• Voucher schemes

Voucher schemes

This note, published by the World Bank, examines a donor-supported scheme in Nicaragua, which involved giving vouchers for sexual health services to commercial sex workers and their partners and clients. The highest rates of voucher redemption were among the poorest women and among groups with the highest initial rates of sexually transmitted infections (STIs). The programme reduced the prevalence of gonorrhea in the female sex worker population by about 5 per cent per year, and the prevalence of syphilis by 10 per cent per year. Women who attended follow-up consultations also stayed free of STIs for longer.

The cost of the scheme was low compared to consultations in public facilities. However, the note argues that reducing costs further by charging the beneficiaries is unrealistic and would exclude the poorest, who also have the greatest health needs. As it is, the costs to the beneficiaries in transport and lost income are significant, and for some constitute a reason not to use their voucher. The note concludes that the scheme provided access to, and increased the use of, high-quality, tailored sexual health services in a non-stigmatising manner for commercial sex workers and their regular sexual contacts. It also reduced the risk of STIs, including HIV, among the general population.

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