Demand-side Financing for Sexual and Reproductive Health Services in Low and Middle-Income Countries : A Review of the Evidence

Witter, Sophie ; Somanathan, Aparnaa

World Bank, Washington, DC

关键词: ACCESS TO EDUCATION;    ACCESS TO SERVICES;    ADOLESCENT;    ADOLESCENT HEALTH;    ADOLESCENTS;   

DOI  :  10.1596/1813-9450-6213
RP-ID  :  WPS6213

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

Demand-side financing approaches havebeen introduced in a number of low and middle-incomecountries, with a particular emphasis on sexual andreproductive health. This paper aims to bring together theglobal evidence on demand-side financing mechanisms, theirimpact on the delivery of sexual and reproductive healthservices, and the conditions under which they have beeneffective. The paper begins with a discussion of modalitiesfor demand-side financing. It then examines 13 existingschemes, including cash incentives, vouchers, and longerterm social protection policies. Based on the availableliterature, it collates evidence of their impact onutilization of services, access for the poor, financialprotection, quality of care, and health outcomes. Evidenceon costs and cost-effectiveness are examined, along withanalysis of funding and sustainability of policies. Finally,the paper discusses the preconditions for effectiveness ofdemand-side financing schemes and the strengths andweaknesses of different approaches. It also highlights theextent to which results for sexual and reproductive healthservices are likely to be generalizable to other types ofhealth care. It is clear that some of these policies canproduce impressive results, if the preconditions foreffectiveness outlined are met. However, relatively fewdemand-side financing schemes have benefited from robustevaluation. Investigation of the impact on financialprotection, equity, and health outcomes has been limited.Most importantly, cost effectiveness and the relative costeffectiveness of demand-side financing in relation to otherstrategies for achieving similar goals have not been assessed.