There is growing interest in “voucher and accreditation” strategies for health services. They go by different names: demand side finance, pay for performance, results-based, output-based, and fee-for-service. Regardless of the term used, the central idea is to link payment to behaviors or improved health status. It is based on the conviction that public health goals can be achieved with incentives to healthcare providers and patients.

At the core of voucher and accreditation programs is a performance-based contract with facilities and vouchers distributed to patients that entitles the bearer to choose care from any contracted health center. Healthcare providers must meet high quality standards to join and then compete to diagnose and treat patients in exchange for the voucher. The vouchers’ cost to the patient is heavily subsidized; in some programs it is free. The provider is reimbursed at a negotiated rate that reflects the cost of service provision and a reasonable profit. Service providers are reimbursed only after verification of contractually delivered services. Voucher programs are designed with several objectives in mind: to give patients the economic power to demand high quality healthcare, to target high risk or low income patients for critical services, to augment general population utilization rates, and to contain per-unit costs.

In 2009 the Population Council, with funding from the Bill and Melinda Gates Foundation, began a project to document, evaluate, and share findings on voucher programs. The five central objectives are:

1. Evaluate the impact of the V&A program on reproductive health behaviors and RH status and reducing inequities at the population level;
2. Assess the effect of the V&A program on access to, quality of, and reducing inequities in the use of, selected RH services at facilities;
3. Document organizational (health facility) responses to the V&A approach and the effect on business models and programmatic efficiency while strengthening African business schools and the skills of health economists;
4. Develop and strengthen capacities for undertaking monitoring and evaluation of V&A approaches and for effectively communicating lessons learned;
5. Develop and manage functional partnerships for designing and undertaking a meta-evaluation of V&A models in several countries.

Over the course of the project, findings will be shared on this blog as well as disseminated in peer review journals, news releases, conference proceedings and workshop sessions.

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©Richard Lord