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USAID maternal health project exposes flaws in free health care

Kampala, Uganda | THE INDEPENDENT | The United States Agency for International Development (USAID) has recommended that  the government drops the public free healthcare system in favour of mechanisms that allow the low-income earners and the informal sector pool resources to service their health bills.

The development comes as the agency winds up its five-year maternal health project dubbed USAID Voucher Plus Activity. Through the project, community volunteers including village health teams sell vouchers to pregnant women for as little as 4,000 Shillings to access antenatal services in private health facilities in rural districts of Eastern and Northern Uganda.

Using the voucher, USAID would identify private health service providers to deliver a package of services including four antenatal care visits, HIV prevention services, delivery, postnatal care, newborn care and postpartum family planning. The providers are reimbursed after quality services provided to the mother and baby are verified using the voucher the mother presents.

Dr Dennis Guluma, the Deputy Chief of Party of the USAID Voucher Plus Activity told URN in an interview that the project has demonstrated that even the poorest can part with some money if they are guaranteed of a good health service.

Dr Guluma notes that while public facilities claim to offer free care, the new normal is that a mother will pay for all the medications they require in addition to sundries and in some cases bribe the health worker through perks for a good service.

In the 35 districts where the project was being implemented, even as some had health centre IIIs and IVs that can offer maternal and child health services including Caesarean section births, they would choose to part with some money to seek care from their facilities.

At some of these subscribing facilities, mothers are charged a fee of 2000 Shillings for antenatal services. Of the 318,000 vouchers bought, 190,000 mothers had delivered by March when the lockdown on transport was declared as a means to halt the spread of the coronavirus (COVID-19).

The project that will climax in September this year has now stopped selling new vouchers to mothers, but Geoffrey Ocheng who runs Alleluyah Joint Maternity Clinic, one of the supported facilities in Alebtong district by USAID to offer treatment to subscribing women said that they are resolving to sustain the initiative through community health insurance.

He said mothers in the community have already formed a group which will be coming up with a pool of money to sponsor whoever gets pregnant.

However, he doesn’t reveal how much each will be expected to contribute since in addition to the 4000 Shillings voucher that women were contributing, USAID has been topping up on this for any other costs which would arise especially with caesarean sections or other delivery-related complications.

Guluma says that their hope now is that local hospitals can take it up and not let the initiative die but the National Health Insurance Scheme that could provide guidance on how exactly this can be run has not yet come out clear on how community insurance schemes.

The National Health Insurance Bill has not yet been discussed in parliament although the draft approved by cabinet had no provisions on how to deal with informal sections yet.



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