Cambodia: Access

As discussed in “What it is”, voucher programs are most commonly used for maternal health services. In 2007, Cambodia implemented a voucher program as a strategy to reduce the maternal mortality ratio through skilled birth attendance. This was implemented in conjunction with other reforms including a Health Equity Fund and performance-based contracting. The voucher program was implemented in three rural districts and targeted poor women.1 Three criteria were used to select facilities that would receive vouchers. They were required to: 1) provide the minimum package of services, 2) have at least one skilled midwife, and 3) have a record of high utilization for antenatal care and delivery. As mentioned in “What it is”, criteria such as these have the potential to catalyze improvements in non-qualifying facilities. Eligibility for participants was determined using pre-specified criteria that were used in the Health Equity Fund. Selected women received vouchers for three prenatal care visits, delivery, and one postnatal visit, as well as all transportation services and hospital referral if needed. The voucher management agency reimbursed the health centers once a month. Utilization was moderate – 44.6% of the individuals who received vouchers used them for delivery. Of the women who did use the vouchers, most were satisfied. They reported using the vouchers because they enabled them to get free care, they felt safer delivering in the health centers, and they were able to get their infants vaccinated immediately. Women who did not use the vouchers reported a few barriers. First, many lived far away from facilities and were concerned that transportation would exceed the amount covered by the voucher. They also often had responsibilities in the home that kept them from accessing services. Additionally, some were not satisfied with the quality of services or reported that they feared midwives would request informal payments.  


  1. Ir P, Horemans D, Souk N, Van Damme W. 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. BMC Pregnancy Childbirth. 2010;10:1–11.