Vouchers for Childbirth | A Field Study

CRRC fellow Simon Gabrichidze and his research partner Tamar Trapaidze evaluated the implementation of a newly launched State Assistance Program (SAP) by the Ministry of Labor, Health and Social Affairs aimed at providing better health services for people living under the poverty line in the Samegrelo and Adjara regions.

The fellow conducted focus groups with stakeholders and structured interviews with 320 mothers living in the abovementioned regions who gave birth in Zugdidi and Batumi between June and September of 2007. Gabrichidze compared three female target groups, those who:

1. Were in the database of people living under poverty line;
2. Were not in the database but applied for a "voucher" that covers delivery expenses;
3. Did not apply for any assistance from the state and paid all the expenses related to child delivery themselves.

According to the findings, the general population is aware of the health benefits envisages by SAP, however, the level of awareness is rather low: only 57% of patients in Batumi and 60% in Zugdidi knew that a voucher for free medical service fully covers all the expenses related to child delivery; the rest of the respondents thought that the voucher only partially covers costs.

The main reasons for mothers not using the State Assistance were the regulations of the program. The study showed that trust in health care professionals was the lowest in this last group, those that paid all for themselves. So that people (curiously even those in need of the social assistance program) preferred to pay money for child birth, rather than visit doctors and health care service provides unknown to them. The respondents from the first group were most satisfied with medical service, while the ones from the second and third groups were more dissatisfied with out of pocket payment and financial affordability of the program.

According to doctors and social agents, very often comparatively rich pregnant women request voucher from the State; as the fellow recommends, the government should introduce more strict criteria for identifying beneficiaries of this group (or completely abolish it) and direct funds to the people that really need such assistance.

Here is the PowerPoint (although, note, this was for a verbal presentation, not specifically for the web). 

Vouchers for Obstretic Care in Georgia

View SlideShare presentation or Upload your own. (tags: georgia vouchers)

The full report is also available on the CRRC-Georgia website.

Results from the Georgia IDP Housing Voucher Program

The Urban Institute, with the help of IPM, just finished a summative survey of their "Georgia IDP Voucher Program," funded by the US State Bureau of Population, Refugees and Migration. (N.B. a voucher is a promised subsidy towards the cost of purchasing a home). The Program aimed to resettle IDPs from Abkhazia and provide them with long-term housing solutions. The project was a piloted and carried out in the Kutaisi area. There seems to be some buy-in from the government to continue the program itself.

An interesting result related to family networks emerged from the presentation. The average income of those households who successfully converted their housing vouchers into the purchase of a residence is only 151 Lari a month and over 80% of successful households are unemployed. However, more than 45% of the successful group put in an average of $1,980 on top of the money (averaging $3,750) provided through the grant program to either purchase a more expensive residence or carry out capital improvements. Those who were unsuccessful had substantially lower incomes (much lower than the national IDP average).

SO, where's the money coming from? I asked the Chief of Party whether he thought IDPs who had successfully bought houses were lying about their income data (it's notoriously unreliable in this part of the world and rarely matches expenditure data). He said he had no information to prove or disprove this. However, the survey showed that most respondents claimed that they were receiving money either from relatives either abroad or inside Georgia.

Such a finding makes sense. IDPs will have strong networks outside and inside Georgia, since the population from Abkhazia was dispersed. This means that poor IDPs may often have a rich relative or close friend to ask for help. Additionally, property is often seen as a good investment in Georgia (since most Georgian view most other investments as too unstable) and networks may especially be willing to help with property.

On a small methodological note, one of the problems raised about the survey was that since the program had been run for two years, IDPs had been in their new housing for different amounts of time, yielding different results.

Please contact us for the PowerPoint presentation if you are interested.