Among the healthcare financing techniques that exist, output-based financing or vouchers is a
strategy that is growing in popularity. There is a need of an in-depth analysis of the impacts of
vouchers on health indicators, particularly for Pakistan. Assessment of the existing evidence on
how much the vouchers impact on health and healthcare utilization can be of greater value to the
policy makers for informed decision making. This systematic review included 16 cross-sectional
and quasi-experimental design studies. Service utilization, knowledge, service quality, costeffectiveness
of the programme and outreach of the population served were observed as outcomes.
We found positive results in with regard to most of these outcomes. Physical accessibility, social
mobility of women, security threats, and sustainability of the project after donor exit appear as
serious challenges. Yet, lessons can be drawn for the scaling up of the reproductive health services
in the country, through the use of vouchers.