How Can Lucknow Improve the Sambhav Voucher Scheme?

Abstract

Maternal health care is an important issue. In order for the population to be healthy, it is essential that children are well nourished and health from the moment of their conception. Unfortunately, in many countries – especially developing countries – the emphasis is directed away from health care, and the concept of health care in pregnancy is nearly non-existent. This occurs for a variety of reasons; cultural biases against medical involvement in health, biases against women, financial barriers and infrastructural barriers. One of the problems is that governments in developing countries often do not have money to invest in improving the medical health care system, or to provide the necessary care for their populations.

The private sector in developing countries has an as yet undefined role in providing health care to the masses. Frequently, the private sector is purely occupied with providing health care to households who can afford to pay, which leaves a large section of the population dependent on health care provided by the public sector. One of the options which has recently arisen has been to involve the private sector in the provision of health care to the underprivileged, using subsidies from the public sector. These are known as Public-Private Partnerships.

Voucher schemes are a form of Public-Private Partnership which specify exactly the sort of services which are included. Voucher schemes involve the distribution of vouchers to eligible individuals, subsidised partially or wholly by the Government, who can then redeem the vouchers at a specific private facility of their choice, conditional to the fact that the private facility has agreed to participate in the scheme. The private facility then provides the services that have been agreed upon to the voucher-holder, free of charge, but withhold the vouchers to hand back to the Government, in order to be reimbursed at a previously agreed-upon rate.

The city of Lucknow, in Uttar Pradesh, has recently introduced the Sambhav Voucher Scheme, using similar reasoning. The Scheme itself is well thought-out, but the reality is somewhat different than the initial hopes for the project were. While the Scheme has excellent potential, there are certain improvements which are required, particularly in implementation. This thesis seeks to understand the background to the Scheme, and to provide suggestions for its improvement.