Increasing FP access for
young people through the
private sector:
Youth vouchers in
Madagascar
Lalaina Razafinirinasoa
Country Director, Marie Stopes Madagascar
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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
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Madagascar: country context
Marie Stopes International
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
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Marie Stopes Madagascar
Marie Stopes International
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
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How does the voucher program work?
Marie Stopes International
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
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Youth voucher program: design & development
Marie Stopes International
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
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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
Marie Stopes International
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
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Results by service
Marie Stopes International
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
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Lesson learned from the pilot: evolving the voucher format to include a paper voucher
Marie Stopes International
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)
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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:
Marie Stopes International
CHE level Client level Franchisee level
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Feedback from franchisees
Marie Stopes International
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
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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
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Thank you!
Marie Stopes International