What exactly is a health care voucher program?
A voucher program (also known as Voucher and Accreditation) is a healthcare financing model that aims to improve the quality and use of targeted health services. In Kenya, with funding from the German Development Bank (KFW), a government agency, National Coordinating Agency for Population and Development (NCAPD), rolled out a pilot voucher program in 2006 in Kisumu, Kiambu, and Kitui districts and two slum areas of Nairobi (Korogocho and Viwandani). Other voucher programs were launched about the same time in Uganda and Bangladesh and other countries will launch similar voucher pilots by the end of 2010.
How does the healthcare voucher system work?
At the core of the program is a performance-based contract with healthcare 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 then only reimbursed after verification of contractually delivered services; in some programs this is referred to as an output-based approach (OBA).
How different is it from other healthcare financing models?
The voucher concept presents a realistic approach to financing healthcare by incentivizing service delivery as opposed to traditional public sector health finance that pays for healthcare inputs (salaries, consumables, and buildings) without addressing patient demand or health worker performance. The voucher places purchasing power in the hands of the patient and in settings where there are multiple providers a positive cycle of competition for patients can improve service quality.
Unlike in other health finance models, the voucher can also be targeted to the poorest of the poor or high-risk populations to ensure that they have access to services. Vouchers can therefore reduce financial barriers to using FP/RH services or products by giving voucher holders a discount on the retail price of health services or by compensating other costs of using health services.
How do organizers reach the poorest and most vulnerable people?
There are three common strategies to target the poorest and economically most vulnerable populations: geographic, standardized means testing and community-based means tests. In the Bangladesh voucher program, geographic and community-based strategies are used. In some districts, community health workers ask village leadership to identify poor households using locally relevant indicators for poverty (community based means test). In other districts, all women automatically qualify (geographic targeting). In Kenya, the KfW / GoK voucher program used a participatory poverty grading tool in the four targeted districts. The tool was developed using indicators specific to each district and included markers for poverty from housing, access to medical facility, water source, rent amounts, sanitation, income levels, and number of meals taken per day.
How many people have received vouchers in the programs the Council is evaluating?
In Kenya, about 70,000 people were served between June 2006 and October 2008. Additional clients have been seen in the interim and now as Phase II begins, it’s expected that an additional 100,000 women will be given antenatal, delivery and postnatal care services over the next three years.
In Uganda, there were 20,000 patient visits to 15 clinics for STI complaints between June 2006 and May 2008. In February 2009, the voucher program began offering maternal delivery services with plans to pay for 53,000 deliveries over the next three years.
In Bangladesh, there were two voucher programs. The Population Council ran a small pilot and subsidized delivery for 1600 patients. In the larger pilot program, the Government of Bangladesh has subsidized demand and supply of more than 100,000 deliveries since 2006 while in Cambodia and Tanzania, the voucher programs will begin later this year.
For additional information please contact;
Email: info@rhvouchers.org
Additional Resources & Links
Lessons from FP/RH voucher programs in Kenya and Uganda
Bangladesh Demand based RH commodity project
The KfW Kenya output-based aid project overview
