PublicationsSystematic reviewsThe Impact of Vouchers systematic review
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The impact of vouchers on the use and quality of health goods and services in developing countries: a systematic review

What do we want to know?

Whether voucher programmes thus far have been successful in achieving their objectives and should therefore be considered as a mechanism for further health aid.

Who wants to know?

Donors of international aid, governments receiving international aid, services contracting with voucher programmes and users of services offered vouchers.

What did we find?

The strongest finding from this review is that the evidence indicates that health voucher programmes have been successful in increasing utilisation of health goods/services. There is also modest evidence that voucher programmes can effectively target specific populations and can improve the quality of services. While these results are encouraging, the subsequent link that voucher programmes improve the health of the population is not evident in the data analysed in this review.

What are the implications?

Future research in this area should focus on four areas. First, a consistent systematic review methodology should be applied to several health financing strategies so that policy-makers can examine the relative effectiveness of different strategies. Second, programme managers of current and future voucher programmes would benefit from a review of lessons learned when implementing voucher programmes. Third, there is a clear need for more evidence on the efficiency of voucher programmes and a different approach for analysing data on efficiency. Finally, an update to this review should take place in approximately three years? time to incorporate new evaluations currently underway.

How did we get these results?

A systematic search and synthesis of evaluations tested the following hypotheses:

  1. Voucher programmes effectively target specific populations.
  2. Voucher programmes increase utilisation of specified health goods/services.
  3. Voucher programmes allow for more efficient distribution of health goods/services compared to other forms of aid distribution.
  4. Voucher programmes improve the quality of health goods/services.
  5. Voucher programmes result in the improved health of a population.

A total of 24 quantitative evaluations of 16 voucher programmes were included in the synthesis. Six programmes were for insecticide-treated bed net distribution programmes and nine voucher programmes addressed some aspect of a reproductive health (e.g. maternity services, family planning, or treatment for sexually transmitted infections). One general health services programme was also evaluated. These voucher programmes were located in Africa (eight), Asia (five) and Latin America (three, all located in Nicaragua).

Most of the 24 evaluation studies were observational studies with a pre/post design, a cross-sectional intervention/control design or a combination of the two. Also included were one case-control study, two economic modelling studies, one clinical record review and a simulated patient before-during-after evaluation.
The EPPI Centre reference number for this report is 1905.

Meyer C, Bellows N, Campbell M, Potts M (2011) The impact of vouchers on the use and quality of health goods and services in developing countries: a systematic review. London: EPPI Centre, Social Science Research Unit, Institute of Education, University of London.

ISBN: 978-1-907345-10-4

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