Because financial resources are limited, those who manage family planning services must often face difficult choices about competing priorities. Decisions about the use of resources require careful comparison of costs for each service, and those costs may be influenced by a variety of factors. Articles discuss the use of client fees, the role of private-sector services, ways to reduce costs and the integration of family planning services with related health-care programs, such as prevention of sexually transmitted diseases.
In this Issue
Introduction: Evaluating Family Planning Costs
Because financial resources are limited, those who manage family planning services must often face difficult choices about competing priorities. Decisions about the use of resources require careful comparison of costs for each service, and those costs may be influenced by a variety of factors.
Do Client Fees Help or Hurt?
In recent years, family planning programs in developing countries have faced increasing demands for services at a time when funding from government and international donor agencies has been declining. One option is to increase fees paid by clients, or to begin charging clients for services that are free.
Fees for Other Services Help Pay for Family Planning
In Ecuador, the Centro Mdico de Orientacin y Planificacin Familiar (CEMOPLAF) has been seeking ways to generate income and recover costs, while increasing clients' access to family planning services and improving quality of care. One strategy is to use fees from an ultrasound diagnostic service to subsidize other services.
Costs Can Influence Family Planning Decisions
Men and women who need family planning services often consider whether they can afford them, given other household expenses. They also weigh potential benefits of family planning against costs to obtain these services, which may include purchasing methods and supplies, traveling time to a clinic, child care during clinic visits and lost work time.
Commercial Sector Can Improve Access
Encouraging commercial family planning services for people who are able to pay is one way to improve services for those who cannot pay. By attracting some clients to the commercial sector, public resources can be used more effectively to serve lower-income clients.
Cost Analysis Serves Many Purposes
An analysis of family planning program costs can be performed for different reasons. For example, cost analyses can be tailored to compare different services within a program or clinic. An analysis of adding Norplant to family planning programs in Thailand and whether to change the number of follow-up office visits for IUD users in Ecuador are among examples.
Ways to Evaluate Staff
Evaluating how staff use their time can be done different ways. One approach is to ask staff members to record how they spend their time. Another way, called "patient flow analysis," collects time data from clients, by having each staff member enter time of arrival and departure on a form carried by the client as the client moves through the clinic. Yet another approach, more expensive and time consuming, is known as a "time-motion" study, based on observing how personnel spend their time.
Integrating Services Involves Cost Issues
Responding to clients' needs and appeals from women's advocates, health providers are searching for ways to integrate care for sexually transmitted diseases with family planning programs. Integrating such services can make them more accessible while also reducing costs.
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