Voucher schemes

Voucher schemes are a potentially effective means of targeting health services or health products to specific population groups such as pregnant women, children under five, or the poorest. These schemes may offer subsidised or free access to specific services (e.g. sexual or maternal health) or health care products (insecticide treated nets – ITNs). Voucher schemes hold potential for helping households avoid catastrophic expenditure on specific types of health care, such as emergency obstetric care.

Pre-requisites for voucher schemes to operate successfully include the following:

• strong administrative capacity for implementation
• accreditation system - or at least a system ensuring quality of care – in health facilities involved in the scheme
• method and capacity for identifying of target groups.

Most voucher schemes to date have been implemented on a small scale. There is limited documented evidence on their success, or on the feasibility and cost implications of scaling up pilots. One exception is a voucher scheme in Nicaragua (see Vouchers for health) that provides treatment and prevention services for sexually transmitted infections to high-risk populations such as commercial sex workers, their partners and clients.

As per other targeted strategies for reaching the very poor, community-based targeting of beneficiaries has potential for elite capture and rent-seeking. Another concern is that ITN voucher schemes in particular may undermine ITN social marketing schemes and the development of commercial ITN initiatives.