What is a Voucher?

Learn how vouchers work to help provide access to reproductive health for poor women in Africa and Asia

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What is a Voucher?
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From the Blog

Articles | April 25th, 2012

Community-level impact of the reproductive health vouchers programme on service utilization in Kenya

Title: Community-level impact of the reproductive health vouchers programme on service utilization in Kenya Authors: Francis Obare, Charlotte Warren, Rebecca Njuki, Timothy ...

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Germany's contribution to achieving MDG5 in Kenya

Resources | April 20th, 2012

Vouchers: making motherhood safer for Kenya’s poorest women

The German Health Practice Collection has released a publication highlighting Germany’s contribution to the achievement of MDG5 in Kenya. This publication was written ...

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Resources | April 10th, 2012

Quick Guide to Developing Voucher Programmes

Do you need to setup a voucher programme? Options Consultancy Services, Ltd. has written a Quick Guide to Developing Voucher Programmes. The Quick Guide to Developing ...

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Presentations | April 6th, 2012

Uganda Safe Motherhood Voucher Impact Evaluation, March 2012 Presentation

Ben Bellows presented findings from a recent Population Council analysis of the impact of the Uganda safe motherhood vouchers program at a World Bank workshop in Kampala on 23 ...

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Research Findings | March 27th, 2012

The Effectiveness of Vouchers: Where We Need More Evidence

Good science requires more than just good data: we also need researchers dedicated to progress. In this two-part series, we sit down with Carinne Brody, a DrPH student at the ...

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A voucher is a card that entitles a poor, pregnant woman to subsidized maternity care.

Family planning, safe abortions, sexually transmitted infection screening, antenatal visits, assisted baby delivery including any complications, and a postnatal visit, all at her choice of qualified facility.

Goals

Give patients the economic power to demand high-quality health care
Target high-risk or low-income patients for critical services
Augment general population utilization rates and contain per-unit costs
Offer incentives to service providers to encourage innovation, cost-effectiveness, and responsiveness to clients

Components

A voucher is a subsidized card that entitles a pregnant woman to antenatal visits, assisted baby delivery including any complications, and a postnatal visit at her choice of qualified facility.

A recipient (or client) is a poor, pregnant mother. A questionnaire called a poverty grading tool is administered to each potential client to determine eligibility for the voucher.

A service provider is a qualified health care facility contracted to provide maternal health services to voucher recipients.

A claim is a request for financial reimbursement for maternal health services provided to voucher recipients.

A voucher management agency is a government, non government, or private-sector organization charged with managing the financial and administrative tasks needed to run voucher programs.

A community-based distributor is a person or organization charged with distributing vouchers to eligible women in target communities.

A poverty grading tool is a questionnaire designed to assess the poverty status of a potential voucher recipient.

Types of Vouchers

Safe Abortion vouchers provide poor women subsidized access to safe abortion services. These vouchers are offered in Cambodia.
Safe Motherhood vouchers provide poor pregnant women subsidized access to maternal health services including antenatal visits, assisted baby delivery including any complications, and a postnatal visit. These vouchers are offered in Bangladesh, Cambodia, Kenya, Uganda, and Tanzania.
Family Planning vouchers provide poor women of reproductive age subsidized access to family planning services and consultation. These vouchers are offered in Cambodia, Kenya, and Uganda.
Gender-based Violence vouchers provide poor women subsidized access to consultations with gender-based violence councilors. These vouchers are offered in Kenya.

Explore Voucher Programs Around the World

Bangladesh
Cambodia
Kenya
Tanzania
Uganda

Uganda

Program Design
Start DateSTI services: July 2006 - present SMH: 2008- present FP: 2010-present
Services ProvidedSMH, FP, STIs
ImplementerMarie Stopes Uganda (MSU)
Regulatory BodyMinistry of Health
Funder(s)KfW, GPOBA (World Bank), DFID, USAID
Competitivecompetitive in local areas where there is more than one provider
Coverage area22 districts in west and south of country
No. of participating health providersSTIs 41 SMH 100 FP 95
No. of CBDs345

Program Activity for Safe Motherhood, SM (2010/2011)
No. of Vouchers distributed41, 467
No. of vouchers utilizedDelivery=29,058; PNC=7969
No. of births with vouchers29, 058
Percentage of births among the poorest quintile attributable to vouchers18%
Total spent providing services~ 1.5 million US$/year

Program Activity for non-SM services (2011)
No. of Vouchers distributedSTIs=39,878 FP=13,823
No. of vouchers utilizedSTIs=31,513;FP=5,591

Voucher costs and subsidies
Cost of voucher to the motherSMH=US$ 1.30 FP=$0.80 STIs= US$ 1.30
Reimbursement rate for ANCUS$22.59
Reimbursement rate for a normal deliveryUS$22.59
Reimbursement rate for a C-sectionUS$ 67.50
Reimbursement rate for PNCUS$22.59

Tanzania

Program Design
Start DateSeptember 2011 to present
Services ProvidedSMH
ImplementerNational Health Insurance Fund (NHIF)
Regulatory BodyMinistry of Health
Funder(s)KfW
CompetitiveNot in the rural areas where dispensaries are the only provider. Perhaps in larger towns.
Coverage areaTanga and Mbeya regions (10 districts)
No. of participating health providers357 facilities in Mbeya and 270 in Tanga mostly Government with some FBOs and private health facilities
No. of CBDs

Program Activity for Safe Motherhood, SM (2010/2011)
No. of Vouchers distributed500
No. of vouchers utilizedUnknown
No. of births with vouchersUnknown
Percentage of births among the poorest quintile attributable to vouchersall clients identified as either residing in a poor area or qualified on a individual poverty score card
Total spent providing servicesN/A

Program Activity for non-SM services (2011)
No. of Vouchers distributedall voucher clients are enrolled in NHIF insurance package. All client households are enrolled in CHF insurance for 12 months
No. of vouchers utilizedUnknown number of non-Safe Motherhood services provided by insurance coverage

Voucher costs and subsidies
Cost of voucher to the motherFree
Reimbursement rate for ANC
Reimbursement rate for a normal delivery
Reimbursement rate for a C-section
Reimbursement rate for PNC

Kenya

Program Design
Start Date2005 to present
Services ProvidedSMH,FP, GBV services
ImplementerPriceWaterhouseCoopers (PwC)
Regulatory BodyMinistry of Public Health and Sanitation (MOPHS)
Funder(s)KfW, EU
Competitivecompetitive in local areas where there is more than one provider
Coverage area4 districts and 2 slums
No. of participating health providers 88 contracted public, private, and non-profit providers.
No. of CBDs70+

Program Activity for Safe Motherhood, SM (2010/2011)
No. of Vouchers distributed38, 370
No. of vouchers utilizedANC=18306, Normal Delivery=19139, CS=2661, Pregnancy and baby complications=5124; Total SMH=45, 231 with spill over from previous year sales
No. of births with vouchers21,800
Percentage of births among the poorest quintile attributable to vouchers
Total spent providing servicesUS$ 4,602,980 (3,501,827 Euros) as at March 2011

Program Activity for non-SM services (2011)
No. of Vouchers distributedFP= 17, 219
No. of vouchers utilizedFP= 10, 548; GBV= 463

Voucher costs and subsidies
Cost of voucher to the motherSMH: US$2.50 FP: US$1.25
Reimbursement rate for ANCUS$13
Reimbursement rate for a normal deliveryUS$70
Reimbursement rate for a C-sectionUS$292
Reimbursement rate for PNC?

Cambodia

Program Design
Start DateJanuary 2011 to present
Services ProvidedSMH, FP, Abortion
ImplementerEPOS-OPM-PwC and AFH
Regulatory BodyMinistry of Health
Funder(s)KfW
Competitivecompetitive in local areas where there is more than one provider
Coverage area9 operational districts
No. of participating health providers78 HCs, 5 RHs, 1 PRH, 2 of Clinics-MSI-C
No. of CBDs

Program Activity for Safe Motherhood, SM (2010/2011)
No. of Vouchers distributed2984
No. of vouchers utilizedANC1=1988 ANC2= 1340 ANC3= 846 Delivery = 1186 PNC= 798 Complicated and CS = 111
No. of births with vouchers1,297
Percentage of births among the poorest quintile attributable to vouchersOnly poor pregnant women receive vouchers
Total spent providing services> 1 million US$/year

Program Activity for non-SM services (2011)
No. of Vouchers distributedFP=13504
No. of vouchers utilizedFP-5416, SA-1839

Voucher costs and subsidies
Cost of voucher to the motherFree
Reimbursement rate for ANCUS$0.7
Reimbursement rate for a normal deliveryUS$7.5
Reimbursement rate for a C-sectionUS$45
Reimbursement rate for PNCUS$0.7

Bangladesh

Program Design
Start DateAugust 2006 to present
Services ProvidedSMH
ImplementerMinistry of Health and Family Welfare (MOHFW)
Regulatory BodyMinistry of Health and Family Welfare (MOHFW)
Funder(s)Pool fund (World Bank administered)
CompetitiveNo
Coverage area46 Upazilas
No. of participating health providersMaternal Health Care Service Providers in 46 Upazila Health Complexes
No. of CBDsFWA, HA and SBAs from 46 Upazilas

Program Activity for Safe Motherhood, SM (2010/2011)
No. of Vouchers distributed
No. of vouchers utilizedANC1= 112,975 ANC2= 97,295 ANC3= 83,836 Delivery= 100,588 PNC= 94,857
No. of births with vouchers100,588
Percentage of births among the poorest quintile attributable to vouchersOnly poor pregnant women receive vouchers
Total spent providing servicesUS$ 5,600,000

Program Activity for non-SM services (2011)
No. of Vouchers distributedN/A
No. of vouchers utilizedN/A

Voucher costs and subsidies
Cost of voucher to the motherFree
Reimbursement rate for ANCUS$13.7
Reimbursement rate for a normal deliveryUS$61.7
Reimbursement rate for a C-sectionUS$21.2
Reimbursement rate for PNCUS$3.4

Bangladesh
Cambodia
Uganda
Kenya
Tanzania

Select a country to view its profile
RHVoucher Programs
Other Voucher Programs

The Population Council with the support of the Bill & Melinda Gates Foundation is evaluating the efficacy of using vouchers to improve access to quality reproductive health services for poor women.

The Birth of a Voucher

Today, there is virtually nowhere on Earth that one cannot get a Coca-Cola™. In 1888, a few years after the company's founding, no one knew what a Coca-Cola was, and no one wanted one until the company invented the coupon (or voucher). Coca-Cola mailed out thousands of coupons entitling the bearer to a free Coca-Cola at any dispenser and reimbursed dispensers by giving discounts on the syrup used to make a Coca-Cola. By 1913, 8.5 million coupons had been redeemed and the idea of the coupon (or voucher) was not only born but was firmly entrenched as a mechanism for stimulating demand for a product or service.

What's the difference between a Coupon and a Voucher?

A coupon and a voucher are both objects that entitle the bearer to a good or service at a discount. The difference is that coupons are available to anyone whereas vouchers are targeted at a specific set of people.

Vouchers and Reproductive Health

Each year 150,000 women die during or as a result of childbirth and 2.8 million babies are still-born or die during the birthing process. Many of these deaths could be prevented if more poor women had access to adequate reproductive health care.

Vouchers are a non traditional way of providing poor women the financial means to access reproductive health services and of establishing a stable market for private or public health providers to offer these services in underserved areas.

Focus Countries

Kenya
Tanzania
Uganda
Bangladesh
Cambodia

What, specifically, is Population Council evaluating concerning vouchers?

Utilization
Are poor women who receive vouchers utilizing more reproductive health services than poor women who have not received a voucher?
Equity
Are voucher programs appropriately targeting poor women who have never delivered in a health facility?
Quality
Are affiliated health service providers providing quality care? Does the presence of the vouchers lead to improvements in the quality of health facilities?
Cost-effectiveness
Are voucher programs cost-effective in terms of dollar's per life saved than competing interventions?
Coverage
What percentage of births are facilitated by vouchers?

Meet the Team

Ben Bellows
Population Council Associate and Project Manager

Jerry Okal
Program Officer

Joyce Ombeva
Program Coordinator

Francis Onyango
Senior Analyst

Lucy Kanya
Program officer

Timothy Abuya
Senior analyst

Charlotte Warren

Nondini Lopa
Research Officer

Kaji Tamanna Keya
Senior Research Officer

Eshita Jahan
Senior Research Officer

Ms. Forhana Rahman Noor
Senior Research Officer

Ubaidur Rob
Senior Associate & Country Director

Md. Moshiur Rahman
Program Officer

From the Blog

Community-level impact of the reproductive health vouchers programme on service utilization in Kenya

Vouchers: making motherhood safer for Kenya’s poorest women

Quick Guide to Developing Voucher Programmes

Uganda Safe Motherhood Voucher Impact Evaluation, March 2012 Presentation

The Effectiveness of Vouchers: Where We Need More Evidence

Stay Connected

A voucher is a card that entitles a poor, pregnant woman to subsidized maternity care.

Family planning, safe abortions, sexually transmitted infection screening, antenatal visits, assisted baby delivery including any complications, and a postnatal visit, all at her choice of qualified facility.

Goals

Components

Types of Vouchers

Explore Voucher Programs Around the World

Uganda

Program Design

Program Activity for Safe Motherhood, SM (2010/2011)

Program Activity for non-SM services (2011)

Voucher costs and subsidies

Tanzania

Program Design

Program Activity for Safe Motherhood, SM (2010/2011)

Program Activity for non-SM services (2011)

Voucher costs and subsidies

Kenya

Program Design

Program Activity for Safe Motherhood, SM (2010/2011)

Program Activity for non-SM services (2011)

Voucher costs and subsidies

Cambodia

Program Design

Program Activity for Safe Motherhood, SM (2010/2011)

Program Activity for non-SM services (2011)

Voucher costs and subsidies

Bangladesh

Program Design

Program Activity for Safe Motherhood, SM (2010/2011)

Program Activity for non-SM services (2011)

Voucher costs and subsidies

The Population Council with the support of the Bill & Melinda Gates Foundation is evaluating the efficacy of using vouchers to improve access to quality reproductive health services for poor women.

The Birth of a Voucher

What's the difference between a Coupon and a Voucher?

Vouchers and Reproductive Health

Focus Countries

What, specifically, is Population Council evaluating concerning vouchers?

Utilization

Equity

Quality

Cost-effectiveness

Coverage

Meet the Team

Area of Research

Why you are passionate about reproductive health and/or vouchers?

Area of Research

Why you are passionate about reproductive health and/or vouchers?

Area of Research

Why you are passionate about reproductive health and/or vouchers?

Area of Research

Why you are passionate about reproductive health and/or vouchers?

Area of Research

Why you are passionate about reproductive health and/or vouchers?

Area of Research

Why you are passionate about reproductive health and/or vouchers?

Area of Research

Why you are passionate about reproductive health and/or vouchers?

Area of Research

Why you are passionate about reproductive health and/or vouchers?

Area of Research

Why you are passionate about reproductive health and/or vouchers?

Area of Research

Why you are passionate about reproductive health and/or vouchers?

Area of Research

Why you are passionate about reproductive health and/or vouchers?

Area of Research

Why you are passionate about reproductive health and/or vouchers?

Area of Research

Why you are passionate about reproductive health and/or vouchers?

Please stay tuned for concrete way you can help poor mothers get access to life-saving reproductive health care.

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