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Table 3 Summary of key findings from quantitative studies on vouchers

From: Demand-side financing for maternal and newborn health: what do we know about factors that affect implementation of cash transfers and voucher programmes?

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 -Awareness generation by voucher distributors [103, 104] -Many women left the facility within 24 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]
  1. aSee systematic review for further details of effect on care-seeking outcomes [14]