FHI - February 20, 1998

Evaluating Family Planning Costs -- February 20, 1998

RESEARCH TRIANGLE PARK, NC--Because financial resources are limited, those who manage family planning services must often face difficult choices about competing priorities.

If a new contraceptive option is added, how will its introduction affect resources available for other methods? If counseling services are expanded, will staff have enough time for other duties? If other reproductive health services are offered through a family planning clinic, do family planning services suffer?

For any family planning clinic, whether in New York or Nairobi, funding sources are also considerations. Recovering costs through client-paid fees is one way that may help programs maintain financial sustainability. However, fees that are too high and are not covered by a client's medical insurance will discourage use of services.

Above all, decisions about allocating resources must be made with the clients' best interests in mind, experts say in the current issue of Network, the quarterly publication of Family Health International (FHI), a nonprofit research and technical assistance organization that promotes better reproductive health worldwide.

Good family planning programs must always provide quality services for their clients. Clients should be able to select a contraceptive method from a range of choices, and they should receive thorough and accurate counseling. Clients should be able to obtain services that are safe, effective and affordable, and they should have contraceptive choices that are convenient for them both to obtain and to use.

One important way to evaluate family planning costs is to analyze all existing resources and services, especially the use of staff time. "You need to find out how staff members spend their time," says Dr. Barbara Janowitz, who directs economics research at FHI. "The only way to do that is to go to the clinic or delivery site. This is the critical element in a cost approach that sees the program as a system -- using specific resources to produce desired services." Dr. Janowitz and her colleagues developed a guidebook to assist program managers in using such a system analysis framework.

Several ways to help reduce the gap between resources and the need for services are examined in Network. These include the following:

Client fees are one source of revenue. Some people who obtain free or low-cost family planning from public health clinics may be willing and able to pay for a greater portion of those services. However, experts say that this strategy should be used with caution, since instituting fees or increasing them may discourage use.

Private sector services offer another approach. In effect, free or low-cost family planning services subsidized by government or nonprofit organizations may limit incentives for commercial involvement in family planning and other reproductive health services. Strategies may include targeting low-cost or free public services more towards those who really need them.

Reducing costs can be achieved in a number of ways. Reducing excess capacity in delivery systems, minimizing or reducing unnecessary procedures, and introducing or emphasizing certain lower-cost contraceptive methods are among cost-reduction measures that have been used successfully.

Integration of services, such as providing care for sexually transmitted diseases at family planning clinics, involves many important questions, especially how much integrated services may cost. Cost analysis can guide policy-makers in deciding whether to integrate services.

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Evaluating Family Planning Costs -- February 20, 1998