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A ‘Stocktake’ of CVA for Health Outcomes in the MENA Region Moving from Evidence to Practice (May 2021)


Executive Summary

Health is inherently complex, and health needs are unpredictable and can lead to high levels of expenditure. Without support, information asymmetries make it difficult for vulnerable people in humanitarian contexts to access the quality healthcare they need. It is increasingly clear from the results of post-distribution monitoring and other surveys that people in receipt of multipurpose cash (MPC) repeatedly spend a proportion of the cash on accessing healthcare, in proportions which vary greatly between contexts, but which may be as high as 60 percent of the transfer.

With effective targeting, Cash and Voucher Assistance (CVA) for health interventions can reach persons of concern (POC) in humanitarian contexts and protect them from catastrophic healthcare costs, reduce financial barriers and enable access to healthcare of sufficient quality.

It is clear that interest in CVA for health is growing, both in the Middle East and North Africa (MENA) region and beyond. This report, commissioned by the Cash Learning Partnership (CaLP) with funding from the German Federal Foreign Office (GFFO), sets out the findings from a ‘stocktake’ (rapid operational research study) of CVA for health outcomes in the MENA region,2 and is part of a broader process of documenting and disseminating learning on CVA programming for health.

What is CVA for health?

The study identified 20 CVA for health interventions, including 13 from the MENA region and 7 in fragile and conflict-affected settings in non-MENA countries judged to be highly relevant to the analysis.3 Six projects which are still at the design or concept stage were also included, giving a total sample size of 26 interventions.

Three questions were used to identify the CVA modalities that can be considered ‘CVA for health’:

  • Does the CVA approach address barriers which are constraining the use of health services for specific groups of persons of concern?

  • Are the benefits ‘tied’ to the beneficiary and provided on a ‘per beneficiary’ basis; i.e., can they be seen to act predominantly on the demand-side (no beneficiaries = no funds)?

  • Is the identification of the beneficiary or target group linked to their actual health needs?

A potential definition for CVA for health, for discussion by CVA stakeholders, would be ‘CVA that is linked to a particular beneficiary or beneficiaries in need of specific healthcare, and which addresses the barriers which they encounter when accessing that care, while