000;\">To review the current RBF design and notably: (1) review the budget and the scope of indicators; (2) review and change the CDV function from the regulatory DHT function<\/span><\/li>\n<li><span style=\"color: #000000;\">Adoption of the free market system for facility commodities<\/span><\/li>\n<li><span style=\"color: #000000;\">Digitalize RBF data management system.<\/span><\/li>\n<\/ul>\n<p><span style=\"color: #000000;\"><strong>References:<br \/>\n<\/strong>Ssengooba, F., B. McPake, et al. (2012). &#8220;Why performance-based contracting failed in Uganda &#8211; An &#8220;open-box&#8221; evaluation of a complex health system intervention.&#8221; Social Science &amp; Medicine (in press).<\/span><\/p>\n<p><span style=\"color: #000000;\">Orem, J. N., F. Mugisha, et al. (2011). &#8220;Abolition of user fees: the Uganda paradox.&#8221; Health Policy and Planning 26(Supplement 2): 41-51.<\/span><\/p>\n<p><span style=\"color: #000000;\">Morgan, L. (2010) &#8220;Some Days are Better than Others: Lessons Learned from Uganda&#8217;s first Results-Based Financing Pilot&#8221;.<\/span><\/p>\n<p><span style=\"color: #000000;\">Bellows, B. and M. Hamilton (2009). &#8220;Vouchers for Health: Increasing Utilization of Facility-Based STI and Safe Motherhood Services in Uganda. Maternal and Child Health P4P Case Study&#8221;. Bethesda MD, Health Systems 20\/20 Abt Assoc Inc.<\/span><strong><br \/>\n<\/strong><\/p>","protected":false},"excerpt":{"rendered":"<p>Start: 2003 Phase: WB performance-based contracting programme 2003-2005,\u00a0New Cordaid financed pilot since 2009, other pilots such as from DFID and demand side voucher programs Coverage Estimate: 60% Feasibility: 42% Supported by: Government, WB, USAID, DFID, SIDA,\u00a0Cordaid Budget : WB $ 68 million 2016-2020 Description: The World Bank-financed RBF project 2003-2006 (Performance-Based Contracting) had many imperfections [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":311,"menu_order":7,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_mi_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":""},"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/www.sina-health.com\/index.php?rest_route=\/wp\/v2\/pages\/228"}],"collection":[{"href":"https:\/\/www.sina-health.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.sina-health.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.sina-health.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.sina-health.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=228"}],"version-history":[{"count":9,"href":"https:\/\/www.sina-health.com\/index.php?rest_route=\/wp\/v2\/pages\/228\/revisions"}],"predecessor-version":[{"id":4101,"href":"https:\/\/www.sina-health.com\/index.php?rest_route=\/wp\/v2\/pages\/228\/revisions\/4101"}],"up":[{"embeddable":true,"href":"https:\/\/www.sina-health.com\/index.php?rest_route=\/wp\/v2\/pages\/311"}],"wp:attachment":[{"href":"https:\/\/www.sina-health.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=228"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}