Voucher schemes in Nicaragua increase access to
sexual health services for the most vulnerable
Authors: P.
Sandiford; A. Gorter; M. Salvetto
Publisher: Public
Policy for the Private Sector [World Bank], 2002
This note, published by the World Bank, examines a
donor-supported scheme in Nicaragua, which involved giving
vouchers for sexual health services to commercial sex workers
and their partners and clients. The highest rates of voucher
redemption were among the poorest women and among groups with
the highest initial rates of sexually transmitted infections (STIs).
The programme reduced the prevalence of gonorrhea in the female
sex worker population by about 5 per cent per year, and the
prevalence of syphilis by 10 per cent per year. Women who
attended follow-up consultations also stayed free of STIs for
longer.
The cost of the scheme was low compared to consultations in
public facilities. However, the note argues that reducing costs
further by charging the beneficiaries is unrealistic and would
exclude the poorest, who also have the greatest health needs. As
it is, the costs to the beneficiaries in transport and lost
income are significant, and for some constitute a reason not to
use their voucher. The note concludes that the scheme provided
access to, and increased the use of, high-quality, tailored
sexual health services in a non-stigmatising manner for
commercial sex workers and their regular sexual contacts. It
also reduced the risk of STIs, including HIV, among the general
population.
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