Cash and voucher assistance (CVA) refers to programs where cash or vouchers, exchangeable for goods or services, are directly provided to community members. CVA can help improve access to and the utilisation of health services, by reducing direct and indirect financial barriers and incentivising the use of free preventive services. There is also a growing body of evidence which shows that CVA should always be considered alongside other supply- and demand-side interventions rather than as a stand-alone action.

Building Evidence

Sexual Reproductive Health and Rights (SRHR) services are an essential component of the humanitarian response. Despite the growing interest in including CVA while planning and providing SRHR services among humanitarian partners, there is limited evidence about its effectiveness and feasibility in humanitarian settings.

This contrasts greatly with the large body of evidence available around the use of CVA as a component of SRHR programs in development settings. Given the fact that experiences from the development sector cannot be automatically transferred to humanitarian situations, there was a need to consolidate existing evidence around CVA for SRHR services, document current practices, and discuss the findings with key actors, with the aim of defining its potential role in the planning and provision of SRHR services in humanitarian settings.

KIT conducted a broad literature review and two case studies in Yemen and Afghanistan and developed a compendium of guidelines and tools for CVA for SRHR in humanitarian settings, to answer the following questions:

• What are the effects of CVA on SRHR outcomes in humanitarian settings?
• What is the operational feasibility of CVA within or complementary to other SRHR interventions in humanitarian settings?
• What are the comparative advantages/disadvantages of CVA within or complementary to other interventions as a means to reduce financial barriers and/or increase access to and utilisation of SRHR services in humanitarian settings?
• What are the lessons learned and the operational recommendations for future CVA for SRHR programming?
• What are appropriate guidelines and tools aimed at assessing feasibility and assisting with the implementation of CVA in humanitarian settings?

Improving Healthcare Access

CVA can be useful to improve access to and the utilisation of health services, by reducing direct and indirect financial barriers and incentivising the use of free preventive services.

Following commitments related made in the World Humanitarian Summit Grand Bargain, donors and aid organisations are increasingly encouraged to consider CVA in their health response option analysis. While the body of evidence around CVA for health is growing, most of it comes from development contexts rather than from humanitarian settings. Given the major differences in a wide range of areas/dimensions, it is not always possible to directly transfer evidence generated in development contexts to humanitarian ones.

Impact on SRHR

SRHR services, such as maternal health, family planning, STIs and HIV/AIDS, and gender-based violence, are essential components of the humanitarian response, and should not be addressed in silos.

It is important to avoid fragmentation, ensuring that there is alignment across women’s, children’s and adolescents’ health and wellbeing in humanitarian settings, taking a life-course approach, with the aim of increasing the effectiveness of interventions throughout a person’s life.

Research Findings

Although evidence from humanitarian settings is limited, there is no indication that approaches with CVA which have proven to be effective in development settings would not work in humanitarian settings. CVA does lead to an increase in the utilisation of certain types of SRHR services and acts on both the demand- and supply-side enablers and barriers.

The research highlighted the importance of doing a full analysis on the key underlying financial and non-financial barriers to the utilisation of services before choosing the most appropriate mix of response options, in addition to assessing the capacities and quality on the supply-side, before the start of the project.

This is key to determining what mix of financial and non-financial interventions are likely to contribute to improved access and utilisation of SRHR programming, as CVA is never a standalone intervention. When demand is increased, there is a need to invest in health system delivery capacity, and when availability is increased, there is a need to understand if the target population face possible barriers to their use and address them.

Tools, Guidelines & Links

CVA – A Compendium of Tools and Guidelines

CVA – Case Studies from Afghanistan and Yemen

CVA – Literature Review

Health Cluster Cash-Based Interventions Task Team Website

The Cash Learning Partnership (CaLP) – maximising the potential humanitarian CVA can bring to people in contexts of crisis.