Evaluation Objectives and Design

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 and output-based. 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.

In 2009 the Population Council began a project to document, evaluate, and share findings on voucher programs. The Council's Reproductive Health Voucher Project will generate evidence about  voucher impact on knowledge, targeting, quality, utilization, cost and health status. This evidence will help improve the efficiency and effectiveness of business models for financing and delivering essential reproductive health services to low-income women and their families.The findings from the project  are meant to help governments and partners decide whether to scale up these programs, include additional services, or support their transition to a different model.

The evaluation has five central objectives:

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 website as well as disseminated in peer review journals, news releases, conference proceedings and workshop sessions.

Evaluation Design

The Reproductive Health Voucher Project has adapted a quasi-experimental design in which surveys are undertaken among the target population for the V&A program before and after its introduction. Quasi experimental design involves selecting groups, upon which a variable is tested, without any random pre-selection processes. The study comprises of four populations: Facilities, Service providers, women of reproductive health age using facilities and women who have been pregnant and/or used family planning within the previous 12 months.