Health care vouchers are paper or electronic referral coupons that clients can take to an accredited health care provider in exchange for health care services. They are used as a service purchasing mechanism and programmatic tool to improve equitable access and increase the use of key health products and services.1 Vouchers are a form of results-based financing, a type of health system reform which includes payment or non-monetary transfers after services have been delivered and verified.2,3 Payment to service providers is only issued when the services have been delivered in accordance with the voucher program standards and guidelines.
In settings where potential clients must pay for contraceptive services and/or methods, individuals (e.g., adolescents) may face financial barriers that restrict their ability to access and use some methods. Vouchers can reduce these financial barriers and facilitate client access to more contraceptive options.4 Vouchers that focus on specific population groups help ensure subsidies reach individuals who may be less likely to have access to and ability to use family planning services and products. Voucher programs can be designed to improve client knowledge of contraceptive method options and inform potential clients where and when they can access services. Vouchers can also support providers to improve the quality of their services through accreditation and to expand the range of contraceptive methods available.
Figure 1 depicts an illustrative example of how contraceptive voucher programs work. Voucher programs typically include a fund processing body (voucher management agency), and an independent monitoring and oversight body (e.g., third-party verification agents or a governance board).5-7 Voucher programs typically contract private and/or public providers who have met quality standards, and they engage community organizations to promote the program and distribute or sell vouchers to eligible, interested clients.6,8
This brief discusses the potential contributions of vouchers to enhancing the quality and voluntary use of contraceptive services, outlines key issues for planning and implementation, and identifies knowledge gaps. Vouchers have been identified as a HIP enhancement by the HIP technical advisory group. A HIP enhancement is a tool or approach that is not a standalone practice, but is often used in conjunction with HIPs to maximize the impact of HIP implementation or increase the reach and access for specific audiences. The intended purpose and impact of enhancements are focused, and therefore the evidence base and impact of a HIP enhancement is subjected to different standards than a HIP. While there is some evidence and programmatic experience implementing voucher programs, more research and documentation is needed to better understand the potential and limitations of this approach.
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