World Bank Reproductive, Maternal and Child Health Services 2017-21

This appraisal forms the basis for a decision on support to the World Bank's "Reproductive, Maternal and Child Health Services Improvement Project" in Uganda. In July 2015, Uganda was chosen as one of eight countries to receive support from the Global Financing Facility (GFF) Trust Fund. The GFF in support of the "Every Woman Every Child" movement is a country-driven partnership aiming at accelerating efforts to end preventable maternal, newborn, child and adolescent deaths and improve their health and quality of life, through an integrated health system approach and evidence-based solutions aiming at improving Reproductive, Maternal Newborn, Child and Adolescent Health (RMNCAH) outcomes. In light of the GFF, the Goverment has revised the "2016-2020 RMNCAH Sharpened Plan", highlighting key gaps in service utilization and coverage and establishing priority RMNCAH interventions. The "Uganda Reproductive, Maternal and Child Health Services Improvement Project", implemented by the World Bank through the Ministry of Health (MoH) and co-funded by IDA and GFF Trust Fund, will directly contribute to the implementation of the 2016-2020 RMNCAH Sharpened Plan for Uganda. The planned support aims at improving quality of care, access and utilization of essential health services within RMNCAH and scaling up birth and death registration activities in targeted districts in Uganda. The overall project objectives are to:a) improve utilization of essential health services with a focus on reproductive, maternal, child and adolescent health services in target districts, and b) scale-up birth and death registration servicesThe specific objective of Component 1, which stands for the largest part of the project budget, is to scale-up and institutionalize RBF with a focus on RMNCAH services. The RBF-package comprises of RMNCAH interventions at facility level III and IV, including Village Health Teams (VHT) and focusing on Ante-Natal Care (ANC), safe delivery, comprehensive emergency obstetric care, essential newborn and postnatal care services, post-abortion care, family planning and community-based RMNCAH services including nutrition, prevention and treatment of common childhood diseases and provision of adolescent health services. RBF payments will be made against verified outputs within all the above areas. RBF is part of the RMNCAH Sharpened Plan as well as Uganda's National Health Financing Strategy and the intervention is aligned with the national RBF Framework and builds on previous RBF experience and pilots in Uganda.Under Component 2, support will be provided to the MoH to address the most critical bottlenecks to RMNCAH service delivery, focusing on improving availability of essential RMNCAH drugs and supplies, recruitment and training of staff, providing, distributing and redistributing medical equipment, improving health infrastructure and improving quality of care and supervision at district level.In addition to providing financial support for the “Uganda Reproductive, Maternal and Child Health Services Improvement Project” and to address perceived weaknesses related to gender and the rights perspective, the Embassy plans to allocate funding to procure a consultant that will work with the project organisation focusing primarily on monitoring the integration of gender equality and Human Rights Based Approach (HRBA) for health issues. Furthermore, as it will be very important to document learnings and experiences, the Embassy is engaged in discussions with the World Bank to allocate a proportion (up to 15 MSEK) of the Swedish contribution towards procuring implementation research regarding RBF in Uganda. In the event that the parties will find an agreement, this commitment will be specified in the budget with appropriate wording inserted into the agreement prior to signature.