increasing fp access for young people through the private sector: youth vouchers in madagascar...

Increasing FP access for

young people through the

private sector:

Youth vouchers in

Madagascar

Lalaina Razafinirinasoa

Country Director, Marie Stopes Madagascar

2

Why a youth voucher?

Marie Stopes International

Young people often express preference for seeking FP from the private sector

But proportion of clients under 20 remains low in MSI franchises

Learning that supply-side interventions such as youth-friendly franchisee training have more lasting results when matched with demand-side component such as vouchers

3

Madagascar: country context


Population: 22 million

92% live on < $2/day

<25 years

64%

64% of the population are < 25 years old

• 48% of girls are married by 18 • 32% of 15-19 year olds have

children • 27% have an unmet need for

FP

4

Marie Stopes Madagascar


Provides FP across all 22 regions of Madagascar, including 80% of LARC/PM services countrywide

Reached 800,000 clients in 2014 through mobile outreach, clinics, mobile midwives, and BlueStar social franchise network

Implements poverty voucher linked to BlueStar, using m-health for voucher claims, reporting and reimbursements

5

How does the voucher program work?


BlueStar Network of 150 private providers, supported by MSM; previously only providing short term FP methods, now also providing LARCs

Vouchers sold by Community Health Educators (cost client USD $0.10) to poor women; BlueStar providers then reimbursed per service

Reporting and reimbursements via mobile money - fast and cost-effective

Over 100,000 women have used FP vouchers (Oct11-Sep14), the majority choosing voluntary LARCs

6

Youth voucher program: design & development


Only 12% of franchisee

clients were 15-19

Cost barrier for young people to access quality SRH services

Opportunity to deliver

vouchers via SMS

MSM experienced in

voucher programs

Launch of the youth voucher for FP and STI services for 15-19 year olds distributed by Community Health Educators (CHEs)and available for redemption at BlueStar franchisees

Training CHEs and franchisees in youth friendly

services

Adapted existing voucher

management software

Rationale

Preparation

Launch

7

Service package covered by the voucher

FP counsellingProvision of short term FP methods Provision of LARCs (3 year implant, 10 year IUD)STI screening and counsellingRemoval of LARCs

A young person can obtain a combination of services under one voucher, eg. an FP method and STI counselling


Youth voucher distribution: step by step

Marie Stopes International8

MSM Field Coordinator distributes

vouchers to CHE

Young person

identified by a CHE

at community

level

SMS sent to MSM

server by the CHE

Young person receives

voucher code via SMS to

their phone or on paper from

the CHE's phone

Young person

redeems the

voucher at a BlueStar franchisee

Voucher reimbursements to BlueStar providers

Marie Stopes International9

Franchisee sends

voucher claim to

MSM server

Server validates that the voucher

code matches the code of

voucher distributed

Daily report of voucher

claims generated and sent to

Voucher Manager

Voucher Manager groups

franchisees claims

together

Reimbursements sent via mobile money to

franchisees

Set reimbursement rates for each

service, or combination of

services

Results (July 2013-Dec 2014):

58,417 vouchers were distributed

43,352 young people used vouchers

to take up a service

78% chose to take a voluntary LARC

51% had STI counselling

11

Results by service


IUD insertion

8,217

Implant insertion 25,794 Short term

FP 8,789 Counseling

535

STI counsel-ing

22,004

IUD removal181 Implant removal 507

IUD insertion

Implant insertion

Short term FP

Counseling

STI counseling

IUD removal

Implant removal

Who are the voucher clients?

July 2015 snapshot client profile data:

69% had never previously used a

method of family planning

96% of clients were aged 20 or younger

47% had one or more children

14

Lesson learned from the pilot: evolving the voucher format to include a paper voucher


E-vouchers were not being frequently used due to:

– a high number of young people interested in receiving a service but who did not own a mobile phone

– Reluctance to provide mobile number due to the sensitive nature of the SMS content

New distribution strategy was established:

– Paper-based voucher distributed at community level

– E-vouchers via MSM’s Call Center (toll-free number)

16

Monitoring & Evaluation

• Real-time monitoring of the voucher program through daily tracking of voucher codes distributed and redeemed, and reimbursement claims

• Verification of validity of voucher claims:


CHE level Client level Franchisee level

17

Feedback from franchisees


Youth-friendly training helped equip them to provide confidential, non-judgemental information and services

Increased youth client load improved provider confidence and willingness to provide services, including voluntary LARCs, to young people

18

Conclusion

• Results demonstrate that vouchers can be an effective tool to reach adolescents at scale, provide them with FP choice, and leverage existing private health infrastructure

• When young people have the choice, many of them choose LARCs

• Holistic demand and supply side intervention key to success

• E-voucher not appropriate in all contexts

• MSM continuing to scale up program - anticipates reaching 50,000 young people in 2015


19

Thank you!


increasing fp access for young people through the private sector: youth vouchers in madagascar...

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