Global Health Ideas

Finding global health solutions through innovation and technology

Output Based Aid Vouchers in Uganda and elsewhere

Output based aid is often used to describe foreign assistance programs that link disbursement of aid to some measurable output. The Global Programme on OBA has some interesting efforts underway and others approved for eligibility.

I’ve been running an evaluation of an output-based aid project in western Uganda among private providers who offer diagnosis and treatment of sexually transmitted infections (STIs). At this time, no HIV treatment is offered.  OBA voucher schemes can have one or more of four possible aims: contain costs, improve provider quality, stimulate utilization of selected services and target services to high-priority populations. Depending on how the program is set up, it may have a performance incentive built-in, it may use vouchers or credits for specific services, and it always has some mechanism in place, usually an enforceable contract, to ensure compliance.

The image above is of the OBA voucher currently in circulation in the Ugandan STIs project. The voucher concept is one of several strategies to deliver public goods and services to socio-economic, demographic or other groups identified as a priority by health policymakers. Examples include poor youth at high risk of HIV infection, women suffering from domestic violence, or administrative districts with high STI incidence. What makes the Uganda voucher project an output-based aid voucher project is the contract. The contract between STI treatment providers and the management agency, operating on behalf of the Uganda Ministry of Health, stipulates fee-for-service payments made conditional on the provider meeting certain performance standards.

OBA in health care has a limited history. Rwanda has recently expanded its OBA services [.pdf], Uganda and Kenya have KfW support for OBA, and Nicaragua used bonos (vouchers) in an output based reimbursement scheme targeting sex workers in Managua.  Similar  fee-for-service output were run nationally in South Korea and Taiwan with Population Council support in the late 1960s and 1970s.

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Written by Ben

March 23, 2007 at 2:23 am

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  1. […] clinics in western Uganda. As mentioned in previous THDblog posts (Jan ‘08, June ‘07, Mar ‘07) there is an output-based aid (OBA) health project in western Uganda that has treated more than […]


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