1. Cash and Markets Forum – Insecure Environments George Fenton – Director - Humanitarian Operations Services Team (HOST) Jonathan Spence – Global Logistics Advisor

2. Case Study: Cash & Vouchers in Bekka Valley, Lebanon Lebanon - $ 20m + programmes funded by WFP and UNHCR Chronic situation with protracted conflict Tension between displaced Syrians and host communities Combination of vouchers and cash distribution to Syrian refugees

3. Keys to successful implementation Functioning markets Mature banking system Beneficiary and vendor openness Lack of Standard Operating Procedures No on-the job training/on-going support Verification and monitoring issues Unconditional cash programming posed significant context related risks Lebanon Key Reflections

4. Syria No MoH system functioning IDPs in desperate need of medical assistance but even at present, no/little income to access necessary services 300 private doctors with unstable incomes, aim to employ them to work in clinics for IDPs Initial plan had been to hire doctors, set up clinics, supply and deliver medicines and equipment Case Study : Medical Voucher programme in Northern Syria

5. Why did we change from In Kind to Vouchers? Problems encountered Not registered as medical organisation – procurement in Turkey not possible Insecurity and lack of access across border (Staff and resources) Operational and Supply Chain risks and costs would be reduced Doctors would have to leave private clinics to work for WV – Not sustainable in long term

6. Current nature of Voucher programme Pilot areas to test modality Beneficiary selection focus on children under 5, IDPs and vulnerable host community members Assessments – IDP populations, clinic capacities and pharmacy capacities Vendor Selection – Private registered GPs linked with geographic location and audit of clinics and pharmacies Geographically appropriate choices for beneficiaries Electronic vouchers to provide access to free consultation and treatment Solutions found?

7. Current nature of Voucher programme Unique vouchers manufactured in Turkey to reduce fraud risk Selection criteria to be expanded to include other vulnerable groups if required (e.g. pregnant women, elderly) Focus on mass support of verified clinics so all can get treated irrespective of income, but also giving freedom of choice High calibre and experienced local staff (health workers and working in IDP camps) Mature supply chain (private doctors and medicines) Solutions found?

8. Risks / Challenges / Lessons Learned Need for nuanced approach in insecure environments No banking system Insufficient internal controls regarding remote management No written SOPs or tested control mechanisms Assessment and monitoring tools bespoke and designed from scratch Insufficient supply chain analysis Expert staff from market analysis is necessity How we will we improve?

9. Any Questions, Comments, Reflections welcomed