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Fees for Other Services Help Pay for Family Planning |
See Also:Issues in the Financing of Family Planning Services in Sub-Saharan Africa Brief 1: The Need for Additional Funds for Family Planning in Sub-Saharan Africa Brief 2: Charging Fees for Family Planning Services Brief 3: Expanding Commercial Sector Participation in Family Planning Brief 4: Reducing Costs and Enhancing Efficiency 
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In Ecuador, the Centro Médico de Orientación y Planificación Familiar (CEMOPLAF) has been searching for ways to generate income and recover costs, while increasing clients' access to family planning services and improving quality of care. One of CEMOPLAF's strategies is charging client fees to recover some of the costs of providing family planning services. Another is subsidizing family planning through income gained from selling ultrasound diagnostic services. CEMOPLAF's main mission is to provide family planning services," says Teresa de Vargas, administrative director. "However, CEMOPLAF also offers other health services to increase self-sufficiency and better service to clients. A focus on sustainability does not imply abandoning our social mission." In 1992, CEMOPLAF began an ultrasound service at a clinic in Quito. The service was established after staff conducted an extensive assessment of potential costs to the clinic for providing this specialized service, possible demand from clients, and expected income during the first five years. Ultrasound was chosen over other services because of the clinic's high number of gynecology and prenatal clients.
Twelve sites were easily eliminated because estimated client use would be too low and the sites lacked necessary staff. In the remaining clinics, detailed estimates examined demand for services, costs, and projected income. In the end, CEMOPLAF purchased three additional ultrasound machines, and services have proven to be profitable. Prior to the evaluation, staff suggested buying 10 machines, which cost U.S. $25,000 each. The analysis helped CEMOPLAF make better decisions, based on estimated demand and income, rather than speculation. In another effort to improve sustainability, CEMOPLAF recently examined its fee structure. Although one of CEMOPLAF's main goals is to serve the poor, a questionnaire given to clients revealed that many were middle- to upper-income. Forty percent of clients owned homes, while 35 percent had completed secondary school or attended a university, and 33 percent sent their children to private schools. In reviewing its charges, CEMOPLAF learned that prices for family planning services varied as much as 65 percent among its 21 clinics. Also, the organization learned that one of the clinics with the highest fees served the largest group of low-income clients. CEMOPLAF concluded that prices were too low in most clinics, deciding to raise prices periodically (twice a year). Also, the difference in charges among clinics is being reduced. CEMOPLAF is developing plans for greater financial independence because support from donors is expected to decline. FHI, the Population Council's Investigación Operativa y Asistencia Técnica en Planificación Familiar y Salud Materno-infantil en América Latina y el Caribe (INOPAL) III Project, and The Futures Group International have worked with CEMOPLAF to conduct studies on financial sustainability. "Some family planning managers may think that just offering a service ensures that it will be profitable, but this point of view is not very realistic," says John Bratt, a senior research associate at FHI, who helped conduct the studies. "There has to be a market for any service, and clients must be willing and able to pay for it." The financial gains from ultrasound services and standardized pricing are relatively small, but contribute to a cumulative, long-term commitment toward financial sustainability. In 1997, CEMOPLAF will generate 75 percent of its operating budget from client fees, a significant increase from previous years. "Progress toward sustainability is often measured in small steps," says Bratt. -- Barbara Barnett French | Spanish |
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The service was so successful at the Quito clinic that managers decided to expand ultrasound to some of CEMOPLAF's 20 other clinics and 12 satellite clinics. However, ultrasound equipment is expensive, as are the costs of training, personnel, materials and supplies. To ensure that services were needed and would be profitable, CEMOPLAF conducted an analysis.