The National – Wednesday, December 8, 2010
By ELIZABETH MIAE
A VOUCHER scheme will be a possible mechanism that the government can adopt to improve maternal and child health in the country.
This was recommended in a joint research by Dr Katherine Lepani and Julienne McKay titled Revitalising PNG’s health system : The need for creative approaches which was launched at the National Research Institute last month.
They stated in their research that the urgent need to addressing the rising rates of maternal mortality in PNG had focused attention on the potential contribution of voucher schemes.
“Voucher schemes are widely used elsewhere to remove access barriers to antenatal care and offer lessons for the design and implementation of schemes in PNG,” they said.
They used Cambodia as an example where the scheme operated in conjunction with a government-run health equity fund (HEF) which covered user fees, transport and other costs of eligible patients.
“This saw an increase of health facility deliveries from 16% of the expected number of births in 2006 to 45% in 2008, significantly greater than in comparable districts without specific measures to address maternal health.
“Overall improvement in provider performance was attributed to a combination of measures that specifically addressed low pay among health workers, including performance-based contracting (PBC) of facilities, increased staff support, improved medical supplies and a delivery-based incentive scheme where midwives and other health workers received an incentive payment for each live birth attended in a referral hospital or health centre.”
They compared the outcomes across project areas – that is the combination of PBC and the delivery of incentive scheme achieved good results.
Better results were achieved in the district where the delivery incentive scheme was complemented by voucher and HEF schemes because they also addressed important financial access barriers (user fees and transport costs).
The research provides useful information that the government and its partners could take on board to improve the health sector through the implementation of some of the mechanisms outlined in the report that would be workable in the country.
This is how the voucher scheme works:
1. Voucher agency receives funding from either a donor or government. Contracts health facilities: contract defines package of health services to be delivered and the fees to be paid to the facility for each voucher redeemed. Voucher agency trains health facility staff and monitors service quality;
2. Voucher agency organises distribution of vouchers to target population;
3. Beneficiaries take the voucher to the health facility and obtain the contracted services; and
4. Health facility returns redeemed vouchers to voucher agency and receives payment according to the number of voucher patients treated. Monitoring and evaluation reports provided by voucher agency to donor/government.