The number of voucher programs is growing in low- and middle-income countries, and there is emerging evidence from the Population Council’s research that vouchers can have a positive impact on maternal and reproductive health (RH) behaviors, use of services, and the health status of women. The Council's RH Vouchers project expanded the evidence base on the role of maternal and RH vouchers in improving service use, equity, quality of care, cost-effectiveness, and coverage in East Africa and South and Southeast Asia. Voucher programs were evaluated in five countries—Bangladesh, Cambodia, Kenya, Tanzania, and Uganda—to generate evidence to help governments and development partners decide whether to expand these programs, include additional services, or support different healthcare financing models. The Council’s evaluations produced important evidence about the strengths and weaknesses of maternal and RH vouchers with different program structures, conditions, and at varying scale; measured program impact; and increased awareness among program managers, policymakers, and governments of the benefits and challenges of vouchers as an effective approach for achieving equitable, high-quality, low-cost healthcare coverage.

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Articles (peer-reviewed)

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A cross sectional comparison of postnatal care quality in facilities participating in a maternal health voucher program versus non-voucher facilities in Kenya, Charlotte E. Warren, Timothy Abuya, Lucy Kanya, Francis Obare, Rebecca Njuki, and Marleen Temmerman

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An assessment of opportunities and challenges for public sector involvement in the maternal health voucher program in Uganda, Jerry Okal, Lucy Kanya, Francis Obare, Rebecca Njuki, Timothy Abuya, Teresah Bange, Charlotte E. Warren, Ian Askew, and Benjamin Bellows

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A policy analysis of the implementation of a reproductive health vouchers program in Kenya, Timothy Abuya, Rebecca Njuki, Charlotte E. Warren, Jerry Okal, Francis Obare, Lucy Kanya, Ian Askew, and Benjamin Bellows

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Assessing the population-level impact of vouchers on access to health facility delivery for women in Kenya, Francis Obare, Charlotte E. Warren, Timothy Abuya, Ian Askew, and Benjamin Bellows

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A taxonomy and results from a comprehensive review of 28 maternal health voucher programmes, Benjamin Bellows, Claudia M. Conlon, Elizabeth S. Higgs, John Townsend, Matta G. Nahed, Karen Cavanaugh, Corinne G. Grainger, Jerry Okal, and Anna C. Gorter

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Burnout at the frontline: The effect of a reproductive health voucher program on health workers in Uganda, Carinne D. Brody, John M. Irige, and Benjamin Bellows

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Can reproductive health voucher programs improve quality of postnatal care? A quasi-experimental evaluation of Kenya’s Safe Motherhood voucher scheme, Claire Watt, Timothy Abuya, Charlotte E. Warren, Lucy Kanya, and Benjamin Bellows

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Community experiences and perceptions of reproductive health vouchers in Kenya, Rebecca Njuki, Francis Obare, Charlotte E. Warren, Timothy Abuya, Jerry Okal, Wilson Mukuna, Lucy Kanya, Ian Askew, Piet Bracke, and Benjamin Bellows

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Community-level effect of the reproductive health vouchers program on out-of-pocket spending on family planning and safe motherhood services in Kenya, Francis Obare, Charlotte E. Warren, Lucy Kanya, Timothy Abuya, and Benjamin Bellows

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Community-level impact of the reproductive health vouchers programme on service utilization in Kenya, Francis Obare, Charlotte E. Warren, Rebecca Njuki, Timothy Abuya, Joseph Sunday, Ian Askew, and Benjamin Bellows

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Distance travelled and cost of transport for use of facility-based maternity services in rural Bangladesh: A cross-sectional survey, Kaji Tamanna Keya, Md. Moshiur Rahman, Ubaidur Rob, and Benjamin Bellows

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Does a voucher program improve reproductive health service delivery and access in Kenya?, Rebecca Njuki, Timothy Abuya, James Kelly Kimani, Lucy Kanya, Allan Korongo, Piet Bracke, Benjamin Bellows, and Charlotte E. Warren

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Effect of a maternal health voucher scheme on out-of-pocket expenditure and use of delivery care services in rural Bangladesh: A prospective controlled study, Forhana Rahman Noor, Md. Noorunnabi Talukder, and Ubaidur Rob

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Evaluation of a voucher programme in reducing inequities in maternal health utilization in Cambodia: A quasi-experimental study, Ashish Bajracharya, Benjamin Bellows, and Antonia Dingle

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Evaluation of the impact of the voucher and accreditation approach on improving reproductive behaviors and RH status: Bangladesh, Ubaidur Rob, Md. Moshiur Rahman, and Benjamin Bellows

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Evaluation of the impact of the voucher and accreditation approach on improving reproductive behaviors and status in Cambodia, Benjamin Bellows, Charlotte E. Warren, Saphonn Vonthanak, Chhea Chhorvann, Hean Sokhom, Chean Men, Ashish Bajracharya, Ubaidur Rob, and Tung Rathavy

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Evaluation of the impact of the voucher and accreditation approach on improving reproductive health behaviors and status in Kenya, Charlotte E. Warren, Timothy Abuya, Francis Obare, Joseph Sunday, Rebecca Njue, Ian Askew, and Benjamin Bellows

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Exploring the effectiveness of the output-based aid voucher program to increase uptake of gender-based violence recovery services in Kenya: A qualitative evaluation, Rebecca Njuki, Jerry Okal, Charlotte E. Warren, Francis Obare, Timothy Abuya, Lucy Kanya, Chi-Chi Undie, Benjamin Bellows, and Ian Askew

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Financial incentives and maternal health: Where do we go from here?, Lindsay Morgan, Mary Ellen Stanton, Elizabeth S. Higgs, Robert L. Balster, Benjamin Bellows, Neal Brandes, Alison B. Comfort, Rena Eichler, Amanda Glassman, Laurel Hatt, Claudia M. Conlon, and Marge Koblinsky

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Improving access to delivery care and reducing the equity gap through voucher program in Bangladesh: Evidence from difference-in-differences analysis, Kaji Tamanna Keya, Benjamin Bellows, Ubaidur Rob, and Charlotte E. Warren

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Increase in facility-based deliveries associated with a maternal health voucher programme in informal settlements in Nairobi, Kenya, Benjamin Bellows, Catherine Kyobutungi, Martin Kavao Mutua, Charlotte E. Warren, and Alex C. Ezeh

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Increasing contraceptive access for hard-to-reach populations with vouchers and social franchising in Uganda, Benjamin Bellows, Anna Mackay, Antonia Dingle, Richard Tuyiragize, William Nnyombi, and Aisha Dasgupta

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Initiation and continuity of maternal healthcare: Examining the role of vouchers and user-fee removal on maternal health service use in Kenya, Mardieh Dennis, Lenka Benova, Timothy Abuya, Matteo Quartagno, Benjamin Bellows, and Oona M.R. Campbell

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Lessons from sexual and reproductive health voucher program design and function: A comprehensive review, Corinne G. Grainger, Anna C. Gorter, Jerry Okal, and Benjamin Bellows

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Out-of-pocket expenses for maternity care in rural Bangladesh: A public-private comparison, Md. Moshiur Rahman, Ubaidur Rob, Forhana Rahman Noor, and Benjamin Bellows

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Performance-based incentive for improving quality of maternal health services in Bangladesh, Ubaidur Rob and Mohammad Masudul Alam

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Population-level impact of vouchers on access to health facility delivery for women in Kenya: A quasi-experimental study, Francis Obare, Charlotte E. Warren, Timothy Abuya, Ian Askew, and Benjamin Bellows

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Redeeming qualities: Exploring factors that affect women's use of reproductive health vouchers in Cambodia, Carinne D. Brody, Julie Freccero, Claire D. Brindis, and Benjamin Bellows

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Reproductive health voucher program and facility based delivery in informal settlements in Nairobi: A longitudinal analysis, Djesika D. Amendah, Martin Kavao Mutua, Catherine Kyobutungi, Evans Buliva, and Benjamin Bellows

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Review of performance-based incentives in community-based family planning programmes, Nicole M. Bellows, Ian Askew, and Benjamin Bellows

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Safe motherhood voucher programme coverage of health facility deliveries among poor women in South-western Uganda, Lucy Kanya, Francis Obare, Charlotte E. Warren, Timothy Abuya, Ian Askew, and Benjamin Bellows

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The use of vouchers for reproductive health services in developing countries: Systematic review, Nicole M. Bellows, Benjamin Bellows, and Charlotte E. Warren

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Using vouchers to increase access to maternal healthcare in Bangladesh, Ubaidur Rob, Md. Moshiur Rahman, and Benjamin Bellows

Audio/Video

Kadi: Saving Mothers and Babies, One Voucher at a Time, Population Council

Kadi the Film—Webisode 1: Vouchers Improve Health Facilities, Population Council

Kadi the Film—Webisode 2: Mobile Technology for Monitoring Vouchers, Population Council

Kadi the Film—Webisode 3: Vouchers in Pregnancies with Serious Complications, Population Council

Kadi the Film—Webisode 4: Getting Vouchers to Those in Need, Population Council

Kadi the Film—Webisode 5: Distributing Vouchers in Rural Uganda, Population Council

Fact Sheets

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Infographic: Vouchers are Transforming Reproductive Health Access Worldwide, Population Council

Presentations

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Population level impact of vouchers on access in Uganda, Benjamin Bellows, Francis Obare, and Reproductive Health Vouchers Evaluation Team

Reports

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Cost estimation for scale-up of voucher services in Kenya, Shubhra Kumar, Smita Sanghrajka, and Benjamin Bellows

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Defining effective voucher management information systems: A blueprint for information systems to support scalable reproductive health voucher programs, based on system evaluations with programs in Bangladesh, Cambodia, Kenya, Uganda, and Tanzania, Mahad Ibrahim, Benjamin Bellows, and Jaspal S. Sandhu

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Evaluation of the impact of the voucher program for improving maternal health behavior and status in Bangladesh, Md. Noorunnabi Talukder, Ubaidur Rob, Syed Abu Jafar Md. Musa, Ashish Bajracharya, Kaji Tamanna Keya, Forhana Rahman Noor, Eshita Jahan, Md. Irfan Hossain, Jyotirmoy Saha, and Benjamin Bellows

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Evaluation of the population-level impact of the maternal health voucher program in Uganda, Reproductive Health Vouchers Evaluation Team

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Report of the Voucher and Accreditation Evaluation Project Meeting, Reproductive Health Vouchers Evaluation Team and Population Council

Working Papers

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Increased coverage of maternal health services among the poor in western Uganda in an output-based aid voucher scheme, Francis Obare, Peter Okwero, Leslie Villegas, Samuel Mills, and Benjamin Bellows