States of fragility and insecurity often give rise to urgent health needs that need to be met quickly and effectively, particularly for women and adolescents. Vouchers are a demand-side financing mechanism which can be used to address some of the health challenges faced by women under these circumstances. A number of organisations have begun to use vouchers to enable access to reproductive, maternal and newborn care services in conflict-affected countries such as Yemen, Syria and Central African Republic. Vouchers allow health programme implementers to use targeted subsidies to reduce financial and other barriers to accessing care, increasing and catalysing the uptake of specific health services among vulnerable and underserved populations. These subsidies are passed onto public and private providers in the form of service reimbursements and are often used to enhance capacity to meet increased demand for services, as well as to invest in quality improvements.

Yemen is one of the poorest countries in the Middle East and North Africa region, and since 2010 has consistently appeared on the lists of fragile states. We present data from the Reproductive Health Voucher Programme in Yemen to show that during 2014, when the conflict was worsening and public facilities faced significant challenges to keep functioning, the vouchers enabled women to continue accessing quality maternal newborn health services. By contracting a range of public and private providers, from referral hospitals to community midwives, the number of services utilised in one governorate in Yemen was consistently higher (17% or more) than the predicted number for all services utilised that make up the safe motherhood voucher package. The programme was able to channel funds to facilities at a time when funds flowing to the governorates were highly erratic, enabling them to address stock-outs of drugs and supplies at the local level and to maximise the supply of critical maternal newborn health services for poor women and their families.