The Ministry of Health and Family Welfare (MOHFW), with technical support from the World Health Organization (WHO), developed a demand side finance (DSF) maternal health voucher pilot program. The program’s objective was to achieve the Millennium Development Goal (MDG) of reducing maternal mortality through increased utilization of quality maternal healthcare services particularly by poor women. Using transport and medical service vouchers, low-income women are encouraged to seek care at designated providers in selected upazilas (sub-districts). The Directorate General of Health Services (DGHS) of the MOHFW, under the Health, Nutrition and Population Sector Program (HNPSP), initially began the DSF pilot program in 21 upazilas and expanded it to 33 upazilas by 2007. The Government of Bangladesh is planning to expand the program to 10 additional upazilas in early 2010 with pooled financial support under SWAp.

There were an estimated 174,000 deliveries annually in the 21 districts. There is a lengthy reimbursement schedule for specific services – from transport to food supplements following delivery. However, on average reimbursements are 1648 taka (US$ 24) (Koehlmoos et al. 2008; Ministry of Health and Family Welfare 2007).

Under the operations plan of National Institute of Population Research and Training (NIPORT), Ministry of Health and Family Welfare and with the financial support from CIDA through UNFPA, Population Council conducted a feasibility study of introducing a voucher program for maternal health services in two unions of one low performing rural upazila in Bangladesh. Under this project, pregnant women received maternal health services from selected facilities/providers in exchange of service vouchers. In addition, financial assistance was provided to poor women to cover transport to facility for antenatal care, institutional delivery, and postnatal care and to purchase medicines for delivery care. The project lasted for one and a half years. The duration of interventions was nine months.