Fitting Health Financing Reforms to Context: Examining the Evolution of Results-Based Financing Models and the Slow National Scale-Up in Uganda (2003-2015)

Figures & data

Table 1. Table showing categories of respondents

Category	Sub category	Number of respondents
Implementers/project staff		10
Health facility managers		7
National level policy-makers	MOH	5
	Academics	3
	Ministry of Finance	1
	Private sector	1
District policy-makers	District health Officers/DHT	5
Development partners		7
TOTAL		39

Table 2. General design and key actors in various schemes

Project feature	Duration	General pilot design	Funder	Fund holder	Purchasing agent	Auditing/Verification agents
Supply side schemes
World Bank Study	2003–2005	Quasi-experimental design, two intervention groups and a control	CIDA, USAID,BTC	World Bank-Washington	World Bank through local government.	Makerere University School of Public Health (MakSPH)
Cordaid project	2009–2015	Interventional design	Cordaid	Cordaid	Jinja Diocese/Cordaid	Cordaid/District health teams (DHTs) and Community-Based Organisations (CBOs)
NuHealth Project	Sept 2011–2015	Quasi-experiment study (RBF & input based financing)	UKAid (formerly DFID)	Health Partners International (HPI) &Montrose International	HPI & Montrose	NU-Health and District health teams (DHTs)
SDS Project	2011–2016	Intervention design	USAID	SDS program	Cardno and other agencies such as (IDI)	SDS + District health teams
Demand side/voucher schemes
Reproductive Health vouchers Project	July 2006–2011	Intervention study	KfW and the GPOBA-World Bank)	Maries Stopes Uganda (MSU	MSU	MSU PWC as independent verifier.
Safe deliveries Project (SDP)	2009–2011	Quasi-experiment study intervention and control.	Bill and Melinda Gates Foundation and WHO-AHPSR	MakSPH	MaKSPH	MakSPH
Health Baby/SMGL Voucher Project.	2012-2017	Intervention design	SMGL funded by US Global Health(GHI) and partners	SMGL initiative	Baylor-Uganda, IDI,STRIDES for family health, MSU.	Respective agencies

Table 3. Changes in geographical scope and service packages across schemes

Project	Population coverage		Service coverage
	Geographical scope	Populations served	Service packages	Facilities
Supply side schemes
World Bank Study	118 facilities (68 PNFPs) from five pilot districts distributed in four regions. No change over project life.	All resident within reach of health facilities	Six service priorities (OPD and malaria, immunization, ANC, attended births & Family planning.	Intervention group included PNFP only. Public, Private sectors in control category.
Cordaid project	Initially three districts in east (Jinja, Kamuli & Iganga). Later restricted to Kamuli.	All residents within reach of facilities	Range of services from national package.	Started with PNFP. Extended to public facilities in 2013
NuHealth Project	31 health centres in two regions or 12 northern Uganda districts. No change in scope overtime.	All residents within reach of facilities	Range of services especially maternal and child health services	PNFP only.
SDS	35 districts initially increased to 50 districts in 2015 across the country.	Local governments and Medical bureaux	Performance-based grants to districts and Medical Bureaux incentivise governance and management functions.	In regard to health services, the facilities targeted were those with bias to HIV/AIDS and the PNFP facilities
Demand side/voucher schemes
Reproductive Health vouchers Project	Evolved from four pilot districts to 20 districts in south western Uganda.	Women for Safe Motherhood (SM) Couples for STI. Poverty grading used to target poorest.	SM services &STI treatment.	PFP and PNFP facilities. Public facilities were referral points
Safe deliveries Project (SDP)	22 health facilities in two districts in Eastern Uganda. No change in scope.	All pregnant women, transport providers used.	MCH and health system strengthening component to deliver obstetric care services.	Public, PFP and PNFP facilities
Health Baby/SMGL Voucher Project.	Four districts in Western Uganda but scaled up to 10 (included six more districts in Northern Uganda)	All pregnant women within districts, transport provisions made available.	ANC, delivery & Post Natal care and Health systems strengthening.	Private and Public facilities involved.

UCMB: Uganda Catholic Medical Bureau, WB: World Bank, PNFP: private not-for – profit, NMS: National Medical Stores, JMS: Joint Medical stores, MOH: Ministry of Health, VHT: Village Health teams, PFP: Private for Profit, DHT: District Health Team, SM: Safe Motherhood, USAID: United States Development Agency, CIDA, Canadian International Development agency, DFID: Department of International Development (now UKaid), BTC: Belgian Development agency, STI: Sexually transmitted Diseases, MakSPH: Makerere University School of Public health, MSU:Maries Stopes International-Uganda, GPOBA: Global Partnership for Output-Based Aid, CBOs: Community-Based Organisations, HPI: Health Partners International, ANC: Antenatal Care,

Source: Authors’ analysis

Availability of data and materials

Interview data are available on reasonable request.