Lessons from sexual and reproductive health voucher program design and function: a comprehensive review

Background Developing countries face challenges in financing healthcare; often the poor do not receive the most basic services. The past decade has seen a sharp increase in the number of voucher programs, which target output-based subsidies for specific services to poor and underserved groups. The d...
Ausführliche Beschreibung

Background Developing countries face challenges in financing healthcare; often the poor do not receive the most basic services. The past decade has seen a sharp increase in the number of voucher programs, which target output-based subsidies for specific services to poor and underserved groups. The dearth of literature that examines lessons learned risks the wheel being endlessly reinvented. This paper examines commonalities and differences in voucher design and implementation, highlighting lessons learned for the design of new voucher programmes. Methodology The methodology comprised: discussion among key experts to develop inclusion/exclusion criteria; up-dating the literature database used by the DFID systematic review of voucher programs; and networking with key contacts to identify new programs and obtain additional program documents. We identified 40 programs for review and extracted a dataset of more than 120 program characteristics for detailed analysis. Results All programs aimed to increase utilisation of healthcare, particularly maternal health services, overwhelmingly among low-income populations. The majority contract(ed) private providers, or public and private providers, and all facilitate(d) access to services that are well defined, time-limited and reflect the country’s stated health priorities. All voucher programs incorporate a governing body, management agency, contracted providers and target population, and all share the same incentive structure: the transfer of subsidies from consumers to service providers, resulting in a strong effect on both consumer and provider behaviour. Vouchers deliver subsidies to individuals, who in the absence of the subsidy would likely not have sought care, and in all programs a positive behavioural response is observed, with providers investing voucher revenue to attract more clients. A large majority of programs studied used targeting mechanisms. Conclusions While many programs remain too small to address national-level need among the poor, large programs are being developed at a rate of one every two years, with further programs in the pipeline. The importance of addressing inequalities in access to basic services is recognized as an important component in the drive to achieve universal health coverage; vouchers are increasingly acknowledged as a promising targeting mechanism in this context, particularly where social health insurance is not yet feasible. Ausführliche Beschreibung

Autor*in:	Grainger, Corinne [verfasserIn] Gorter, Anna Okal, Jerry Bellows, Ben

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2014

Schlagwörter:	Results-based financing Demand-side financing Sexual and reproductive health Maternal health Voucher program Social franchising Poverty targeting Social health insurance Incentives Subsidies

Anmerkung:	© Grainger et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (

Übergeordnetes Werk:	Enthalten in: International journal for equity in health - London : BioMed Central, 2002, 13(2014), 1 vom: 29. Apr.
Übergeordnetes Werk:	volume:13 ; year:2014 ; number:1 ; day:29 ; month:04

Links:	Volltext

DOI / URN:	10.1186/1475-9276-13-33

Katalog-ID:	SPR028707265