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, do family planning services suffer?
These decisions about use of resources require careful comparison of costs for each
service, and these costs may be influenced by a variety of factors. For example, a program
may offer a contraceptive method through different channels --in clinics, through
community-based distribution posts, and by using outreach workers who visit clients in
their homes. Moreover, many family planning programs offer a range of other reproductive
health services, including prenatal check-ups, gynecological examinations, screening for
sexually transmitted diseases, pediatric visits and general consultations. Consequently,
the cost of providing one family planning service is influenced by such factors.
Funding sources are also considerations. Recovering costs through client-paid fees is
one way that may help programs to improve financial sustainability. However, fees that are
too high will discourage use of services.
Above all, decisions about allocating resources must be made with the clients' best
interests in mind. Good programs must 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.
Increasing efficiency is becoming even more imperative due to the unfortunate pressures
of growing needs and uncertain financial support. The worldwide gap between family
planning needs and services is already immense. An estimated 350 million couples do not
have access to a full range of modern family planning information and services, and their
numbers are growing.1 Many of the countries where the need for
services is greatest are also those least able to bear the financial burden.
At the 1994 International Conference on Population and Development in Cairo, a program
of action endorsed by 180 nations called for universal access to family planning by the
year 2015. The United Nations Population Fund has estimated that today's current spending
of about $5 billion annually for family planning services in developing countries would
need nearly to triple to $14 billion by the year 2015 to reach this goal. Another $8
billion annually would be necessary by that year for related reproductive health-care
services, such as maternal care and sexually transmitted disease treatment.2
Donor nations and developing country governments cannot absorb this additional cost
alone. Other sources of revenue and ways to continue quality services at lower costs must
be found. Even maintaining the current level of financial contributions from
industrialized countries to the developing world is far from assured. Public support in
donor countries for foreign aid is often tenuous, and this aid must be used for many
purposes. In 1993, the 19 countries providing the bulk of population assistance devoted an
average of under 2 percent of their total development aid to population programs.3
Ways of reducing the gap between limited resources and growing needs are explored in
this issue of Network. These include other sources of revenue, reducing the numbers
served through public-sector programs by expanding services in the private sector, as well
as ways to provide quality services at lower cost:
Client fees are one source of revenue. People who obtain services at public and
nongovernmental organization family planning clinics may be willing and able to pay a
higher share of the costs of those services. However, experts say that this strategy
should be used with caution, since instituting fees or increasing them may discourage use.
Organizations can also generate additional funds by selling other health-related services
at prices that are high enough to subsidize family planning services.
Private sector services offer another approach. By supporting free or low-cost
family planning services, governments and donors have, in effect, limited the incentives
for commercial involvement in family planning and other reproductive health services.
Strategies to address this concern include revolving loan funds to assist commercial
providers, social marketing projects, and better training for private doctors and
midwives.
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 ways 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.
References
- Alex Marshall, ed. The State of World Population
1997. New York: United Nations Population Fund, 1997.
- Financing the Future: Meeting the Demand for Family
Planning. Poster. Washington: Population Action International, 1994.
- Population Issues Briefing Kit 1997. New York:
United Nations Population Fund, Information and External Relations Division, 1997.
For more information, visit Family Health International's Website at www.fhi.org
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