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Vouchers in Fragile States: Reducing Barriers to Long-Acting Reversible Contraception in Yemen and Pakistan.
Glob Health Sci Pract 2016; 4 Suppl 2:S94-S108GH

Abstract

In conflict-affected states, vouchers have reduced barriers to reproductive health services and have enabled health programs to use targeted subsidies to increase uptake of specific health services. Vouchers can also be used to channel funds to public- and private-service providers and improve service quality. The Yamaan Foundation for Health and Social Development in Yemen and the Marie Stopes Society (MSS) in Pakistan-both working with Options Consultancy Services-have developed voucher programs that subsidize voluntary access to long-acting reversible contraceptives (LARCs) and permanent methods (PMs) of family planning in their respective fragile countries. The programs focus on LARCs and PMs because these methods are particularly difficult for poor women to access due to their cost and to provider biases against offering them. Using estimates of expected voluntary uptake of LARCs and PMs for 2014 based on contraceptive prevalence rates, and comparing these with uptake of LARCs and PMs through the voucher programs, we show the substantial increase in service utilization that vouchers can enable by contributing to an expanded method choice. In the governorate of Lahj, Yemen, vouchers for family planning led to an estimated 38% increase in 2014 over the expected use of LARCs and PMs (720 vs. 521 expected). We applied the same approach in 13 districts of Punjab, Khyber Pakhtunkhwa (KPK), and Sindh provinces in Pakistan. Our calculations suggest that vouchers enabled 10 times more women than expected to choose LARCs and PMs in 2014 in those areas of Pakistan (73,639 vs. 6,455 expected). Voucher programs can promote and maintain access to family planning services where existing health systems are hampered. Vouchers are a flexible financing approach that enable expansion of contraceptive choice and the inclusion of the private sector in service delivery to the poor. They can keep financial resources flowing where the public sector is prevented from offering services, and ensure that alternative sources are available for reproductive health services such as family planning. Programs should consider using vouchers in fragile states to facilitate access to family planning services and support the countries' health systems.

Authors+Show Affiliations

Options Consultancy Services, London, UK lukeboddamw@gmail.com.Marie Stopes Society Pakistan, Karachi, Pakistan.Options Consultancy Services, Sana'a, Yemen.Independent consultant, Roosendaal, Netherlands.

Pub Type(s)

Evaluation Studies
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

27540129

Citation

Boddam-Whetham, Luke, et al. "Vouchers in Fragile States: Reducing Barriers to Long-Acting Reversible Contraception in Yemen and Pakistan." Global Health, Science and Practice, vol. 4 Suppl 2, 2016, pp. S94-S108.
Boddam-Whetham L, Gul X, Al-Kobati E, et al. Vouchers in Fragile States: Reducing Barriers to Long-Acting Reversible Contraception in Yemen and Pakistan. Glob Health Sci Pract. 2016;4 Suppl 2:S94-S108.
Boddam-Whetham, L., Gul, X., Al-Kobati, E., & Gorter, A. C. (2016). Vouchers in Fragile States: Reducing Barriers to Long-Acting Reversible Contraception in Yemen and Pakistan. Global Health, Science and Practice, 4 Suppl 2, pp. S94-S108. doi:10.9745/GHSP-D-15-00308.
Boddam-Whetham L, et al. Vouchers in Fragile States: Reducing Barriers to Long-Acting Reversible Contraception in Yemen and Pakistan. Glob Health Sci Pract. 2016 08 11;4 Suppl 2:S94-S108. PubMed PMID: 27540129.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vouchers in Fragile States: Reducing Barriers to Long-Acting Reversible Contraception in Yemen and Pakistan. AU - Boddam-Whetham,Luke, AU - Gul,Xaher, AU - Al-Kobati,Eman, AU - Gorter,Anna C, Y1 - 2016/08/18/ PY - 2015/09/30/received PY - 2016/02/29/accepted PY - 2016/8/20/entrez PY - 2016/8/20/pubmed PY - 2017/11/29/medline SP - S94 EP - S108 JF - Global health, science and practice JO - Glob Health Sci Pract VL - 4 Suppl 2 N2 - In conflict-affected states, vouchers have reduced barriers to reproductive health services and have enabled health programs to use targeted subsidies to increase uptake of specific health services. Vouchers can also be used to channel funds to public- and private-service providers and improve service quality. The Yamaan Foundation for Health and Social Development in Yemen and the Marie Stopes Society (MSS) in Pakistan-both working with Options Consultancy Services-have developed voucher programs that subsidize voluntary access to long-acting reversible contraceptives (LARCs) and permanent methods (PMs) of family planning in their respective fragile countries. The programs focus on LARCs and PMs because these methods are particularly difficult for poor women to access due to their cost and to provider biases against offering them. Using estimates of expected voluntary uptake of LARCs and PMs for 2014 based on contraceptive prevalence rates, and comparing these with uptake of LARCs and PMs through the voucher programs, we show the substantial increase in service utilization that vouchers can enable by contributing to an expanded method choice. In the governorate of Lahj, Yemen, vouchers for family planning led to an estimated 38% increase in 2014 over the expected use of LARCs and PMs (720 vs. 521 expected). We applied the same approach in 13 districts of Punjab, Khyber Pakhtunkhwa (KPK), and Sindh provinces in Pakistan. Our calculations suggest that vouchers enabled 10 times more women than expected to choose LARCs and PMs in 2014 in those areas of Pakistan (73,639 vs. 6,455 expected). Voucher programs can promote and maintain access to family planning services where existing health systems are hampered. Vouchers are a flexible financing approach that enable expansion of contraceptive choice and the inclusion of the private sector in service delivery to the poor. They can keep financial resources flowing where the public sector is prevented from offering services, and ensure that alternative sources are available for reproductive health services such as family planning. Programs should consider using vouchers in fragile states to facilitate access to family planning services and support the countries' health systems. SN - 2169-575X UR - https://www.unboundmedicine.com/medline/citation/27540129/Vouchers_in_Fragile_States:_Reducing_Barriers_to_Long_Acting_Reversible_Contraception_in_Yemen_and_Pakistan_ L2 - http://www.ghspjournal.org/cgi/pmidlookup?view=long&pmid=27540129 DB - PRIME DP - Unbound Medicine ER -