Voices of Change

Ben Bellows: Evaluating Reproductive Health Voucher Programs in East Africa and South Asia

Ben Bellows is an associate with the Population Council’s Reproductive Health program in Kenya. He is the program manager for the reproductive health vouchers project, which evaluates programs in East Africa and South Asia.

There is growing interest in innovative "voucher and accreditation" strategies to pay for health services. We want to find out whether public health goals can be achieved through incentives to health care providers and patients.

All of the voucher programs assessed by the Population Council are aimed at increasing access to safe motherhood services for pregnancy, attended delivery, and postpartum care. Some countries also developed additional voucher services to target key public health needs. For example, the Uganda program offers STI treatment at private facilities, and the Kenya program distributes a family planning voucher and reimburses post-rape care at provincial hospitals.

People in many developing countries rely on basic health care services provided in underfunded government facilities, informal urban clinics, private shops in semi-urban trading centers, and the homes of paramedic aides in rural villages. Some of these providers are government medical staff. Others run a private practice, trying to meet the health care needs of patients who cannot afford to travel to district facilities for nominally free care.

In order to join voucher and accreditation programs, health care providers must meet high-quality standards. They diagnose and treat patients in exchange for a voucher that the client has received at low cost, or free. In most voucher programs, the provider is reimbursed at a negotiated rate that often reflects the cost of service provision and a reasonable profit. There is no typical clinic—some facilities may be a single consultation room lit by one bulb; other voucher facilities are high-level hospitals seeing patients with a wide range of health care needs. In every case, voucher programs expand the facility’s revenue base by giving poor women access to services they would previously be unable to access.

Although voucher and accreditation pilot programs have been implemented in several countries, little is known about their impact. With funding from the Bill & Melinda Gates Foundation and in collaboration with KfW, the German Development Bank, the Population Council is evaluating voucher programs in East Africa and South Asia, measuring changes in reproductive health behaviors, service use, and health status, especially among the poor. Our evaluations are generating much-needed evidence to help governments and partners decide whether to scale up these programs, include additional services, or support their transition to a different finance model.