Expanding universal coverage: Reproductive health vouchers in Cambodia

One approach to delivering healthcare in developing countries is through voucher programs, where vouchers are distributed to a specific population for free or subsidized health care. Recent evaluations suggest that vouchers have the potential to extend coverage of priority health services to the poor in developing countries. In Cambodia, a reproductive health voucher program was implemented in January 2011. This study aims to explore women's experiences accessing services with their vouchers at accredited clinics. This qualitative study used focus group methodology to gather information from both older (>25 yrs) and younger (18-25 yrs) women who were eligible for the voucher program in three provinces. Focus groups were digitally recorded, transcribed and translated from Khmer into English. Data analysis was an iterative process, which comprised of the development of a conceptual framework during data collection, careful coding of all transcripts, and the generation of themes, categories and sub-categories. Two overarching themes were identified in the data: 1) factors that facilitate voucher use and 2) factors that inhibit voucher use. Within each of these themes, three subthemes were identified: 1) pre-existing factors, 2) distribution factors and 3) redemption factors. Overall, women expressed positive feelings towards the voucher program, reporting that they now sought earlier and more frequent care. Several important areas for program improvement were identified such as better counseling during voucher distribution and addressing informal payments expected by midwives despite voucher use. Early information from program beneficiaries can lead to timely and responsive changes that can help to maximize program success.