Innovative Financing Partnerships Help Uganda Meet the Unmet Need for Family Planning
A performance-based financing (PBF) grant has helped the Kamuli VSC health clinic in Kamuli District, Uganda drastically increase the quantity of family planning services provided to clients. In September 2010, the clinic saw 10 family planning clients per week; now nearly 80 clients receive family planning services each week. Kamuli VSC health clinic is supported by Family Life Education Program (FLEP), a local private sector organization that STRIDES for Family Health has assisted with a PBF contract since September 2010. The new grant allowed Kamuli health clinic the opportunity to provide additional family planning services, including Long-Acting and Permanent Methods (LAPM) which were previously unavailable.
STRIDES for Family Health, led by Management Sciences for Health (MSH) and funded by the US Agency for International Development (USAID), is creating innovative partnerships by using PBF with local organizations to improve access to and quality of health services in rural Uganda. In September 2010, 12 private sector organizations were awarded PBF contracts from STRIDES. PBF is a contracting mechanism that focuses on paying for results, not for processes. Health managers and workers are paid based on the quantity and quality of the services they provide.
The Family Life Education Program, a PBF grant recipient, is increasing accessibility and utilization of quality LAPM for family planning to women and couples in underserved districts of Uganda by strengthening service delivery at 16 health centers. Hard-to-reach communities with limited accessibility to established health service points are also served through mobile outreach clinics.
Before the STRIDES' intervention, the Kamuli health clinic only offered short-term contraceptive methods such as pills, injectables, and condoms. It now offers all methods, including short term, long acting, and permanent methods such as: intrauterine device (IUD), implants, vasectomy, and elective female sterilization.
Kaswa Hebert, who works at the Kamuli clinic, says, "Before our area of operation was limited, but ever since STRIDES contracted with us, we have been able to expand our services."
Faridah Kawuda a resident of Bulwamaza village in Kamuli district is one of the clients who received the newly available family planning services. She recently had a bilateral tubal ligation (BTL) and is confident that she has made the right choice. At 28, she has five children; the eldest is 12 years of age and the youngest four. Faridah opted for injectable family planning services for four years, but "I decided to have a BTL because I thought these children were enough," she shared.
In her sub-county alone, more than ten women have benefited from the services offered by FLEP; unfortunately, male involvement is still low. STRIDES has started to engage men through activities such as: community dialogues, radio talk shows, sports activities, and use of male champions.
FLEP anticipates that by the end of the STRIDES contract, approximately 8,000 individuals and couples will have received adequate counseling on contraceptive choices. FLEP is planning to conduct a client-satisfaction survey and will use the results for targeted quality improvement activities in the three districts. With FLEP, STRIDES believes that counseling and quality of care are the most important factors influencing clients' family planning decisions. Continuous improvement of all aspects of quality of care must be given the highest priority.
STRIDES for Family Health in Uganda is implemented by MSH in partnership with Jhpiego, Meridian International, and the Ugandan organizations Communication for Development Foundation and the Uganda Private Midwives Association. STRIDES works with the Ministry of Health, districts, communities, local private organizations, and individual private providers in 15 districts to increase contraceptive use and healthy timing and spacing of pregnancy, decrease maternal and child mortality, and create a scalable nationwide intervention by the year 2014.