As health care systems in developing countries evolve, expand, and diversify to deliver an increased quantity and range of services for populations with varying abilities to pay, financing of reproductive health care services has become increasingly critical. Numerous approaches are being developed and tested, including greater private-sector involvement and improving efficiency in public, NGO, and private-sector delivery. Balancing efficiency and equity to reach the poorest of the poor and ensuring service quality are particular challenges. Much attention is being paid to a range of “output-based” approaches for increasing the quantity, quality, and use of services, such as performance-based financing, subsidized vouchers, and conditional cash transfers.
Population Council focus
The Council is pilot-testing a range of innovative health care financing models in both the public and private sector, conducting impact evaluations of large-scale output-based approaches, and developing tools that can help program managers improve service delivery efficiency.
Population Council impact
- The Council is implementing a program of research and evaluation activities in multiple countries in Africa and Asia to determine the impact of subsidized vouchers on the quality and utilization of RH services and their effect on the efficiency of public and private service delivery models.
- In Bangladesh, the Council recently completed a series of studies to pilot-test demand-based financing models for increasing access to maternal health services, male reproductive health services, long-acting contraceptive methods, and reproductive health services for urban slum dwellers.
- To help NGOs achieve greater financial sustainability, the Council’s FRONTIERS program undertook a series of research and capacity-building activities to help develop tools that can be used in this process.
- In India, the Council is assessing the viability of providing financial incentives to encourage institutional delivery among poor women through the public-sector Janani Suraksha Yojana program.
Projects
Strengthening Evidence for Programming on Unintended Pregnancy (STEP UP) (more)
The Population Council is the coordinating partner for STEP UP, which will generate policy-relevant research to promote an evidence-based approach for improving access to family planning and safe abortion.
(1/2011 - 1/2016)
Bangladesh, Ghana, India, Kenya, Senegal
Evaluating Voucher-and-Accreditation Interventions to Improve Reproductive Health Service Delivery Business Models (more)
The Population Council is studying health voucher programs in East Africa and South Asia and sharing findings with national and global partners.
(11/2008 - 10/2013)
Bangladesh, Cambodia, Kenya, Tanzania, Uganda
Demand-based Reproductive Health Commodity Project (more)
Council researchers introduced DBRHCP to increase use of reproductive health services by emphasizing creating demand and improving the quality of reproductive health services through informed choice.
(10/2005 - 8/2009)
Bangladesh
Demand-based Reproductive Health Commodity Project: Creating a Space for Men and Youth at Health and Family Welfare Centers (more)
Council researchers tested the feasibility of providing access to reproductive health services among men and youth in rural areas of Bangladesh.
(7/2007 - 3/2009)
Bangladesh
Demand-based Reproductive Health Commodity Project: Increasing the Rational Use of Modern Contraceptive Methods During the Reproductive Life Cycle (more)
Operations research in Bangladesh sought to increase the appropriate use of contraceptives based on the reproductive life cycle and decrease discontinuation of methods.
(2/2007 - 3/2009)
Bangladesh
Demand-based Reproductive Health Commodity Project: Improving the Quality of Family Planning Services for Urban Slum Populations (more)
Population Council research is improving the quality of family planning services for urban slum populations in Bangladesh.
(7/2007 - 12/2008)
Bangladesh
Demand-based Reproductive Health Commodity Project: Voucher Scheme for Poor, Rural Women to Access Pregnancy Care (more)
Council researchers in Bangladesh tested providing financial assistance through vouchers to poor women for maternal health care.
(2/2007 - 9/2008)
Bangladesh
Assessing the Need and Opportunities for Improved Linkages Between Conditional Cash Transfers and Reproductive Health Programs in the Latin America and Caribbean Region (more)
The Council’s FRONTIERS program documented conditional cash transfer programs in six countries to determine how they could be better linked to reproductive health programs.
(6/2007 - 2/2008)
Dominican Republic, El Salvador, Honduras, Jamaica, Nicaragua, Peru
Financial Sustainability of Rampura and Bashabo Clinics in Bangladesh (more)
Council researchers with the FRONTIERS program worked with the Population Services and Training Centre in Bangladesgh to improve the financial sustainability of two clinics.
(11/2005 - 4/2007)
Bangladesh
Resources
Redeeming qualities: Exploring factors that affect women's use of reproductive health vouchers in Cambodia (abstract) (HTML)
Brody,Carinne D.; Freccero,Julie; Brindis,Claire D.; Bellows,Benjamin
BMC International Health and Human Rights 13(1): 13-
Publication date: 2013
A policy analysis of the implementation of a reproductive health vouchers program in Kenya (abstract) (PDF)
Abuya,Timothy; Njuki,Rebecca; Warren,Charlotte; Okal,Jerry; Obare,Francis; Kanya,Lucy; Askew,Ian; Bellows,Benjamin
BMC Public Health 12: 540-
Publication date: 2012
Defining effective voucher management information systems: A blueprint for information systems to support scalable reproductive health voucher programs, based on system evaluations with programs in Bangladesh, Cambodia, Kenya, Uganda, and Tanzania (PDF)
Ibrahim,Mahad; Bellows,Benjamin; Sandhu,Jaspal S.
Research report
Publication date: 2012
Exploring the effectiveness of the output-based aid voucher program to increase uptake of gender-based violence recovery services in Kenya: A qualitative evaluation (abstract) (HTML)
Njuki,Rebecca; Okal,Jerry; Warren,Charlotte; Obare,Francis; Abuya,Timothy; Kanya,Lucy; Undie,Chi-Chi; Bellows,Benjamin; Askew,Ian
BMC Public Health 12(1): 426-
Publication date: 2012
Evaluation of the impact of the voucher and accreditation approach on improving reproductive behaviors and status in Cambodia (abstract) (PDF)
Bellows,Benjamin; Warren,Charlotte; Vonthanak,Saphonn; Chhorvann,Chhea; Sokhom,Hean; Men,Chean; Bajracharya,Ashish; Rob,Ubaidur; Rathavy,Tung
BMC Public Health 11: 667-
Publication date: 2011
The use of vouchers for reproductive health services in developing countries: Systematic review (abstract) (PDF)
Bellows,Nicole M.; Bellows,Benjamin; Warren,Charlotte
Tropical Medicine and International Health 16(1): 84-96
Publication date: 2011
Manual on financial mechanism for the health facilities: Introducing pay-for-performance approach to increase utilization of maternal, newborn, and child health services in Bangladesh (PDF)
Rahman,Laila; Shil,Dipak Kumar; Rashid,Md.Mamun-or; Hena,Ismat Ara; Talukder,Md.Noorunnabi; Akter,Farhana; Dey,Anup Kumar; Ali,Ripa; Abedin,Joynal; Rahman,Mursheda; Rahman,Md.Ataur; Julkarnayeen,Md.; Rahman,Arifur; Sardar,Md.Abdur Rab
Publication date: 2010
Public expenditure on health care in Orissa: Focus on reproductive and child health services (PDF)
Kumar Rout,Sarit
Health and Population Innovation Fellowship Program Working Paper (no. 12)
Publication date: 2010
RH vouchers newsletter, August 2010 (PDF)
Population Council
Publication date: 2010
RH vouchers newsletter, December 2010 (PDF)
Population Council
Publication date: 2010
RH vouchers newsletter, March 2010 (PDF)
Population Council
Publication date: 2010
Financial sustainability of reproductive health services: Understanding costs: An essential skill in reproductive health programs (PDF) (HTML)
FRONTIERS Legacy Themes
Publication date: 2009
Improving the quality of family planning and reproductive tract infection services for urban slum populations: Demand-based reproductive health commodity project (PDF)
Talukder,Md.Noorunnabi; Rob,Ubaidur; Rahman,Md.Mafizur
Publication date: 2009
Reproductive health vouchers news, December 2009
Population Council
Publication date: 2009
Assessing the need and opportunities for improved linkages between conditional cash transfers and reproductive health programs in Latin America and the Caribbean (PDF)
Vernon,Ricardo; Rivero-Fuentes,M.Estela
FRONTIERS Final Report
Publication date: 2008
Financial sustainability for reproductive health NGOs (HTML)
Bratt,John H.; Foreit,James R.
Publication date: 2008
Strengthening financial sustainability through integration of voluntary counseling and testing services with other reproductive health services (PDF)
Das,Rumeli; Biswas,Kaushik; Panda,Pradeep; Khan,M.E.; Homan,Rick
FRONTIERS Final Report
Publication date: 2007
Face-to-face complementary selling of health products in Ghana (PDF)
Bruce,Egbert; Mensah,Daniel; Idun,John; Ashabley,Francis; Foreit,James R.; Nyarko,Philomena
FRONTIERS Final Report
Publication date: 2006
Operations research to improve financial sustainability in three Bolivian NGOs (PDF)
Merida,Martha; Arce,Javier; Moscoso,Douglas; Ramirez,Carlo; Riveros,Patricia; Bratt,John H.
FRONTIERS Final Report
Publication date: 2006
Promoting financial sustainability among NGOs: FRONTIERS initiative in South Asia
Pradeep,Panda; Khan,M.E.; Homan,Rick
Research Update (no. 7)
Publication date: 2006
Health sector reform in developing countries: Trends and lessons learned
Rob,Ubaidur; Talukder,Md.Noorunnabi; Anwar,Md.Mahabub Ul; Rahman,Laila; Mutahara,Marium ul
Publication date: 2005
Bridging the gap between evidence-based innovation and national health-sector reform in Ghana (PDF)
Awoonor-Williams,John Koku; Feinglass,Ellie S.; Tobey,Rachel; Vaughan-Smith,Maya; Nyonator,Frank K.; Jones,Tanya C.; Phillips,James F.
Policy Research Division Working Paper (no. 191)
Publication date: 2004
Integration of reproductive health service for men in health and family welfare centers in Bangladesh (PDF)
Al-Sabir,Ahmed; Alam,Mohammed Ahsanul; Hossain,Sharif Mohammed Ismail; Rob,Ubaidur; Khan,M.E.
Publication date: 2003
The impact of price changes on demand for family planning and reproductive health services in Ecuador (abstract) (PDF) (HTML)
Bratt,John H.; Weaver,Mark A.; Foreit,James R.; de Vargas,Teresa; Janowitz,Barbara
Health Policy and Planning 17(3): 281-287
Publication date: 2002
Health sector reform and reproductive health in Latin America and the Caribbean: Strengthening the links (PDF)
Langer,Ana; Nigenda,Gustavo; Catino,Jennifer
Bulletin of the World Health Organization 78(5): 667-676
Publication date: 2000
What's New
- Can vouchers help move health systems toward universal health coverage? Population Council researcher Ben Bellows participated in a Q&A following his plenary presentation at the GIC Forum on Health and Social Protection. (abstract)
- Learn more about reproductive health vouchers by visiting the RH vouchers project page and blog maintained by Council program associate Ben Bellows. (more) (offsite link)
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