Continuity of maternal and newborn health service provision among private sector players following donor transition. Hope amidst challenging implementation experiences in Uganda.

backgroundSupporting service delivery through the private sector is a policy priority for improving maternal and child health service delivery for UHC. Despite the increased attention, it is not clear how pay-for-performance interventions within the private sector perform post-donor transition. This study aimed to examine the impact of donor transition on private service providers' ability to deliver maternal and newborn health in Uganda.

methodsAn exploratory qualitative study was conducted in Uganda's Rwenzori and Lango sub-regions, which benefited from a USAID project to reduce maternal and newborn deaths from 2012 to 2016 in Rwenzori and 2015-2020 in the Lango sub-region. A purposive sample of 52 respondents (Rwenzori = 26, Lango = 16, National = 10) took part in the study. A thematic analysis technique was followed, guided by the components of the health systems dynamics framework, with data management supported by Atlas. ti a qualitative data management software.

resultsOverall, results reflect a mix of progress and setbacks following the cessation of donor funding to the participating private health service providers. The subnational governance to provide oversight to the private sector was strengthened, which extended into the post-transition period. Despite setbacks in the provision of a comprehensive MNCH package, such as a drastic reduction in patient volumes, reduced scope of services offered and inconsistent supply of emergency medicines, the popularisation of MNCH services among the private sector players created awareness of the same post-transition. The information systems built with donor support contributed to improved data reporting from the private sector, which was sustained post-transition. Human resources for health among private sector players were greatly affected post-transition, although the same benefited the public sector with an experienced pool of health workers from which they recruited into public service. Despite the continued use of equipment procured during donor support, the medicines and supplies were greatly affected by funding cessation. Equally affected was the financing following donor cessation to the private sector players post-transition.

conclusionDespite the mixed results following donor cessation of funding to the private sector, these results have important implications for supporting private sector players to improve MNCH services in low-resource settings. The governance, health information systems, and service delivery experiences are critical aspects worth emulating for better engagement of the private sector in strengthening MNCH service delivery. CLINICAL TRIAL NUMBER: Not applicable.