Can vouchers deliver? An evaluation of subsidies for maternal health care in Cambodia

Poel, Ellen Van de; Flores, Gabriela; Ir, Por; O’Donnell, Owen; Doorslaer, Eddy van

doi:10.2471/blt.13.129122

Cited by 41 publications

(33 citation statements)

References 22 publications

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“…Similarly, a cross-sectional study of a pilot voucher programme in Cambodia found births in healthcare facilities increased among the poorest 40% of households regardless of whether voucher distribution was universal or targeted to the poorest households, but births in healthcare facilities did not increase among the other 60% of households [50]. Data from a before-and-after study on a pilot targeted voucher programme in Pakistan indicated that births in healthcare facilities increased for recipients of the vouchers, and disaggregated data showed increases for all wealth quintiles except the least poor [60].…”

Section: Resultsmentioning

confidence: 99%

The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review

et al. 2017

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BackgroundCash transfers and vouchers are forms of ‘demand-side financing’ that have been widely used to promote maternal and newborn health in low- and middle-income countries during the last 15 years.MethodsThis systematic review consolidates evidence from seven published systematic reviews on the effects of different types of cash transfers and vouchers on the use and quality of maternity care services, and updates the systematic searches to June 2015 using the Joanna Briggs Institute approach for systematic reviewing. The review protocol for this update was registered with PROSPERO (CRD42015020637).ResultsData from 51 studies (15 more than previous reviews) and 22 cash transfer and voucher programmes suggest that approaches tied to service use (either via payment conditionalities or vouchers for selected services) can increase use of antenatal care, use of a skilled attendant at birth and in the case of vouchers, postnatal care too. The strongest evidence of positive effect was for conditional cash transfers and uptake of antenatal care, and for vouchers for maternity care services and birth with a skilled birth attendant. However, effects appear to be shaped by a complex set of social and healthcare system barriers and facilitators. Studies have typically focused on an initial programme period, usually two or three years after initiation, and many lack a counterfactual comparison with supply-side investment. There are few studies to indicate that programmes have led to improvements in quality of maternity care or maternal and newborn health outcomes.ConclusionFuture research should use multiple intervention arms to compare cost-effectiveness with similar investment in public services, and should look beyond short- to medium-term service utilisation by examining programme costs, longer-term effects on service utilisation and health outcomes, and the equity of those effects.

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Section: Resultsmentioning

confidence: 99%

The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review

et al. 2017

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“…While this article does not intend to compare obstetric care with civil registration, the several decades of experience tackling the barriers of distance, cost, and quality of care in the reproductive health field can be adapted to inform effective interventions for civil registration. Using a shared framework highlights the natural overlap between birth delivery and birth registration and promotes leveraging existing health approaches, such as voucher systems to overcome transportation barriers for the poor [26]. …”

Section: Discussionmentioning

confidence: 99%

Using the Three Delays Model to Examine Civil Registration Barriers in Indonesia

et al. 2016

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The Three Delays Model has proven a useful framework for examining barriers to seeking obstetric care and preventing maternal and child mortality. This article demonstrates the applicability of the Three Delays Model to the case of civil registration in rural Indonesia and examines ways that efforts to strengthen civil registration services can draw on lessons from maternal and child health programming. Twenty focus group discussions were conducted using a participatory ranking exercise in four Indonesian districts. Focus groups were stratified into four groups: (1) government officials involved in civil registration, (2) civil society organization members that assist communities in civil registration, and (3) female and (4) male community members. Transcripts were analyzed using constant comparative method and thematic analysis, revealing barriers that communities commonly faced in accessing civil registration services. In examining the categories and themes related to these barriers, the research team found a significant overlap with the factors and phases of the Three Delays Model. Participants were delayed from seeking registration services by a range of sociocultural factors and by the perceived inaccessibility and poor quality of services. Once they decided to seek care, long distances to services and poor transportation options delayed their access to registration offices. Finally, a series of bottlenecks in service provision created extended delays once applicants reached registration offices. Ownership of civil registration documents in Indonesia remains exceptionally low, with just over half of children and youth possessing a birth certificate. To strengthen civil registration and health systems more generally, it is important to understand the factors that enable and constrain civil registration, how these factors relate to one another, and how they change over a child’s life.

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“…It was noticed that there is considerable potential for improvement among the voucher scheme receivers groups in 2014. 5 Financial protection is needed for the poorest to encourage the use of facilities for delivery and to prevent families from impoverishment. 3 The present study also found that voucher scheme receivers are 17.64 times more likely to receive delivery care services than respondents who did not receive the voucher scheme.…”

Section: Discussionmentioning

confidence: 99%

“…3 As a result, a program was introduced, namely demand-side financing (DSF), but also known popularly as the maternal health voucher scheme for low-income (poor) pregnant women. 5 The aim of the program was to enhance the utilization of child and maternal health services and to remove financial barriers as a step towards improving maternal and children's health. The program is predominantly focused on MDGs 4 with implementation and evaluation of multisectoral interventions to improve the access and quality of care for women who are poor, less-educated and live in rural areas in the post-MDG health and development agenda for achieving universal health coverage as there is considerable potential for improvement among these groups.…”

mentioning

confidence: 99%

Improving access to safe delivery for poor women by voucher scheme in Bangladesh

Das

2015

SE Asia J. Pub. Health

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Maternal and child mortality are still higher in Bangladesh where delivery care services are associated with a number of problems. Demand-side financing, popularly well-known as maternal health care voucher, is found to reduce the financial barriers, increases choice for clients, and improves efficiency in delivery and quality of services which ultimately enhances maternal health. A cross-sectional study was conducted in different upzilas of Bhola district in Bangladesh among poor married women and found that voucher scheme receivers were 17.64 times more likely to receive delivery care services than respondents who were not part of the voucher scheme. On the other hand, the study pointed out that recipients of the voucher scheme received comparatively higher levels of delivery care services compared to those not in the voucher scheme, such as skilled birth attendance (64.2% vs. 26.3%), institutional delivery services (86.9% vs. 24.7%), and transport costs (92.5% vs. 23.1%). As the voucher scheme receivers' delivery care services ensured better health status and care services than non-voucher scheme receivers in Bangladesh, the current study suggests that increasing the accessibility of voucher scheme programs will facilitate the provision of effective maternal health care services.

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Can vouchers deliver? An evaluation of subsidies for maternal health care in Cambodia

Cited by 41 publications

References 22 publications

The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review

The effects of cash transfers and vouchers on the use and quality of maternity care services: A systematic review

Using the Three Delays Model to Examine Civil Registration Barriers in Indonesia

Improving access to safe delivery for poor women by voucher scheme in Bangladesh

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