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J Biosoc Sci. 1997 Apr;29(2):219-33.

Costs of family planning programmes in fourteen developing countries by method of service delivery.

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DKT International, Washington, DC 20036, USA.


The cost effectiveness of several modes of family planning service delivery based on the cost per couple-year of protection (CYP), including commodity costs, is assessed for 1991-92 using programme and project data from fourteen developing countries (five in Africa, four in Asia, three in Latin America and two in the Middle East). More than 100 million CYP were provided through these family planning services during the 12 months studied. Sterilisation services provided both the highest volume (over 60% of total) and the lowest cost per CYP ($1.85). Social marketing programmes (CSM), delivering almost 9 million CYPs, had the next lowest cost per CYP on average ($2.14). Clinic-based services excluding sterilisation had an average cost of $6.10. The highest costs were for community-based distribution projects (0.7 million CYPs), which averaged $9.93, and clinic-based services with a community-based distribution component (almost 6 million CYPs), at a cost of $14.00 per CYP. Based on a weighted average, costs were lowest in the Middle East ($3.37 per CYP for all modes of delivery combined) and highest in Africa ($11.20).


This study of cost effectiveness of family planning programs is important in light of declining donor support. The study examines cost per couple years of protection (CYP) for family planning programs in 14 developing countries. Cost effectiveness is evaluated by mode of service delivery. Modes of service delivery include sterilization, clinic-based services (CBS) excluding sterilization, community-based distribution (CBD) excluding sterilization, and contraceptive social marketing (CSM). Costs are determined by a variety of methods: actual expenditures, budget allocations, or estimation. Costs include donor and government support related to service delivery. Omitted costs include, for example, nonspecific health care training, research and evaluation, data collection, and general IEC (information, education, and communication). In combined family planning and maternal/child health services, estimates are used to distinguish between the separate functions. CSM costs do not include revenues from inside the CSM sale system. Findings indicate that service volume includes about 60% or more of total services provided by organized family planning programs in 1991, excluding China. 55% of services provided in study countries were devoted to sterilization, 31% were devoted to CBS, and 9% were devoted to CSM. In 1991, almost 57 million CYP were provided by sterilization. The least expensive mode of service delivery was sterilization, based on data from India and Colombia. The next most cost-effective delivery mode was contraceptive social marketing, except in African countries where programs are new and small in scale. The most expensive service was CBS, which includes CBD. Costs were lowest in the Middle East and highest in Africa. Except for Africa, CSM within countries showed the lowest costs. The authors recommend that programs meet country and AIDS prevention needs.

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