Family Planning Vouchers: A tool to boost contraceptive method access and choice

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 financing mechanism and programmatic tool to improve equitable access and increase the use of key health products and services. 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 attained and verified. Clients can choose when and where to seek care, but payment to providers and voucher management systems are only issued when the provider has delivered the care, in accordance with the voucher program standards and guidelines.

In settings where potential clients must pay for contraceptive services and/or methods, individuals 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. In addition to reducing financial barriers, 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 various 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 funding body, an implementing body called a voucher management agency), and an independent monitoring and oversight body (e.g., third-party verification agents or a governance board). Voucher programs typically contract with 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.

This brief describes how vouchers can be used to enhance high impact practices in family planning (HIPs) by addressing specific barriers to accessing and using contraception. It also 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 it 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.