EXPERIENCE OF VOUCHERS FOR REPRODUCTIVE HEALTH SERVICES IN DEVELOPING COUNTRIES: MAKING A CASE FOR PAKISTAN THROUGH A SYSTEMATIC REVIEW

Authors

  • Gulrukh Mehboob Health Economics, Health Systems & Policy, Health Services Academy, Islamabad
  • Babar Tasneem Shaikh Health Economics, Health Systems & Policy, Health Services Academy, Islamabad

Abstract

Among the healthcare financing techniques that exist, output-based financing or vouchers is a strategy that is growing in popularity. There is a need of an in-depth analysis of the impacts of vouchers on health indicators, particularly for Pakistan. Assessment of the existing evidence on how much the vouchers impact on health and healthcare utilization can be of greater value to the policy makers for informed decision making. This systematic review included 16 cross-sectional and quasi-experimental design studies. Service utilization, knowledge, service quality, cost-effectiveness of the programme and outreach of the population served were observed as outcomes. We found positive results in with regard to most of these outcomes. Physical accessibility, social mobility of women, security threats, and sustainability of the project after donor exit appear as serious challenges. Yet, lessons can be drawn for the scaling up of the reproductive health services in the country, through the use of vouchers. 

References

World Health Organization, UNICEF, UNFPA, World Bank, UN Population Division. Trends in maternal mortality: 1990-2013. Geneva: 2013.

National Institute of Population Studies and Macro International. Pakistan Demographic and Health Survey 2006-07. Islamabad: 2008.

National Institute of Population Studies and Macro International. Pakistan Demographic and Health Survey 2012-13. Islamabad: 2013.

Shaikh BT. Marching toward the millennium development goals: what about health system, health seeking behaviours and health service utilization in Pakistan? World Health Popul 2008;10(2):44–52.

Ahmed S, Creanga A, Gillespie D, Tsui AO. Economic status, education and empowerment: Implication for maternal health service utilization in developing countriues. Plos One 2010;5(6):1119.

Bellows NM, Bellows BW, Warren C. The use of vouchers for reproductive health services in developing countries: systematic review. Trop Med Int Health 2011; 16(1):84–96.

Janisch C, Potts M. Evaluation of the impact of the voucher and accreditation approach on improving reproductive behaviors and status in Cambodia. Lancet 2005;366:1343–4.

Meyer C, Bellows NM, Campbell PM. The impact of vouchers on the use and quality of health goods and services in developing countries. EPPI-Centre, Social Science Research Unit, Institute of Education, London: 2011.

Gupta, I, Jow W, Rudra S. Demand Side Financing in Health:How far can it address the issue of low utilization in developing countries? Background paper no. 27; World Health Report 2010. Geneva: 2010.

Ahmed S, Khan M. Is demand-side financing equity enhancing? Lessons from a maternal health voucher scheme in Bangladesh. Soc Sci Med 2011;72(10):1704–10.

United Nations Development Programmeme. Human Development Report 2013: The Rise of the South: Human Progress in a Diverse World. New York: 2013.

Cernada G, Chow L. The coupon system in an ongoing family planning programme. Am J Public Health 1969; 59(12):2199–208.

Agha S. Changes in the proportion of facility-based deliveries and related maternal health services among the poor in rural Jhang, Pakistan: results from a demand-side financing intervention. Int J Equity Health 2011;10(2):57.

Ir P, Horemans D, Souk N, Van Damme W. Using targeted vouchers and health equity funds to improve access to skilled birth attendants for poor women: a case study in three rural health districts in Cambodia. BMC Preg Childbirth 2010;10:1.

Nguyen H, Hatt L, Islam M, Sloan NL, Chowdhury J, Schmidt JO, Hossain A, Wang H. Encouraging maternal health service utilization: An evaluation of the Bangladesh voucher programme. Soc Sci Med 2012; 74(7):989–96.

Obare F, Warren C, Njuki R, Abuya T, Sunday J, Askew I, Bellows B. Community-level impact of the reproductive health vouchers programmeme on service utilization in Kenya. Health Policy Plan 2012; 27(8):1–11.

Tan ESM, Kusharto CC, Budiyati S. Case study 2: Vouchers for midwife services in Pemalang district, Central Java Province: Case studies on innovations in service delivery in Indonesia. 2005; http://www.innovations.harvard.edu/download-doc.html?id=6515.

Donaldson D, Sethi H, Sharma S. Vouchers to Improve Access by the Poor to Reproductive Health Services: Design and Early Implementation Experience of a Pilot Voucher Scheme in Agra District, Uttar Pradesh, India. November 2008, United States Agency for International Development, Washington DC, USA.

Bellows NM. Vouchers for reproductive health care services in Kenya and Uganda. Discussion Paper. Ed: Competency Center for Education, Health & Social Protection. KFW Bankengruppe, Frankfurt: 2012.

Bellows B, Kyobutungi C, Mutua KM, Warren C, Ezeh A. Increase in facility-based deliveries associated with a maternal health voucher programme in informal settlements in Nairobi, Kenya. Health Policy Plan 2012;27(8):78–86.

Health and Nutrition Development Society (HANDS). New Approaches for Reproductive Health Initiatives (NARI) OBA Voucher Scheme. Islamabad: 2010.

Meuwissen LE, Gorter AC, Arnold D, Knottnerus A. Does a competitive voucher programme for adolescents improve the quality of reproductive health care? A simulated patient study in Nicaragua. BMC Public Health 2006; 6:204.

Schmidt J, Ensor T, Hossain A, Khan S. Vouchers as demand side financing instruments for health care: A review of the Bangladesh maternal voucher scheme. Health Policy 2010; 96(2): 98–107.

Azmat SK, Murtaza G, Bilgrami M. Perspectives and practices of client, provider and marketing worker of an effective family planning social franchise intervention in rural Pakistan: qualitative enquiries. International Conference on Family Planning. Dakar: 2011.

Borghi J, Gorter A, Sandiford P, Sequra Z. The cost-effectiveness of a competitive voucher scheme to reduce sexually transmitted infections in high-risk groups in Nicaragua. Health Policy Plan 2005; 20(4):222–31.

Howe S, Vargas D, Granada D. Cervical cancer prevention in remote rural Nicaragua: a programme evaluation. Gynecol Oncol 2005; 99(3):232–5.

Health Services Academy. Social protection strategies & health financing to safeguard reproductive health for poor in Pakistan Health Systems & Policy Department. Islamabad: 2011.

Nishtar S. Choked Pipes. Oxford University Press. Islamabad: 2010.

Pakistan Medical Research Council. National Health Survey of Pakistan: 1990-1994. Islamabad: 1994.

Jacobs B, Ir P, Bigdeli M, Annear PL, Van Damme W. Addressing access barriers to health services: an analytical framework for selecting appropriate interventions in low income countries. Health Policy Plan 2012;(27):288–300.

Sultan M, Cleland J, Ali MM. Assessment of a new approach to family planning services in rural Pakistan. Am J Public Health 2002; 92(7):1168–72.

Shaikh BT, Haran D, Hatcher J. Women’s social position and health seeking behaviors: Is healthcare system accessible and responsive in Pakistan? Healthcare Women Int 2008; 29(8/9):945–59.

Bhutta ZA, Hafeez A, Rizvi A, Ali N, Khan A, Ahmad A, et al. Reproductive, maternal, newborn, and child health in Pakistan: challenge & opportunities. Lancet 2013; 381(9884):2207–18.

Bellows B, Warren C, Vonthanak S. Evaluation of the impact of the voucher and accreditation approach on improving reproductive behaviors and status in Cambodia. BMC Public Health 2011; 11:667.

Rob U, Rahman M, Bellows B. Evaluation of the impact of the voucher and accreditation approach on improving reproductive behaviors and RH status: Bangladesh. BMC Public Health 2011; 11:275.

Bhatia M, Gorter AC. Improving access to reproductive and child health services: Are competitive vouchers scheme an option? J Int Dev 2007; 9(7): 975–81.

Shaikh BT. Unmet need for family planning in Pakistan-PDHS 2006-7: It’s time to re-examine déjà vu. Open Access J Contraception 2010; 1:113–8.

Published

2015-09-30

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