Sambhav Voucher System
Country of Operation
- Family planning and reproductive health
- Maternal, newborn and child health
SummarySambhav, Hindi for “it is possible”, uses vouchers to provide subsidized reproductive health services to low income mothers.
Limited access to health services leads to higher fertility rates and maternal, neonatal and child mortality among the poor. These women also incur substantial out-of-pocket expenses for family planning and reproductive health services, including medicines and transportation. The Sambhav voucher system aids to link these populations to subsidized access to reproductive, maternal, and child health services.
Key program components
Sambhav’s voucher scheme is one component of the Innovations in Family Planning Services Project - a collaborative effort of the Government of India and (USAID)/India that has worked in the region for two decades. Four pilot districts included Agra (seven blocks), Kanpur Nagar (368 urban slums), Haridwar (two blocks), and Gumla (two blocks). The Sambhav vouchers targeted subsidies to below-the-poverty-line populations, while offering the poor a choice of private providers and enabling access to high-quality services. The vouchers covered a range of services, including antenatal care, institutional delivery, postnatal care, neonatal care, and family planning. The voucher management units (VMUs), led by the district chief medical officers, coordinated the voucher programs. These units distributed vouchers to NGOs responsible for training and supporting community level health workers known as accredited social health activists(ASHAs) in Agra and Haridwar, community health volunteers (CHVs) in Kanpur Nagar, and Sahiyyas in Gumla. The community level health workers identified impoverished and slum households, offered information on available services, distributed the vouchers to clients, and accompanied clients to seek services, as appropriate (e.g., institutional delivery). The community-level health workers were drawn from the communities they served. These women were instrumental in motivating clients to available services, especially services such as postnatal care and family planning that are not perceived as essential by families in rural, urban slum, and tribal areas. Clients exchanged vouchers for services provided by private nursing homes and hospitals, which submitted the vouchers to the VMUs for reimbursement. Only accredited private facilities can participate in the program. Provider training, regular medical audits of accredited facilities, and client satisfaction surveys and follow-up helped promote quality improvement. The VMUs also monitored quality. The state health societies, SIFPSA and UKHFWS, facilitated the flow of funds to the VMU and fostered linkages between the government and private providers. A multi-partner Project Advisory Group (PAG) was also established USAID implemented four voucher programs, called Sambhav, from 2006-2012 as part of the Innovations in Family Planning Services (IFPS) Project, a bilateral project of the Government of India and USAID, to expand access to family planning and reproductive health services to below poverty line beneficiaries in selected districts of Uttar Pradesh, Uttarakhand, and Jharkhand. Sambhav voucher pilot programs facilitated delivery in private health facilities of nearly 12,500 infants, supported approximately 44,000 antenatal care visits and 10,300 postnatal care visits. Women and men also used approximately 9,500 vouchers to avail a range of FP methods, including 2,007 sterilizations, 1,744 IUCDs, and 3,051 injectables.
- USAIDForeign aid agency or multilateral organization
- Government of IndiaGovernment