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Stud Fam Plann. 1991 Mar-Apr;22(2):83-101.

Cost-effectiveness analysis of family planning programs in rural Bangladesh: evidence from Matlab.

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  • 1Department of Population Planning and International Health, University of Michigan, Ann Arbor.


The Family Planning Health Services Project in Matlab is often seen as more expensive than similar activities carried out by the government of Bangladesh. At the same time, it as been observed that the project is much more effective. The alleged high cost of the project is said to make it difficult to replicate throughout the nation. Previously, the true costs of the project had not been documented. This study systemically examines the cost of the project and assesses its cost-effectiveness. An experimental design framework is used as a basis for understanding the cost-effectiveness of the project, although a sensitivity analysis lends further support to the relative efficiency of the approach undertaken in Matlab. Although in the aggregate, the Matlab Project is more expensive than the government's family planning program, it is also more effective, generating enough output to offset the extra costs of the intensified delivery system.


The cost-effectiveness, in terms of cost per averted birth, of the Family Planning Health Services Project (FPHSP) in Matlab, Bangladesh was analyzed on 3 levels in comparison to that of the comparison area, which received the Government's family planning services. The Matlab project began in 1977, and is now renowned for its effectiveness, and quality and longevity of data. The experimental area received an intense, cafeteria-type family planning method mix (pills, tubectomy, condoms, foal, IUDs and injectables), with vaccinations, ORS and medicines by household delivery, structured horizontally, with in-depth, repeated surveys. The control area receives limited family planning methods (pills, tubectomy, vasectomy, condoms), ORS only, by vertical design. The project has yielded about 45% contraceptive prevalence of effective methods, and 6914 births averted from 1978-1985. The costing scheme is categorized into service rings denoted service delivery, supervision and administration, data management, research and international assistance and overhead. Research is included as a cost because it generates effects by a "Hawthorne effect." Costs have ranged from $133,000-164,000 yearly. Three models of cost analysis are presented and discussed from the viewpoint of sensitivity analysis. The estimated cost per birth prevented ranges from $150-220, figures that do not account for reduced mortality or improved reproductive health. The Matlab project generates about 3 times as many services as the government program. It costs more overall, but less per birth averted than the control government program. This suggests that the government program may benefit by offering a wider choice of contraceptive methods.

[PubMed - indexed for MEDLINE]
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