Record Detail

States of fragility and insecurity often give rise to urgent health needs that need to be met quickly and effectively,
particularly for women and adolescents. Vouchers are a demand-side financing mechanism which can be used to
address some of the health challenges faced by women under these circumstances. A number of organisations have
begun to use vouchers to enable access to reproductive, maternal and newborn care services in conflict-affected
countries such as Yemen, Syria and Central African Republic. Vouchers allow health programme implementers to use
targeted subsidies to reduce financial and other barriers to accessing care, increasing and catalysing the uptake of
specific health services among vulnerable and underserved populations. These subsidies are passed onto public and
private providers in the form of service reimbursements and are often used to enhance capacity to meet increased
demand for services, as well as to invest in quality improvements.
Yemen is one of the poorest countries in the Middle East and North Africa region, and since 2010 has consistently
appeared on the lists of fragile states. We present data from the Reproductive Health Voucher Programme in Yemen
to show that during 2014, when the conflict was worsening and public facilities faced significant challenges to keep
functioning, the vouchers enabled women to continue accessing quality maternal newborn health services. By
contracting a range of public and private providers, from referral hospitals to community midwives, the number
of services utilised in one governorate in Yemen was consistently higher (17% or more) than the predicted
number for all services utilised that make up the safe motherhood voucher package. The programme was able to
channel funds to facilities at a time when funds flowing to the governorates were highly erratic, enabling them to
address stock-outs of drugs and supplies at the local level and to maximise the supply of critical maternal newborn
health services for poor women and their families.