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Hoima is one of 20 districts participating in a pilot project to help poor communities gain access to reproductive health services. The Global Partnership on Output-Based Aid (GPOBA), a partnership program administered by the World Bank, is using output-based aid (OBA) to make access to health services possible. OBA is a results-based approach that ties payment of public funding directly to the delivery of specific services or “outputs”.
The clinic serves an estimated 50,000 people, mostly refugees from the Congo and Sudan and internally displaced people from Northern Uganda. The facility is a one block building housing offices, a maternity ward, and a general ward. The wall partitions are made of papyrus mats. St Jude Thaddeos is an example of the small, local service providers that have made the OBA scheme possible.
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On June 21, 2012, the International Development Association (IDA), acting as administrator of the Global Partnership on Output-Based Aid (GPOBA), signed a Grant Agreement with the Government of Uganda to establish an Grid-Based OBA Fund.
More than half a million people in rural Uganda are expected to benefit from a new US$5.5 million grant that will increase their access to grid-based electricity services. The funds will be used to subsidize electricity connections for approximately 102,000 low-income households (approximately 510,000 people). The project will be managed by the Rural Electrification Agency (REA) on behalf of the government, and implemented over a 4.5-year period - initially by the six service providers licensed by the Electricity Regulatory Authority and approved to participate in the output-based aid (OBA) scheme.
This scheme will “pilot” the OBA approach in grid-based electrification in Uganda, while also creating an OBA facility for the sector, embedded within the REA, which provides for output-based subsidies for utilities that provide pro-poor connections. The facility will also provide flexibility for future generations of electrification through, for example, additional future funding from other development partners and the government.
This is GPOBA’s fourth OBA project in Uganda, and builds on its experiences in water supply and reproductive health where, to date, GPOBA has supported over 250,000 poor people to gain access to basic services.
The OBA facility will support four types of “no-pole” connections for poor households. For households that can afford to install internal wiring in their home prior to connection the facility will support a conventional post-paid meter connection; and a pre-paid meter connection.
For households that cannot afford to install internal wiring at the time of connection the facility will support:
- A ready-board with pre-paid meter connection for households that plan to wire their house over time after connection; and
- A load-limited ready-board connection for the poorest households that have no immediate prospect of being able to afford internal wiring.
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Photo: Dominic Chavez / World Bank
A highly successful pilot program to improve maternal health care for poor women is scaling up under a recent grant agreement signed by the World Bank Group -- acting as an administrator for the Global Partnership on Output-Based Aid (GPOBA) -- and the government of Uganda.
With $13.3 million in new funding from the Swedish International Development Cooperation Agency (SIDA), the expanded program relies on innovative, results-based financing that provides vouchers for safe maternal and reproductive health care. The vouchers help women pay the cost of professional health care service, and then service providers are reimbursed after the service is delivered. The program builds on a highly successful $4.3 million pilot launched in 2007, and the reproductive health voucher program exceeded its targets, assisting in the safe delivery of 65,590 babies and providing reproductive health care services to more than 136,000 people in rural communities in western Uganda.
Under the recently signed agreement, the five-year program will be part of the government’s national development and health plans and will provide 132,400 poor women with a “Safe Delivery” health care voucher that entitles them to an assisted delivery, pre and post-delivery care by certified, skilled medical professionals, and treatment and management of selected pregnancy-related medical conditions and complicated deliveries, including emergency transport. The agreement also supports project management functions and builds national capacity to mainstream and scale up the safe delivery voucher scheme in the health sector.
While Uganda is on track to achieve many of the UN’s Millennium Development targets – such as halving poverty, improving gender equality, and empowering women – the country lags behind on maternal mortality. Peri-natal and maternal mortality make up 20.4 percent of the disease burden in Uganda, and the government has established a health sector strategic plan to reverse poor maternal health outcomes.
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THIRD ANNUAL INN-OBA-TIONS AWARD RECIPIENT - JANUARY 2016
The Uganda Grid-Based OBA Facility: Energy for Rural Transformation II, team led by Mitsunori Motohashi, supports improved access to electricity for poor households by subsidizing connection fees in peri-urban and rural areas throughout Uganda. The highly collaborative project is based on a PPP between the government of Uganda (GoU) and service providers, and includes strong collaboration between the GoU and the World Bank/IDA, GPOBA and KfW. To date, the project has reached 75 percent of its target, with 102,000 households connected to electricity supplies. (Read article in East African Businessweek, "Uganda Grid-Based Output-Based Aid Facility."
Read about other recipients.
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The awards were presented by Ede Ijjasz-Vásquez, Senior Director for the Social, Urban, Rural and Resilience Global Practice (SURR), who praised the winning projects for their strong links to the goals of both GPOBA and SURR. “All of these projects support more resilient, inclusive, sustainable communities,” he said. “They push the frontiers of development approaches in ways that are producing real results.”
Carmen Nonay, Practice Manager for SURR’s Partnerships and Resource Mobilization unit, expressed her appreciation to the teams within the World Bank that are working with OBA and RBF approaches. “Collaborating on projects is a very rewarding experience, and these innovative approaches have the potential to change the way we all view development solutions.”
Catherine Commander O’Farrell, Head of GPOBA, part of SURR’s Partnerships and Resource Mobilization unit, stressed the range of the winning projects and the challenges they overcame for successful implementation, whether working in areas affected by conflict and fragility or utilizing climate-change mitigation mechanisms in untested regions, noting “Each project is pioneering in its own way.”
The Inn-OBA-tions awards were divided into four categories to recognize specific achievements using results based approaches. The Pioneer Award recognizes a project that takes a visionary approach to working in less-tested sectors or challenging environments; the Collaboration Award goes to a project that leverages partnerships and exemplifies cooperation among World Bank units, governments, and/or other development partners; the Social Inclusion/Green Award honors projects supporting the development of green, inclusive, and resilient communities while addressing the social inclusion of the poor, vulnerable, and other excluded groups; and the newly created Governance Award goes to a project that exemplifies accountability and capacity building through effective governance.
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In Uganda there are 160 small towns and about 850 rural growth centers, with a total estimated population of 2.5 million. In 2008 safe water coverage extended to about 46 percent of the population in the 160 small towns, and systems functioned 89 percent of the time on average. The government’s goal was to achieve 65 percent coverage and 95 percent functionality by 2015, and full coverage by 2035. To support the government of Uganda with this vision, GPOBA supported an OBA pilot project in small towns and rural growth centers to test a risk transfer mechanism that leverages private sector finance and expertise in system design, construction, and operation within the existing institutional framework. The project provided affordable safe water to new customers among poorer groups while promoting effective implementation, value for money, and private participation.
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In Uganda, large segments of the urban poor are not connected to piped water systems and are therefore paying large sums of money for consuming water of inferior quality from private vendors. National Water and Sewerage Corporation (NWSC), in charge of providing water services continually seeks to improve coverage for serving the urban poor through piped schemes. To support this effort GPOBA provided funding to design an OBA scheme to focus on extending connections to Kampala’s urban poor using performance-based subsidies. The project targets the poor living in slum areas in and around Kampala as well as the peri-urban areas and provide these poor with subsidized connections to the water supply network.
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Germany’s Kreditanstalt für Wiederaufbau (KfW) approached GPOBA to help expand its existing health voucher scheme in Uganda. KfW successfully launched a pilot project in July 2006, which finances the diagnosis and treatment of Sexually Transmitted Diseases (STDs). In addition, the current project will fight maternal mortality through provision of vouchers for safe child birth. This includes ante-natal and post-natal visits as well as birth attendance by trained professionals, and provision of caesarean section (where required). The voucher scheme will target rural and poor peri-urban populations living in the areas of approved providers in the greater Mbarara region in western Uganda. KfW will implement the project on GPOBA’s behalf.
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Objective: In Uganda, the grid electrification rate is one of the lowest in the world, at only about 18 percent. Power shortages remain one of the biggest obstacles to economic growth. To address this challenge, the Government of Uganda established the Rural Electrification Agency (REA) in 2001 and formulated a Renewable Energy Policy in 2006. Comprehensive reforms have since focused on making the sector financially viable, creating independent regulation of the electricity industry, and attracting private investment to the sector. GPOBA funding was to help make grid electricity accessible and affordable for low-income rural households. The OBA facility was to support provision of over 105,000 grid connections to low-income households (525,000 residents), representing about 10 percent of new connections country-wide from 2013–2016.
Outputs: The project was implemented by the Rural Electrification Agency in cooperation with eight licensed distribution companies. It established an OBA facility funded by the Government of Uganda, the EU, KfW, and GPOBA. The Facility connected 106,600 households, representing about 10% of the electrification rate of the country, of which GPOBA subsidies went to 36,900 connections. The scheme has been instrumental in increasing connection uptake in Uganda, and coupled with public awareness, has contributed to a reduction in illegal connections.
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Overview
Uganda RHVP II (a scale up of the $4.3m IFC pilot, closed in 2012), supported poor mothers in rural and disadvantaged areas of eastern and south western Uganda by providing access, through subsidized vouchers, to a package of reproductive health services, including antenatal care (ANC), deliveries with skilled medical attendants, postnatal care (PNC), treatment and management of selected pregnancy-related medical conditions and complications, and emergency transport. The package included services for elimination of mother-to-child transmission of HIV (EMTCT), as part of ANC. The project was also designed to expand the capacity of health service providers in these rural and disadvantaged regions.