Table 3 Summary of key findings from quantitative studies on vouchers
Programme | Effect on care-seeking outcomes a | Key findings from synthesis of factors influencing implementation | |
|---|---|---|---|
Enablers | Barriers | ||
Vouchers for maternity care services | |||
Maternal Health Voucher Scheme, Bangladesh | Increased skilled birth attendance, facility births, antenatal care and postnatal care | -Activities by community workers and local leaders to raise awareness of the programme [81] -Inclusion of transport costs [80, 81] -‘Seed’ funds for participating facilities to promote investment in services and capacity [81] | -Perceived poor quality of care at participating facilities [81] -Pressure from local politicians to distribute vouchers to ineligible women [81] |
Pilot vouchers, Bangladesh | Increased skilled birth attendance, facility births, antenatal care and postnatal care | -Inclusion of transport and medicine costs [85] | -Poor awareness of the programme among target groups [85] -Perceived poor quality of care at participating facilities [85] |
Voucher programme, Cambodia | Increased skilled birth attendance and postnatal care. No effect on antenatal care. | -Awareness generation by voucher distributors [87] -Output-based reimbursements for providers [87] | None stated |
Chiranjeevi Yojana, India | No effect on skilled birth attendance, antenatal care and postnatal care | -Community health workers provided information on the programme [88] -Use of an existing government system (‘below poverty line’ cards) as a targeting mechanism [88] | -Poor awareness of the programme among target groups [89] -Distance to participating facilities in rural areas [88] -Cost of transportation [92] -Demands for additional or informal payments [88, 92] -Providers not reimbursed for postnatal care [88] -Provider attrition in urban areas [89] -Waning political commitment [89] |
Vouchers for Health, Kenya | Increased skilled birth attendance and facility births. No effect on antenatal care and postnatal care | -Awareness generation by voucher distributors and previous service users [99] -Locally appropriate tool for targeting pregnant women from low-income households [99] -Output-based reimbursements for providers [94] | -Perceived poor behaviour of staff at participating hospitals [94] -Distance and lack of transport to participating facilities [96, 100] -Cost of travel to health facilities [99, 100] -Cost of purchasing vouchers [96, 100] -Overly bureaucratic process for determining eligibility [94] -Delays in contract signing and voucher printing [99] |
Pilot vouchers, Pakistan | Increased facility births. Mixed picture of positive and no effect on antenatal and postnatal care | -Many women left the facility within 24Â h after giving birth as there was no one to look after their homes and children [103] -Distance to participating facilities [104] | |
Makerere University Voucher Scheme, Uganda | Increased facility births | -Inclusion of transport costs [107] -Output-based reimbursements for providers [107] | None stated |
HealthyBaby vouchers, Uganda | Increased facility births, antenatal care and postnatal care | -Locally appropriate tool for targeting pregnant women from low-income households [106] | -Turnover of staff in the Ministry of Health [106] -Cost of travel to health facilities [106] -Procedural burden of fraud detection system [106] -Inclusion (based on geographical needs) of facilities that did not meet minimum quality requirements [106] |
Vouchers for merit goods | |||
Tanzanian National Voucher Scheme | Increased use of insecticide-treated nets | -Awareness generation by service providers [109] | -Distribution of vouchers during antenatal care visits misses women who do not seek formal antenatal care [109] -Cost of purchasing insecticide-treated net (even at a reduced rate) [109] |