1. 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?
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
Marie Stopes International

3. Madagascar: country context
Population: 22 million
92% live on < $2/day
64% of the population are < 25 years old
48% of girls are married by 18
32% of year olds have children
27% have an unmet need for FP
Marie Stopes International

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
Marie Stopes International

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
Marie Stopes International

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
Rationale
Training CHEs and franchisees in youth friendly services
Adapted existing voucher management software
Preparation
Launch of the youth voucher for FP and STI services for year olds
distributed by Community Health Educators (CHEs)
and available for redemption at BlueStar franchisees
Launch
Marie Stopes International

7. Service package covered by the voucher
FP counselling
Provision of short term FP methods
Provision of LARCs (3 year implant, 10 year IUD)
STI screening and counselling
Removal of LARCs
A young person can obtain a combination of services under one voucher, eg. an FP method and STI counselling
Marie Stopes International

8. Youth voucher distribution: step by step
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
Marie Stopes International

9. Voucher reimbursements to BlueStar providers
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
Marie Stopes International

10. 58,417 vouchers were distributed
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
Marie Stopes International

12. Who are the voucher clients?

13. 69% had never previously used a method of family planning
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)
Marie Stopes International

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
Marie Stopes International

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
Marie Stopes International

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
Marie Stopes International

19. Thank you!
Marie Stopes International