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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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Kadi

Saving Mothers and Babies,
One Voucher at a Time

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World Bank Institute: Kadi Screening

Venue: The World Bank Institute Date: December 13, 2012 A flagship course at the World Bank Institute in Washington, DC to be held in December will spend one day  of the ...


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Events | November 15th, 2012

USAID: Kadi Screening

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Touro University: Kadi Screening

Venue: Farragut Inn, Touro University, Vallejo, California (United States) Date: 29 November 2012 Time: 16:00


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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.
  • STI Treatment vouchers provide poor women and their partners access to diagnosis and treatment for sexually transmitted infections. These vouchers are offered in Uganda.

Explore Voucher Programs Around the World

  • Bangladesh
  • Cambodia
  • Kenya
  • Tanzania
  • Uganda
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Uganda

  • Program Design

  • Start dateSTI services: July 2006–2009; SMH: 2009–2011; 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=7,969
  • No. of births with vouchers29,058
  • Percentage of births among the poorest quintile attributable to vouchers18%
  • Total spent providing services~US$1.5 million/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=US$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

  • FP Voucher Program, 2011–present

  • FundersDFID, USAID
  • Cost of voucher to the clientUS$0.76
  • No. of vouchers distributed/sold88,996
  • No. of vouchers utilized65,157
  • No. of health providers (BlueStar facilities)424
  • No. of CBDs1,123
  • CoverageEntire country
Close

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
Close

Kenya

  • Program Design

  • Start date2005–present
  • Services providedSMH, FP, GBV
  • ImplementerPriceWaterhouseCoopers (PwC)
  • Regulatory bodyMinistry of Public Health and Sanitation (MOPHS)
  • FundersKfW, EU
  • CompetitiveCompetitive in local areas where there is more than one provider
  • Coverage area4 districts and 2 slums
  • No. of participating health providers 153 contracted public, private, and nonprofit providers (includes newly accredited facilities in Malindi)
  • No. of CBDs70+

  • Program Activity for Safe Motherhood (SM) Services, 2012

  • No. of vouchers distributed93,174 (FP, SMH, SGBV)
  • No. of vouchers utilizedANC=65,062; normal delivery=37,309; CS=4,853; pregnancy and baby complications=8,738; total SMH=106,986 (ANC, ND, CS) with spillover from previous year's sales
  • No. of births with vouchers41,924
  • Percentage of births among the poorest quintile attributable to vouchers
  • Total spent providing servicesUS$4,066,235 (€3,093,485) as of December 2012

  • Program Activity for non-SM Services, 2012

  • No. of vouchers distributedFP=40,825
  • No. of vouchers utilizedFP= 19,974; GBV=296

  • Voucher Costs and Subsidies

  • Cost of voucher to the motherSMH=US$2.50; FP=US$1.25
  • Reimbursement rate for ANCUS$12.00
  • Reimbursement rate for a normal deliveryUS$47.00–US$82.00
  • Reimbursement rate for a C-sectionUS$235.00–US$294.00
  • Reimbursement rate for FP methodsUS$12.00–US$29.00
  • Reimbursement rate for PNCIncluded in normal delivery reimbursement
Close

Cambodia

  • Program Design

  • Start dateJune 2010–present
  • Services providedSMH, FP, SA (safe abortion)
  • ImplementerEPOS-OPM-PwC, AFH
  • Regulatory bodyMinistry of Health
  • FunderKfW
  • CompetitiveCompetitive in local areas where there is more than one provider
  • Coverage area9 operational districts
  • No. of participating health providers118 HCs, 7 RHs, 1 PRH, 2 Clinics-MSI-C, 1 RHAC clinic, 1 private provider
  • No. of CBDs

  • Program Activity for Safe Motherhood (SM), January 2011–December 2012

  • No. of vouchers distributed11,943
  • No. of vouchers utilizedANC1=8,326; ANC2=6,036; ANC3=4,099; ANC4=1,394; Delivery=4,573; PNC1=3,908; PNC2=911; Complicated and C-section=787
  • No. of births with vouchers5,528
  • Percentage of births among the poorest quintile attributable to vouchersOnly poor pregnant women receive vouchers
  • Total spent providing servicesUS$643,308

  • Program Activity for non-SM Services, January 2011–December 2012

  • No. of vouchers distributedFP=42,887
  • No. of vouchers utilizedFP=13,783; SA=5,782

  • Voucher Costs and Subsidies

  • Cost of voucher to the motherFree
  • Reimbursement rate for ANCUS$1.50
  • Reimbursement rate for a normal deliveryUS$15.00
  • Reimbursement rate for a C-sectionUS$100.00
  • Reimbursement rate for PNCUS$1.50
  • Reimbursement rate for SAUS$25.00
Close

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 (Jan-Dec 2011)

  • No. of Vouchers distributed180,526
  • No. of vouchers utilizedANC1= 159,282 ANC2= 141,724 ANC3= 123,675 Delivery= 146,558 PNC= 139,204
  • No. of births with vouchers146,588
  • 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$5.43
  • Reimbursement rate for a normal deliveryUS$34.76
  • Reimbursement rate for a C-sectionUS$68.28
  • Reimbursement rate for PNCUS$1.52
  • 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
Area of Research
Health systems research

Why you are passionate about reproductive health and/or vouchers?
I’m passionate about reproductive healthcare finance given the market based efficiencies to be made in this field!
default_headshot_rhv
Area of Research
Integrating reproductive health and HIV and AIDS services; developing and improving the quality of community-based reproductive health services; understanding the causes and consequences of sexual and gender-based violence; and seeking to eliminate female genital mutilation/cutting.

Why you are passionate about reproductive health and/or vouchers?
jerry-okal
Area of Research
Qualitative research

Why you are passionate about reproductive health and/or vouchers?
Reducing sexual and reproductive health (SRHcom) risks through innovative strategies like the voucher program that empower underserved communities to access comprehensive SRH services.
joyce-ombeva
Area of Research
• Provide administrative support to the team
• Prepare field budgets and implementation of field work
• Processing of consultants appointments
• Organize conference, workshops and training venues
• Recruitment of field research assistants and data entry clerks


Why you are passionate about reproductive health and/or vouchers?
The initiative to introduce the vouchers system is an interesting concept by helping the poor to access highly subsidized quality reproductive health services, be it safe motherhood, family planning but also gender based violence recovery services. The reason why I am passionate about the RH Vouchers program is the way it has touched one of the most important part of a human being, which is health.
francis-obare
Area of Research
Managing research and evaluation activities including managing data collection, conducting multivariate analysis of household and health facility data and primary authorship of manuscripts

Why you are passionate about reproductive health and/or vouchers?
Being part of the team that is generating evidence on the impact of vouchers on reproductive health outcomes.
lucy-kanya
Area of Research
Analyzing sales, claims and costs datasets to determine:
1. Trends in the utilization of vouchers by facility and regions in Kenya and Uganda.
2. Coverage of the vouchers in both poor and general populations in Kenya and Uganda.
3. Unit costs of offering various SRH voucher services at both voucher and non-voucher sites in Kenya.
4. Effectiveness of the voucher in addressing intended RH outcomes (cost effectiveness).


Why you are passionate about reproductive health and/or vouchers?
Vouchers empower target populations to make reproductive health choices today, gaining long-term positive impacts on individuals, communities and health systems.
timothy-abuya
Area of Research
Assessing the effect of voucher program on quality of maternal and child care, policy analysis and understanding the implementation process of voucher programs.

Why you are passionate about reproductive health and/or vouchers?
Vouchers not only Safeguard the Health of mothers and Newborns but also increases opportunities for accessing quality services.
charlotte-warren
Area of Research
PI for Kenya evaluation, and quality assurance across five countries

Why you are passionate about reproductive health and/or vouchers?
PI for Kenya evaluation, and quality assurance across five countries.
nondini-lopa
Area of Research
My area of research is reproductive health. Currently, I am working in OBA/Gates project, where my role is to monitor and supervise project activities, collect service statistics and health management information system data, prepare transcript of qualitative data and provide assistance in writing reports.

Why you are passionate about reproductive health and/or vouchers?
In our efforts to reduce maternal and neonatal mortality voucher can help to address the Millennium Development Goal a step ahead.
tamanna-keya
Area of Research
I am currently involved in reproductive health research under output based aid (OBA) project. My role is to develop study tools, collect periodic data, conduct evaluation study and communicate program managers and stake holders.

Why you are passionate about reproductive health and/or vouchers?
Lack of accessibility in quality services, and financial cost burden contribute in high MMR and morbidity where voucher can be effective.
eshita-jahan
Area of Research
I am working on maternal health care issues under reproductive health research. My responsibilities is to develop research instruments, coordinate data collection and analysis, supervise project activities, conduct training, maintain liaison with partners and stakeholders, and documentation of evaluation activities of Demand Side Financing Program (DSF).

Why you are passionate about reproductive health and/or vouchers?
In Bangladesh maternal mortality is high and DSF program has been introduced for reducing this MMR.
forhana-noor
Area of Research
I am working with maternal health care voucher project under reproductive Health research. My responsibilities are to develop research instruments, conduct training, supervise data collection & field activities, analyzing data, maintain liaison with partners and stakeholders and assist the Team Leader in writing report and disseminate findings.

Why you are passionate about reproductive health and/or vouchers?
Bangladesh has one of the highest maternal mortality ratios (MMR) in the world. DSF can contribute in this field.
ubaidur-rob
Area of Research
For the last 28 years my work has focused on managing, developing, implementing and disseminating operations research projects in family planning/reproductive health program. As Country Director to the Population Council office in Bangladesh, I am responsible for all areas of program management including evaluation of research projects implemented by the Government of Bangladesh, development partners, and NG0s, providing technical assistance in developing and conducting policy analysis for the introduction of new programmatic interventions. My primary areas of expertise include project development; implementation and evaluation; dissemination/utilisation of research findings; conducting in-depth surveys; consultation on program development, monitoring and evaluation. Since 1990 I have been conducting graduate courses in population planning, demography and research methodology at different universities. I oversee the implementation of OBA project activities in Bangladesh.

Why you are passionate about reproductive health and/or vouchers?
I found that financial support through vouchers can change the behaviors and attitudes of poor pregnant women to improve utilization of health care services.
moshiur-rahman
Area of Research
I am involved in reproductive health research especially on maternal health care issues and my current role is to develop data collection instruments, overseeing data management activities including analysis and documentation of evaluation activities of Demand Side Financing (DSF) Program.

Why you are passionate about reproductive health and/or vouchers?
Maternal mortality ratio, especially among poor pregnant women, is quite high in Bangladesh where DSF program can reduce this MMR.
ABajracharya140px
Area of Research
Quantitative research and program evaluation, management and monitoring of household survey data and facility data, authorship on empirical papers on the evaluation of vouchers.

Why you are passionate about reproductive health and/or vouchers?
This project provides a unique opportunity to work on a program that combines the use of innovative approaches to creating demand for critical services for improving maternal and neonatal health and generating evidence on the impact of such programs on improving reproductive health and status through rigorous empirical evaluations.
Becky_135px
Area of Research
RH voucher effect on increasing skilled birth attendance among the poor

Why you are passionate about reproductive health and/or vouchers?
ben-bellows
Ben Bellows
Population Council Associate and Project Manager
default_headshot_rhv
Ian D. Askew
Director, Reproductive Health Services and Research
jerry-okal
Jerry Okal
Program Officer
joyce-ombeva
Joyce Ombeva
Program Coordinator
francis-obare
Francis Onyango
Senior Analyst
lucy-kanya
Lucy Kanya
Program officer
timothy-abuya
Timothy Abuya
Senior analyst
charlotte-warren
Charlotte Warren
nondini-lopa
Nondini Lopa
Research Officer
tamanna-keya
Kaji Tamanna Keya
Senior Research Officer
eshita-jahan
Eshita Jahan
Senior Research Officer
forhana-noor
Ms. Forhana Rahman Noor
Senior Research Officer
ubaidur-rob
Ubaidur Rob
Senior Associate & Country Director
moshiur-rahman
Md. Moshiur Rahman
Program Officer
ABajracharya140px
Ashish Bajracharya
Staff Associate
Becky_135px
Rebecca Njuki
Research & Policy Analyst

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

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