Home Programme Components Tanzanian National Voucher Scheme

The Tanzanian National Voucher Scheme

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The Tanzanian National Voucher Scheme (TNVS), known to the public in Kiswahili as Hati Punguzo (HP), was developed in 2003 and rolled out in 2004. Funding has been provided by different donors over the years, including the Global Fund to Fight AIDS, TB and Malaria (GFATM), United States Agency for Aid and Development (USAID), and currently the UK Department for International Development (DFID).

TNVS is implemented through a Public-Private Partnership (PPP) of government, development partners, and mosquito net manufacturing companies as well as wholesalers and retailers. The retailers enable the nets to reach the grassroots level in both rural and urban areas.

The main activities of the TNVS are to:

  • Design and implement systems to ensure effective and efficient transfer of vouchers to pregnant women and infants via the Reproductive Child and Health (RCH) clinics.
  • Identify, train and monitor selected retail outlets eligible to receive vouchers.
  • Design and manage the voucher redemption system.
  • Design and implement risk management systems to minimise misuse and fraud.
  • Develop and deliver training and sensitization programme to all relevant RCH staff dealing with the vouchers.
  • Develop and deliver promotion campaigns to all stakeholders at the different levels (council, regional, national).

TNVS: 2004 - 2009

The TNVS for pregnant women was launched in 2004 with funding from GFATM and rolled out to all regions of mainland Tanzania. The NGO Mennonite Economic Development Associates (MEDA) was selected by the MoHSW through competitive bidding to be the Logistics Contractor of the programme. World Vision Tanzania and Care International were selected as Training and Communication Contractors; and Ifakara Health Research and Development Centre (IHRDC – now know as the Ifakara Health Institute) in a consortium with the London School of Hygiene and Tropical Medicine were contractor as Monitoring and Evaluation Contractors.

Pregnant women were eligible to obtain a Pregnant Women Voucher (PWV) at their first visit to an antenatal clinic with which they could purchase a choice of polyester nets bundled with an insecticide retreatment kit (IRK) in participating retail outlets at discounted rate. In November 2006 infants were added as a target vulnerable group with the Infant Voucher (IV). Initially the IV was provided to mothers only at the time they brought their infant to a health facility for measles vaccination (at around 9 months of age). Since late 2009, clinics issue infant vouchers as soon as the child attends the clinic for a vaccination, whether at 3, 6 or 9 months. Upon awarding the IV, the clinician makes a mark on the vaccination card indicating that the IV has been received. Each child is eligible to receive only one voucher.

The voucher provided a discount on a commercial price of a net. As retail prices vary through the country, the amount of top-up that a voucher beneficiary had to pay also varied. As retail prices are generally higher in remote rural areas where a larger proportion of poor people live, poor women were paying much higher top-up amounts for a net than their counterparts in urban areas. Originally, both vouchers had a value of Tshs 2,750 which was later raised to TShs 3,250.

Two other voucher types – the Project Voucher and the Equity Voucher – were part of the TNVS program for a short time but were discarded because they were not operationally feasible.

TNVS: 2009 - 2012

In October 2009, the programme introduced an ‘upgraded’ voucher which could be exchanged for a Long Lasting Insecticide Treated Net (rather than a convention polyester net bundled with an IRK). The top-up amount was reduced and fixed at Tsh 500 (currently USD~0.30). This change from a fixed discount voucher to a fixed top-up voucher was initiated to counter the documented inequity in voucher redemption rates between social economic quintiles.

The new voucher type had an important effect on how the TNVS was run and also the number of net manufacturers that could participate. In the old model, four net manufacturers (all based in Tanzania) were part of the programme and it allowed competitive commercial sales to occur while simultaneously providing a subsidy on that sale to a targeted beneficiary. These manufacturers supplied an initial stock of nets to wholesalers on credit. The flow of nets from manufacturer to wholesaler to retailers was based on a ‘pull-system’ of vouchers being exchanged for new nets. The manufacturer was reimbursed the amount of the voucher by the Logistics Contractor (LC) once it made its way back up the system. This system functioned through supply and demand, which entailed less involvement of the LC. In addition to voucher sales, the TNVS stimulated a strong market for ITNs with over 2 million commercial sales  per year. This model however also meant that areas with less demand, e.g. remote under-populated rural areas, were more likely to have stock-out of nets.

When the upgrade voucher was introduced, there was only one LLIN manufacturer in Tanzania (A-Z Textiles in Arusha) which in effect changed the programme from a multi-supplier to a single-supplier model with only one net type. The LLINs were much more expensive than traditional polyester nets (approximately four times the price) and were not commercially available at the time. As the discount voucher was now fixed and the LLINs were not for sale commercially, the LLIN manufacturer had to play a much more active role in supplying retail outlets directly. In addition, policies were implemented that restricted “voucher LLINs” to only be acquired with a voucher.

The introduction of the upgraded voucher, voucher redemption rates which had been dropping to with the previous vouchers due to increasing top-up rated, picked up dramatically even though the timing coincided with the roll out of the Under Five Campaign. Recent analysis of TNVS data in fact suggests that mass campaigns do not negatively influence the uptake of vouchers, contrary to was initially expected.

TNVS: 2012 - date

Although greatly improving voucher uptake and equity, the new upgraded voucher model was not conducive to the re-development of a vibrant commercial market for nets. Recognizing this as a serious constraint, the Logistics Contractor was tasked by the MoHSW and development partners to develop a “Choice and Competition Strategy”.

The goal of this strategy was to re-establish a robust supply chain for LLINs consisting of competitive, commercial enterprises that supply a choice of LLIN’s to voucher recipients and consumers at affordable prices.  This will enable those who are able and willing to buy a full-price LLIN to do so, while at the same time allowing targeted beneficiaries to acquire one with a voucher and small top-up. The contribution made by consumers will reduce donor dependency and ensure better, more efficient utilization of the LLINs distributed.

To achieve this goal, a ‘hybrid’ model was introduced late 2012 which incorporates the principles of the ‘fixed top-up’ voucher with the benefits of the old system of ‘fixed value’ voucher. The underlying principles of the strategy are:

  1. Voucher recipients should be given more choice in terms of type, size, and shape of LLIN that they can buy with the voucher;
  2. Equity should be maintained and women should be able to access a ‘base-net’ (similar size as the previous  TNVS net) at the same fixed top-up price (i.e. Tsh 500);
  3. All LLINs that are included in the TNVS should also be commercially available at retail price to non-voucher customer in order to open up the market and make LLINs more widely available in all areas of Tanzania;
  4. Fair competition among manufacturers should be encouraged in order to improve quality and reduce costs.

The value of the new voucher was determined through a competitive process. Two LLIN suppliers participated in this process (A-Z and BestNet). Both were required to specify: (1) a fixed retail price (including any and all manufacturing, packaging and transportation costs, and all required retail or wholesale mark-up) for a ‘base net’; and (2) the distribution premium required to distribute the LLINs to the pre-determined hard-to-reach areas. The new value was set at Tsh 9,250 and the set retail price of the standard sized net at Tsh 9,750. The top-up price for the voucher recipient stays the same if she chooses to buy a standard sized net. Larger size nets have a slighter higher retail price.

An evaluation of the effect on this strategy on commercial sales will be undertaken late 2014.

The Voucher Cycle

There are two types of vouchers: a paper voucher and an electronic voucher. Currently 60% of vouchers are e-vouchers.

The Paper Voucher

Paper vouchers are ordered from a private security firm in South Africa and are sent to MEDA Tanzania in Dar es Salaam.  They are packaged in books of 25 and have security features similar to that of a bank cheque.  MEDA scans each book and designates it for a specific RCH clinic based on voucher requests received from the field.  New voucher are shipped to the District Medical Officer’s (DMO) office where they are stored until requested by individual clinics.  Due to poor infrastructure and to avoid stock outs, MEDA must maintain a six-month inventory in the field at all times.

RCH staff issue HP vouchers to pregnant mothers during their first antenatal visit, and also to infant caretakers at the time of an infant’s measles vaccination.  The RCH attendant records the recipient’s personal information on both the voucher and the voucher stub.  The voucher stub remains with the RCH attendant and is sent back to MEDA where it is scanned into the system.  The mother leaves with the voucher, travels to the nearest HP retailer and redeems it for an ITN of her choice. The retailer records the voucher information and exchanges it with a participating wholesaler for another ITN.  This process continues until it reaches the manufacturer, who brings the vouchers to MEDA to receive final payment.  MEDA scans the voucher back into the system, hence completing the voucher cycle.

Voucher Cycle

The Electronic Voucher

In 2011 MEDA piloted an electronic voucher, which allows for tracking at each step of the redemption process using SMS messaging and verification codes. The e-Voucher aims to use mobile phones and messaging to replace the role of the paper voucher in the existing TNVS voucher supply chain. The e-voucher workflow is indicated below:

  1. Beneficiary visits a Clinic
  2. Clinic staff issues a voucher to a beneficiary
    - Voucher requested and delivered to the clinic staff via an SMS
  3. Program beneficiary visits a TNVS retailer along with their voucher ID
  4. Retailer redeems the voucher
    - Voucher validity confirmed and transaction recorded via SMS sent by Retailer
  5. LLIN supplier provides new replacement LLINs to the retailer in exchange for proof of voucher transaction (net barcode, e-Voucher confirmation number)

All TNVS data – inputted by the net supplier, MEDA staff, and retailers – is centralized in a web-based Management Information System. Stakeholders each have unique access levels and reports based on their role in the program. The bed net supplier can plan delivery routes based on the SMS orders they receive.  MEDA Regional Managers can monitor retailer inventory levels and delivery activity in their districts. The platform is built using open-source code (RapidSMS framework).

Voucher Utilization and Redemption Rates

MEDA tracks the status of every voucher (paper and e-voucher) sent to the field.  
When a paper voucher stub returns its status is updated in the system, and when the actual voucher returns it is scanned and the voucher cycle is complete.  In order to measure the program’s success MEDA uses two calculations: utilization rate and redemption rate.  The definition for each term is as follows:

  • Utilization rate = total number of vouchers returned ÷ total number of voucher issued
  • Redemption rate = total number of vouchers returned (with corresponding stub returned)  ÷ corresponding stubs

All e-voucher data – inputted by the net supplier, MEDA staff, and retailers – is centralized in a web-based Management Information System. Stakeholders each have unique access levels and reports based on their role in the program. The LLIN net supplier can plan delivery routes based on the SMS orders they receive.  MEDA Regional Managers can monitor retailer inventory levels and delivery activity in their districts. The platform is built using open-source code (RapidSMS framework).