Options has designed a pilot transport voucher scheme in Orissa to facilitate timely access for poor pregnant women to health facilities for delivery and treatment of illness during the post-natal period. Current transport systems in the state, such as the Orissa Ambulance System, tend to work only on roads where a motorised vehicle can easily pass, and often restricted to the main roads. The chief objective of the voucher scheme is to enable women and their newborns living away from these roads to quickly reach an approved facility, regardless of where they live.

Under the new scheme, women will be able to use a Janani Express ambulance, or private vehicle to arrive at the facility. However, sometimes, there is no ‘motorable’ road near a woman’s home, and the project will work with women’s self help groups to explore ways to include non-motorised local transport such as bullock carts or stretchers to take a woman to the nearest road where she can then be picked up by a vehicle, particularly in the case of obstetric emergencies.

The scheme will provide the following benefits:

• Poor pregnant or post-natal women will not have to pay cash for transportation to an approved health facility, but can use the voucher instead.
• Community-based transport providers, ranging from Janani Express operators and private vehicle owners to stretcher-carriers and other local forms of transport, will be contracted to provide transport and be guaranteed timely payments.
• Community groups (self help groups) will act as agents for arranging transport, and participate in the management of the transport system, thus making the scheme more relevant for beneficiaries and rooted in the community.
• Facilities will be accredited in both public and private sectors, thus widening access and increasing choice for women.
• Facilities will be approved to enter the scheme thereby ensuring women are accessing quality care.
• The vouchers will be publicised widely through Ashas, auxiliary nurses and midwives, health facility staff and community groups (self help groups) thus raising awareness of the benefits of institutional delivery.
• Vouchers will provide the basis for a ‘tracking system’ to follow the pregnancies of beneficiaries, both before and after delivery. Thus the voucher will considerably strengthen the monitoring and evaluation system and can be used to monitor where the woman began her journey, how she reached the facility, which facility was used, and the pregnancy outcome.

Incentives will be built into the scheme to encourage transporters both to widen their field of operation, and to take women from more remote and inaccessible locations. Reimbursable amounts to transport owners will be flexible and reflect the real cost of taking women to and from facilities.