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This study, published in BMC Public Health, evaluates the impact and sustainability of a competitive voucher programme on the quality of sexual and reproductive health (SRH) care for poor and underserved female adolescents. Vouchers were distributed to adolescents in disadvantaged areas that gave free-of-charge access to SRH care in four public, ten non-governmental and five private clinics. The paper finds that some aspects of service quality improved during the voucher programme: more of the patients left with a contraceptive method during the programme than before it began; and shared decision-making on contraceptive method as well as condom promotion significantly increased. Female doctors had best scores before, during and after the intervention. The improvements were more pronounced among male doctors and doctors older than 40, though these improvements were not sustained after the programme ended.

The paper concludes that adolescents often face provider-related obstacles when requesting contraception. The care provided during the voucher programme improved for some important outcomes. The improvements were more pronounced among providers with the weakest initial performance. [adapted from author]

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