Implementing a reproductive health voucher in Yemen to reach one million women in rural Yemen

We have been working in Yemen with the Yamaan Foundation for Health and Social Development since April 2013, implementing a reproductive health voucher programme that reaches over 1 million people in the governorates of Lahj and Ibb. We ensure that women in poor rural areas can access a range of safe motherhood and family planning services, free of charge, and have seen a significant increase in the uptake of these services since the start of the programme.

During the first half of 2015, conflict in the country escalated resulting in widespread insecurity and the deterioration of services. More than 50% of the population lost their jobs and with the increase of the cost of food and fuel, most of the population now live below poverty line.

Many of the public health services collapsed as a result of not receiving government funding. The private and non-governmental sector adapted and has survived much better. It has continued to provide services where the public sector has failed, but many people cannot afford these services.

Voucher programmes boost demand for services by removing financial obstacles and allowing poor people to access services. They also provide much needed additional resources for public health facilities. Through the vouchers, facilities are paid for the services they provide and are strongly encouraged to invest their income in staff incentives and in their facilities, therefore increasing the quality of the services.

In 2014, the voucher programme was introduced to Jibla hospital, located in a rural mountainous district in the centre of the country. The hospital was underfunded and in desperate need of an ambulance to be able to respond to emergencies in difficult terrain. It was also struggling to cater for the number of patients due to lack of beds and space.

A year before, a donor had built a new maternity ward, fully equipped with a neonatal care department, but the hospital was unable to use it because it did not have a fully functioning oxygen system, a key piece of equipment. The management had requested funds from the government and other donors, but none were forthcoming. The hospital enrolled in our voucher programme and, as the only hospital in the area, soon started to see a healthy income from all of the safe deliveries it was providing. Within six months, the hospital management team were in a position to buy an ambulance. Nine months later they installed the final pieces of the oxygen system that had been missing, and opened the new ward that had been closed since January 2014.

The hospital director said, “The income from the programme accelerated the opening of the new building of the Mother and Child hospital that belongs to Jibla hospital, by enabling the hospital to complete the work that was suspended due to financial problems. Now the hospital capacity has increased, more clients will be served and the high demand for services can be met”.

We have also been working in the Al-Makatira district where the Al-Anbouh health center is enrolled on the scheme. Al-Anbouh is located in a challenging mountainous area where there is an unreliable water supply.

Water is needed regularly in the hospital to clean medical instruments using a sterilization device, in delivery rooms for the toilets and for the overall cleanliness of the facility.  The local supply can fail for months at a time and, as a backup, water has to be brought in by trucks. This is costly; the facility’s water storage facilities are limited and, according to the Health Centre In-Charge, “The water supply was erratic, leading to problems such as frequent interruption of water in the health facility and we were spending a lot of money due to the high cost of water that is brought in by trucks”. Using income from the voucher programme, Al-Anbouh health center has been able to construct a large water storage tank that ensures that supplies of water last between visits from water trucks. This has enabled the health centre to provide consistent, higher quality services to clients.

We will continue to support the Yamaan Foundation to enable poor women in Yemen to access essential maternal and newborn care, and to enable health facilities to invest in better quality services.