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About a year ago, The Population Council turned our attention to a compelling video featuring new mothers in Kenya. 

With jobless husbands, no money, and no wealthy relatives to call on, a small piece of paper made a big difference in determining whether they and their babies would survive pregnancy and childbirth.
 
“… I thank God because of the voucher,” said Grace Wanjiro as she looked into the camera, swaddling her newborn child, who was delivered by caesarean section. “The voucher program has helped me for my first baby and then the second baby.”
 
A mother holding her baby in Kenya
 
There are many similar stories around the world, and also many lessons for governments, practitioners, policymakers and health workers to learn in A Taxonomy and Results from a Comprehensive Review of 28 Maternal Health Voucher Programmes. In an article published in the Journal of Health, Population and Nutrition recently, the authors share findings from the 28 voucher schemes reviewed. They also provide some insight on what such schemes need to reach scale as the MDGs conversation begins to move to the post-2015 agenda.
 
Here are five takeaways worth noting.
 
1. Voucher management by third-party agencies works
Overall, the research showed that programs fraught with “significant operational problems with claims and disbursement” were run by public management entities or by existing offices tasked with voucher management in addition to other assignments. Third-party agencies emerged as more likely to respond to evolving program needs, and more accountable in meeting performance standards.
 
2. Community mobilization is a powerful marketing tool
Programs that target individuals or households through community-based distributors were found to be more successful. This community approach proves to be useful in raising awareness and creating demand among people who, without vouchers as an option, would not have sought proper healthcare. The most common forms of marketing, in order of popularity, were:
  • home visits linked to voucher distribution
  • community meetings
  • mass-media messages
 
3. Voucher programs come with a risk
The authors found that, in some cases, voucher programs offer a narrow benefits package and come with a risk. Specifically, one primary programmatic risk was identified: voucher schemes make great efforts to distribute subsidies to beneficiaries, who then fail to use the service. Additional factors that limit the use of vouchers are expiry dates and a focus on antenatal care, delivery and postnatal care. However, the research showed that transportation subsidies could help improve voucher use.
 
4. Using private-sector facilities has benefits
The perception is that health providers from the private sector come with a high price tag. Despite this notion, the review found that most maternal health voucher programs contracted healthcare providers from the private sector, more so than the public sector. According to the article, “Contracting private providers allowed voucher programs to extend the reach of social protection services and essentially create additional options for poor healthcare consumers who were previously priced out of the private sector.”
 
5. Vouchers aren’t a cure-all but they are effective
There still isn’t adequate evidence to prove that vouchers can help improve health status or technical efficiency. However, there is proof that vouchers help in several other areas and are a critical form of aid in helping accelerate progress toward universal health coverage. The evidence reviewed suggests that voucher programs can increase utilization of health services, improve the quality of service, and target resources to the people who need them most.
 
Read the complete findings in the Journal of Health, Population and Nutrition article.

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