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Cash&Voucher Assistance for Health

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Cash&Voucher Assistance for Health A Case Study from Jordan Cash&Voucher Assistance for Health 02 Cash & Voucher Assistance for Health Cash & Voucher Assistance for Health 03 Acknowledgements Executive summary The activities described in this report would not have been possible without vidence is slowly emerging on the use of cash Vulnerable refugees were targeted based on lack the financial support from various donors including Auswärtiges Amt (AA), and voucher assistance (CVA) to reach health of workforce within the household, expenditure, Chaîne du Bonheur (CdB), the Directorate-General for European Civil Protec- outcomes. The key entry point for CVA in debt levels, coping mechanisms adopted as well as tion and Humanitarian Aid Operations (DG ECHO), the EU Regional Trust Fund Ehealth is the strategy Healthcare 2030, which lack of registration. They were identified by Medair in Response to the Syrian Crisis (‘Madad’), and the United Nations Office for aims at Universal Health Coverage (UHC) and access through community health volunteers based on the the Coordination of Humanitarian Affairs (OCHA). Medair would also like to to healthcare when people need it without inducing project’s selection criteria. Medair focused its health acknowledge its health staff and Community Health Volunteers (CHVs), who financial hardships CVA can be useful to improve project on assistance to pregnant women (delivery, have been devoted and tireless in their efforts to reach those in need. access to and utilization of health services in human- antenatal and postnatal care), individuals affected itarian settings, by reducing direct and indirect finan- by non-communicable diseases, acute health needs This report was authored by Stephen Chua, with assistance and reviews by cial barriers and/or by incentivizing the use of free and emergency needs of Jordanian host households. Alex Fergusson, Darine Abu Saadeh, Haneen Abu Laila, Margie Davis, Dominika preventive services. Bednarova and Namseon Beck – all from Medair. The capacity and quality of the supply side of health This study sheds light on the use of cash transfers services, although quite overstretched by the in- This report was reviewed by the Global Health Cluster (GHC) cash task team by Medair in Jordan between 2017 and 2019 as part creasing demand caused by the inflow of refugees and the Cash Learning Partnership (CaLP). The Medair case study helps build of its response to health-related needs of vulnerable to the country, was found to be adequate in Jordan; more evidence on the use of cash transfers for health outcomes. It is a great populations, both refugee and host communities, Jordan’s health system is one of the strongest in example of how an organization integrated cash transfers into their health living in Jordan. the region. However, the preferred option, to ensure response and provides practical considerations on how to implement it. The coverage of vulnerable refugees under the national GHC cash task team and CaLP would like to emphasize that any decision The health and socio-economic impacts of the con- health insurance scheme, continues to experience on cash and voucher assistance (CVA) for health in other contexts needs to flict and displacement meant that much of the refu- gaps in coverage. Furthermore, when international be grounded in a contextual analysis of accessibility and barriers to health gee population in Jordan required access to health partners contract providers directly to purchase ser- needs and a response option analysis. services. While facing different and complex health vices, they are charged foreign rates of up to three needs, refugees living in Jordan have all reported times more than if refugees pay for the services All correspondence should be addressed to (Medair) Margie Davis: barriers in accessing required health services, of themselves. Hence, the next appropriate response [email protected], (WHO) Yassmin Moor: [email protected] or which financial constraints in paying user fees has option was to enable vulnerable populations to ac- (CaLP) Julie Lawson-McDowall: [email protected] been reported as the major one. This created a sig- cess services directly by making cash transfers to nificant barrier to accessing services and is a major patients to overcome financial constraints to ac- This publication of this study is made possible by the generous support of the reason why people postpone or forego healthcare cess healthcare at the time of need. Swiss Agency for Development and Cooperation (SDC). despite increased health needs. Medair’s project in Jordan aimed to reduce these Refugees living in Jordan have financial barriers and help vulnerable populations ❝ access healthcare in a timely manner. Medair oper- all reported barriers in accessing ated in the governorates where the highest number required health services, of of refugees were present: Amman, Irbid, Mafraq, and Zarqa. Between January 2017 and July 2019, Me- which financial constraints dair provided CVA for health for a total of 8,848 in- in paying user fees has been Cover image: dividuals, of which 6,892 were refugees. Medair also reported as the major one. A Syrian refugee family that received covered emergency health needs of host Jordanian CVA from Medair in Amman, Jordan. ©Medair/Deema Abdallah/2018 households that had been assessed as vulnerable. 04 Cash & Voucher Assistance for Health Cash & Voucher Assistance for Health 05 Acronyms and Abbreviations disease, the cash transfers were made as a one-off ANC Antenatal care transfer or on a recurring basis. ATM Automated teller machine Based on Medair’s experience in CBO Community-based organization ❝ The cash transfers were predominantly made through CCF Common cash facility Jordan, it is concluded that CVA pre-paid bank cards under the common cash facility CCT Conditional cash transfer was an appropriate modality umbrella and at times through physical cash, also in the case of reimbursements. The amounts were set to CHV Community health volunteer to provide health assistance. include the cost for the delivery, consultations or treat- CS Caesarean section ments, as well as transportation costs in some cases. CVA Cash and voucher assistance FCM Feedback and complaints mechanism Medair conducted post-distribution monitoring and FGD Focus group discussion collected feedback from beneficiaries. Based on Me- GoJ Government of Jordan dair’s experience in Jordan, it is concluded that CVA HAUS Health Access and Utilization Survey When further analysing the feasibility of this ap- was an appropriate modality to provide health assis- proach, in addition to the availability of health servic- tance. Some of the challenges Medair faced could be ICU Intensive Care Unit es of acceptable quality, Medair noted the presence addressed through the following recommendations, JOD Jordanian Dinar of advanced banking systems and other financial made in the report: JRP Jordan Response Plan service providers, familiarity of use by targeted pop- MEAL Monitoring, Evaluation, Accountability and Learning ulations of these services, and relatively low securi- 1) recommendation to agencies implementing CVA MEB Minimum Expenditure Basket ty concerns and other protection-related risks in the for health (including Medair) and the health sector to MoH Ministry of Health case of CVA. Furthermore, the existing conditions standardize definitions of ‘quality care’ and provide combined with the widespread provision of cash as- tools for monitoring and quality on the supply side; MoI Ministry of Interior sistance for basic needs were deemed likely to pro- MoPIC Ministry of Planning and International Cooperation vide an environment where CVA for health would be 2) recommendation to the Global Health Cluster MPC Multipurpose cash used as intended to achieve health outcomes. and research institutions to design and conduct re- NCD Non-communicable disease search to understand the impact of CVA for health NVD Normal vaginal delivery For timely access to health services, Medair provided programmes on health outcomes, behaviours and OOP Out-of-pocket payment unconditional cash transfers for pregnant women to coping mechanisms, cost effectiveness and ad- PDM Post-distribution monitoring cover delivery and to Jordanian households to cover verse financial outcomes (for example, to track the for emergency health needs; conditional cash trans- proportion of the population pushed into poverty, PNC Postnatal care fers to incentivize access to essential public health and/or pushed further into poverty due to out-of- RAIS Refugee Assistance Information System services and preventive services, such as immuniza- pocket payments for health); 3) recommendation to UCT Unconditional cash transfer tion, antenatal care and compliance with consulta- the Government of Jordan and the donor community UHC Universal Health Coverage tions of non-communicable diseases. Under certain to review the functioning of the Multi-Donor Account UNHCR United Nations High Commissioner for Refugees conditions, Medair also provided cash transfers as and its support in the integration of refugees (and/or VAF Vulnerability Assessment Framework reimbursement for seeking health services for acute other vulnerable individuals) into the national health health needs. Depending on whether these were to insurance scheme, applying the same rates as for WHO World Health Organization cover for an emergency need, a delivery or a chronic Jordanians, to achieve Universal Health Coverage. WFP World Food Programme Cash Voucher Assistance for Health Cash
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