Strategies for reaching the poor
Consumer-led demand side financing for health and education: an international review
Voucher schemes can increase school enrolment and use of health services
Authors:
T. Ensor
Publisher:
Oxford Policy Management , 2003
This paper, published by Oxford Policy Management, examines "demand side financing" of health and education services. This involves placing purchasing power into the hands of consumers, for instance through issuing them with vouchers they can use to pay for services. The paper’s review of international evidence suggests that vouchers have been successful in raising the consumption of key services among key groups. Impacts include increases in enrolment and reduced drop-out rates for schools, and increased clinic utilisation and compliance with treatment regimes for health programmes. However, vouchers on their own may not be able to improve the quality and distribution of services.
The paper argues that there is some scope for extending voucher schemes in low income countries for health services. Such schemes should perhaps focus primarily on fixed packages of key services aimed at easily identifiable groups. This itself will require the development of capacity in administering the financing schemes and also accrediting providers. Extending demand side financing to services such as hospital coverage is unlikely to be appropriate in most low income countries, since it would involve issuing vouchers that could be used to purchase insurance, and low income countries tend to lack developed insurance markets.
