Yellow Star Program-Uganda
Country of Operation
- Uganda Government Ministry of HealthGovernment
Target income level
- Bottom 20%
SummaryThe Yellow Star Program, carried out between 2000 and 2006, worked to check the quality of family planning services, increase the readiness of clinics to offer basic family planning services, improve provider motivation, and empower clients to request quality services.
The quality of health services has been a major deterrent to service utilisation in Uganda. Supervision reports indicate that health providers often do not adhere to Ministry of Health guidelines, and that services are compromised by frequent deficiencies in essential supplies and drugs. Improving supervision and quality has also been a challenge, causing the Ministry of Health to established a Quality Assurance Department to develop and disseminate guidelines for facilitative supervision of health facilities. It was to such challenges that Yellow Star Program was established to monitor and motivate health workers through recognition of good performance and active community participate in the provision of good quality services.
Key program components
The program aimed to strengthen the existing supervision system and improve the quality of care through a system of certification and recognition of facilities that met and maintained a set of 35 basic standards of quality. These standards fall into the following six categories: (1) infrastructure and equipment, (2) management systems, (3) infection prevention, (4) information, education and communication/interpersonal communication, (5) clinical skills, and (5) client services. Quarterly monitoring was carried out against 35 quality standards. If a facility met all standards for two quarters, they received a yellow star. If a facility did not meet all standards for more than one quarter, the star was withdrawn. During initial assessments, 179 government and NGO facilities met on average only 46.8% of the program’s basic standards. By the second assessment, this had increased to 64.8%, an 18% increase in only 3 months. For individual health facilities, improvement in standard achievement ranged from 13.7 to 20.9%. Although improvements in quality were noted, the program ran into a number of challenges, including local ownership, maintaining quarterly supervision visits, encouraging the involvement of higher level facilities and the private sector, and expansion to other districts while sustaining the program in the original project districts. A comparison of facilities with and without yellow star certification found that at facilities with certification satisfaction with waiting times was higher whereas patients were more satisfied with prices at non-certified facilities.