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Cash and Voucher Assistance for Health: Partner experiences in Ukraine

December 2024 — By Health Cluster Ukraine, World Health Organization

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Humanitarian cash has a long history in Ukraine and has evolved along the contours of the crisis. In December 2014, the Humanitarian Cluster Coordination System was activated following the outbreak of armed conflict in the Donetska and Luhanska oblasts earlier that year. At the time, humanitarian cash programming was a relatively new approach for many agencies in Ukraine, with limited knowledge of principles and best practices. However, by 2015, the situation improved significantly, as most agencies involved in cash assistance began deploying cash specialists to various locations across the country, enhancing program delivery and effectiveness. In the 2016 Humanitarian Response Plan (HRP), vouchers for food, non-food items, pharmaceutical products, shelter and multipurpose vouchers, accounted for 16% of the cash response.

After the 2022 escalation of the war, Ukraine’s cash response improved through the leadership of the UN OCHA led Cash Working Group (CWG). Multipurpose cash assistance (MPCA) was scaled up with standardized values, better targeting, and digital payment platforms for efficiency. Localization and capacity building empowered local organizations, ensuring a more unified and effective response to conflict-affected populations. While cash for health is an emerging cash modality in the Ukraine response, MPCA remains dominant, underscoring adherence to Grand Bargain commitments to use cash where feasible. MPCA transfers correspond to the amount of money a household needs and are either one-off or regular, designed to help households meet a range of essential needs, fully or partially.

Assessments highlight beneficiary preferences for cash. However, MPCA has limitations for addressing barriers to health care as the frequency and value of MPCA transfers do not fully support the complexity of health needs such as prescriptions that are purchased monthly and the unpredictable nature of health costs. The percentage of the minimum expenditure basket (MEB) allocated for health is about 600 UA (about USD 14) and is only given once per quarter.

This is compounded by health market dysfunctions such as unequal provider-patient knowledge, low demand for preventive services, and the high cost of quality treatments. In situations where beneficiaries are spending MPCA on health costs, Post Distribution Monitoring (PDM) results indicate spending above and beyond what has been allocated, taking away expenditures from other areas of the household budget meant to be covered by MPCA.