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Use of Cash and Voucher Assistance for Health Services

September 2021 — By Health Cluster Iraq, Cash Working Group, Protection Cluster Iraq

The use of Cash and Voucher Assistance (CVA) as a modality for providing humanitarian assistance has expanded rapidly in recent years. Arguments for the use of CVA to address several needs and facilitate people’s access to them include greater flexibility, cost-efficiency and dignity. There is extensive experience in the use of CVA for specific needs such as food, shelter or non-food items and evidence shows it can also be a relevant modality to improving access to and utilization of quality health services in humanitarian and recovery settings.

The availability and quality of health services is crucial to obtaining positive health outcomes. However, evidence shows that socio-economic barriers from the demand side (e.g. medical fees) are one of the key barriers for people to use a health service.

The use of CVA in the health sector has the potential to reduce direct and indirect financial barriers and support the utilization on the demand side. However, no single modality (CVA, services or in-kind) is sufficient to meet health objectives and achieve public health outcomes. Therefore, CVA can be used as a complementary intervention when providing health assistance and should not replace the supply side interventions of providing health services.

In Iraq, health services are provided either by the government, private centers or humanitarian organizations. However, socio-economic vulnerable populations, primarily the displaced people and refugees, face financial barriers to accessing specific health services, while humanitarian organizations have a limited scope of support.

Based on this data, health is a priority need for a large number of beneficiaries. However, the MPCA assistance is also used for other basic needs, although health is still one of the relevant expenses. It is important to highlight that the Survival Minimum Expenditure Basket (SMEB) in Iraq does not include a health component. Therefore, it is envisaged that CVA, as a modality of assistance, may be drawn upon to address this need and mitigate barriers by supporting direct and indirect costs for accessing health services.

The Cash Working Group (CWG), the Health Cluster and the Protection Cluster in Iraq are in close coordination to design the strategy for the use of CVA in the health sector. This document outlines the guidance to effectively incorporate the use of CVA by the health partners in Iraq.