Titel Deelnemers "Using targeted vouchers and health equity funds to improve access to skilled birth attendants for poor women: a case study in three rural health districts in Cambodia" "Por Ir, D Horemans, N Souk, Wim Van Damme" "Improving access to safe delivery for poor pregnant women: a case study of vouchers plus health equity funds in three health districts in Cambodia" "Ir Por, D Horeman, S Narin, Wim Van Damme, WILLEM VAN LERBERGHE, Guy Kegels, Vincent De Brouwere" "A policy analysis of the implementation of a reproductive health vouchers program in Kenya" "Timothy Abuya, Rebecca Njuki, Charlotte Warren, Jerry Okoth Okal, Francis Obare, Lucy Kanya, Ian Askew, Ben Bellows" "The logistics of voucher management : the underreported component in family planning voucher discussions" "Moazzam Ali, Madeline Farron, Syed Khurram Azmat, Waqas Hameed" "Background: The purpose of health care vouchers or coupons is to receive a health service in exchange which is fully or partially subsidized, such as any treatment offered for communicable disease; for immunization; antenatal care-/postnatal care-related maternal health services; a family planning (FP) service; or to get a health commodity like a medicine. Vouchers are targeted for a group of people who can benefit the most such as on the basis of poverty ranking, marginalized or living in rural areas. According to the World Health Organization, voucher schemes in the area of sexual and reproductive health are considered of high value if they are implemented to address the issues of contraceptive commodity or service unavailability or to address the barriers to access such services through contracting out health services, for example, through social franchising (SF). FP vouchers can substantially expand contraceptive access and choice and empower the underserved populations. Literature cites voucher's effectiveness in better targeting, increasing use, and improving program outcomes in FP programs; however, there is little research or explanation of how voucher management is done in practice. Discussion: The paper attempts to describe various components of voucher management system and its functioning using example of a voucher program in Pakistan. There are challenges such as high upfront cost, targeting the appropriate clients, validation of vouchers, and quality assurance, but these can be managed with better preparation at the planning and design stage. Strong monitoring and evaluation are integral to successful implementation of the voucher program. Also, voucher interventions that are targeted and adopt a pro-poor strategy have been found to improve access to care within poor and marginalized populations. Such programs have the capacity to bridge health inequities in developing nations. Targeted voucher schemes such as those which are designed as pro-poor or pro-rural are known to reduce barriers to access for those living with poverty or for the ones considered as marginalized population. Hence, such interventions have the capacity to fulfill the gaps in health inequities, especially, in low-and/or middle-income countries. Conclusion: Voucher programs should report the voucher logistics and management to build a larger evidence base of best practices. All voucher schemes must be designed, implemented, and evaluated on the basis of set objectives through addressing the local context. But any voucher implementing organization also conducting the in-house voucher management simultaneously may be considered as a weakness in program design, in turn providing rationale for either failure or success of that particular voucher intervention. Therefore, separating implementation and management of a voucher initiative can lead to enhanced transparency, improved accountability, allow for independent validation of services, and facilitate compliance for payments." "Using targeted vouchers and health equity funds to improve access to skilled birth attendants for poor women: a case study in three rural health districts in Cambodia." "Por Ir, D Horemans, N Souk" "Background: In many developing countries, the maternal mortality ratio remains high with huge poor-rich inequalities. Programmes aimed at improving maternal health and preventing maternal mortality often fail to reach poor women. Vouchers in health and Health Equity Funds (HEFs) constitute a financial mechanism to improve access to priority health services for the poor. We assess their effectiveness in improving access to skilled birth attendants for poor women in three rural health districts in Cambodia and draw lessons for further improvement and scaling-up. Methods: Data on utilisation of voucher and HEF schemes and on deliveries in public health facilities between 2006 and 2008 were extracted from the available database, reports and the routine health information system. Qualitative data were collected through focus group discussions and key informant interviews. We examined the trend of facility deliveries between 2006 and 2008 in the three health districts and compared this with the situation in other rural districts without voucher and HEF schemes. An operational analysis of the voucher scheme was carried out to assess its effectiveness at different stages of operation. Results: Facility deliveries increased sharply from 16.3% of the expected number of births in 2006 to 44.9% in 2008 after the introduction of voucher and HEF schemes, not only for voucher and HEF beneficiaries, but also for self-paid deliveries. The increase was much more substantial than in comparable districts lacking voucher and HEF schemes. In 2008, voucher and HEF beneficiaries accounted for 40.6% of the expected number of births among the poor. We also outline several limitations of the voucher scheme. Conclusions: Vouchers plus HEFs, if carefully designed and implemented, have a strong potential for reducing financial barriers and hence improving access to skilled birth attendants for poor women. To achieve their full potential, vouchers and HEFs require other interventions to ensure the supply of sufficient quality maternity services and to address other non-financial barriers to demand. If these conditions are met, voucher and HEF schemes can be further scaled up under close monitoring and evaluation." "Offline NFC Payments with Electronic Vouchers" "Gauthier Van Damme, Karel Wouters, Bart Preneel" "© 2009 ACM. In this paper a practical offline payment system based on digital vouchers using Near Field Communication (NFC) in mobile phones is presented. This work was performed within the scope of the IBBT NFC-Voucher project. The goal of the project is to assess the feasibility of such a system, from a technical and security perspective, using tangible NFC devices such as the Nokia 6131 NFC mobile phone. This involved an in-depth technical and security analysis of all actors in the system and a rigorous elaboration of the practical security requirements and assumptions. In the architecture implementing and connecting all the different actors of this voucher payment system, no compromises regarding security were made. At device level all sensitive data is stored in a Secure Element (SE) with limited access for nonauthorised users. The backbone and voucher transfer system uses a classical Public Key Infrastructure (PKI), such that only trusted and registered parties can handle and transfer vouchers. After having implemented this system, we conclude that it is possible to build an off-line payment system for mobile phones without compromising security, but that it remains quite challenging, given the current limitations on speed, available memory and security functionality." "Payment with Mobile (NFC) Vouchers – Using Co-design Techniques to Identify User Requirements" "Karin Slegers" "This paper presents an ongoing co-design study focusing on the application of Near Field Communication (NFC) technology in the area of voucher payment. The research that is described is conducted to a) gain a thorough understanding of the current context of use of paper vouchers, including user experience and user needs, and b) evaluate the potential of the concept of NFC-vouchers with endusers in an early stage. Several aspects of the context of use as well as the future NFC-vouchers will be discussed." "Initiation and continuity of maternal healthcare: examining the role of vouchers and user-fee removal on maternal health service use in Kenya" "Mardieh L Dennis, Lenka Benova, Timothy Abuya, Matteo Quartagno, Ben Bellows, Oona M R Campbell" "This study explores the relationship between two health financing initiatives on women's progression through the maternal health continuum in Kenya: a subsidized reproductive health voucher programme (2006-16) and the introduction of free maternity services in all government facilities (2013). Using cross-sectional survey data, we ran three multivariable logistic regression models examining the effects of the voucher programme, free maternity policy, health insurance and other determinants on (1) early antenatal care (ANC) initiation (first visit within the first trimester of pregnancy), (2) receiving continuous care (1+ ANC, facility birth, 1+ post-natal care (PNC) check) and (3) completing the maternal health pathway as recommended (4+ ANC, facility birth, 1+ PNC, with first check occurring within 48 h of delivery). Full implementation of the voucher programme was positively associated with receiving continuous care among users of 1+ ANC [interaction term adjusted odds ratio (aOR): 1.33, P = 0.014]. Early ANC initiation (aOR: 1.32, P = 0.001) and use of private sector ANC (aOR: 1.93, P < 0.001) were also positively associated with use of continuous care among ANC users. Among continuous care users, early ANC was associated with increased odds of completing the maternal health pathway as recommended (aOR: 3.80, P < 0.001). Higher parity was negatively associated with all three outcomes, while having health insurance was positively associated with each outcome. The impact of other sociodemographic factors such as maternal age, education, wealth quintile, urban residence, and employment varied by outcome; however, the findings generally suggest that marginalized women faced greater barriers to early ANC initiation and continuity of care. Health financing and women's timing and source of ANC are strongly related to their subsequent progression through the maternal health pathway. To increase continuity of care and improve maternal health outcomes, policymakers must therefore focus on equitably reducing financial and other barriers to care seeking and improving quality of care throughout the continuum." "Perspectives of cocaine users on addiction recovery : a qualitative study following a CRA + vouchers programme" "Anne Dekkers, Clara De Ruysscher" Vouchers "Filip Debelva"