Internships

Provider perspectives on the impact of competitive vouchers for reproductive health in southwestern Uganda

, 2010

A mother holds her new baby and the voucher that saved her life. She had a serious obstetric complication and would have lost the baby if she had given birth in the village. Thanks to the voucher she delivered in a hospital and they were able to do a cesarean section.

Carrine Meyer, DrPH Candidate

This study aimed to assess providers’ opinions of a reproductive health voucher program in Uganda regarding the following five dimensions:  1)voucher revenue, 2)job satisfaction, 3)competitiveness, 4)general functioning of the program and 5)unanticipated consequences. Semi-structured interviews were conducted with providers from a purposive sample of 22 voucher facilities and 15 non-voucher (control) facilities.

At voucher facilities, 96% of respondents reported that facility revenue had increased in the past year as compared to control facilities where only 10% of respondents reported that revenue had increased in the past year (p<0.001).  Using an adaptation of validated scale, providers at voucher clinics had a better average satisfaction score (17.9) than providers at control clinics (19.0) (ns).  Providers at voucher facilities where salaries were increased as a result of the voucher program reported significantly better job satisfaction scares (16.3 vs. 19.3, p=0.02).  Over 45% of providers identified increased salaries as the number one benefit of the voucher program for providers.  The second most reported benefit was that providers gained more experience as a result of seeing more patients (16%).  In regard to perceived disadvantages of the voucher program, 36% of respondents reported that they saw no disadvantages.  A third of respondent reported feeling overworked.  Eighteen percent indicated that the fixed prices and treatment guidelines were a disadvantage.   Unanticipated consequences reported include more male involvement in maternal care, increased recognition of providers in their communities and decreased loss of revenue from cesarean section due to patients alluding payment.

While these results are preliminary and further analysis will be carried out, they are suggestive of a number of important patterns regarding the impact of the voucher program on providers.  First, the voucher program increased facilities revenue and enabled proprietors to re-invest in their facility.  Second, providers’ workload increased and employees were unmotivated to manage the workload unless they received some compensation– even in the form of small allowances or stipends.  Finally, providers exhibit strong support for the voucher program but would like more input on treatment reimbursement guidelines so that is reflects their needs and clinical opinions.

A mother holds her new baby and the voucher that saved her life. She had a serious obstetric complication and would have lost the baby if she had given birth in the village. Thanks to the voucher she delivered in a hospital and they were able to do a cesarean section.