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PubMedDate not supplied

The costs and benefits of government expenditures for family planning programs.

In 1979, federal and state governments spent a total of $285 million to finance family planning clinic services in the United States. As a result, about 695,000 pregnancies (239,000 births, 370,000 abortions and 86,000 miscarriages) were averted among low- and marginal-income patients; and at least $570 million was saved in government expenditures during the following year for childbirth, postnatal and pediatric care, abortions and welfare payments that would have been required in the absence of the clinic services. In other words, for every dollar spent by the government on family planning clinic services in 1979, about two dollars were saved in public-sector expenditures for health and welfare services to women and their babies during the next year. The first-year benefits were especially high for teenagers--about three dollars saved for every government dollar expended. Although teenagers accounted for only one-third of the clinic patients served in 1979, nearly half of the government savings can be attributed to family planning clinic services to women in their teens. Costs were greater than savings for patients aged 30 and older, but these older patients represent only 12 percent of the clinic patient population.

Abortion, Induced↗
PubMedDate not supplied

The simulated client method: evaluating client-provider interactions in family planning clinics.

The "simulated client" method was first detailed in the family planning literature in 1985, but it has not been extensively covered since. As used by the authors to study client-provider interactions in family planning programs, this method essentially consists of sending women to a family planning service provider to request information, and interviewing them after the encounter. The women do not reveal to service providers they are participating in the study. This report describes the method; reviews some of the theoretical, ethical, and methodological issues related to it; and underlines its usefulness as a tool for examining quality-of-care issues in family planning programs.

Developing Countries↗
PubMedDate not supplied

The impact of service delivery frequency on family planning program output and efficiency.

Operations research is the study of factors that can be controlled by program administrators. Among such factors is the frequency of performing program activities. The present experiment, conducted in Lima, Peru during 1985-86, tested the impact of holding family planning post sessions once per month, twice per month, and weekly. Frequency was shown to have a major impact on program outputs, costs, and cost-effectiveness. Depending on the indicator, sessions held twice per month produced between 1.5 and 2.1 times the output of those conducted once per month. Weekly sessions produced between 1.3 and 1.6 times the output of those held twice per month. At an output level of nearly 11,200 visits per year, twice-per-month sessions were estimated to be 7-38 percent more cost-effective, depending on the indicator, than once-per-month sessions, and 6-28 percent more cost-effective than weekly sessions.

Community Health Services↗
PubMed1989

Family planning programmes in ten developing countries: cost effectiveness by mode of service delivery.

The cost effectiveness of various modes of family planning service delivery based on the cost per couple-year of protection (CYP) is assessed using 1984 data for 63 projects in ten countries (three each in Africa and Asia, and four in Latin America). More than 4.8 million CYPs were provided through these projects during the year studied. Programmes with the highest volume of services delivered corresponded to lowest average costs: social marketing (2.8 million CYPs) and sterilization projects (960,000 CYPs) cost about $2 per CYP, on average; highest costs were for full service clinics and community-based distribution projects ($13-14 per CYP). Costs of clinics combined with community-based distribution services fell approximately midway between these two extremes.

Africa↗
PubMedDate not supplied

A cost-benefit analysis of the Mexican Social Security Administration's family planning program.

A cost-benefit analysis of the family planning program of the Mexican Social Security System (IMSS) was undertaken to test the hypothesis that IMSS's family planning services yield a net savings to IMSS by reducing the load on its maternal and infant care service. The cost data are believed to be of exceptionally high quality because they were empirically ascertained by a retrospective and prospective survey of unit time and personnel costs per specified detailed type of service in 37 IMSS hospitals and 16 clinics in 13 of Mexico's 32 states. Based on the average cost per case, the analysis disclosed that for every peso (constant 1983 currency) that IMSS spent on family planning services to its urban population during 1972-1984 inclusive, the agency saved nine pesos. The article concludes by raising the speculative question as to the proportion of the births averted by the IMSS family planning program that would have been averted in the absence of IMSS's family planning services.

Child Health Services↗
PubMed1980

Impact of the national family planning program on fertility in rural Korea: a multivariate areal analysis.

The impact of the previous three years' input of the national family planning program on 1975 fertility levels in rural Korea was assessed using multivariate areal analysis techniques. Program input had a measurable negative effect on fertility, but the magnitude of the effect was lower than that of nonprogram factors. Holding availability of nonprogram methods of fertility limitation constant strengthened the impact of program input. It was suggested that the effect of the national program was statistically obscured by the selective concentration of program input in high-fertility, physician-poor areas.

Adult↗
PubMed1993

Evaluation of natural family planning programmes in Liberia and Zambia.

Studies to evaluate use-effectiveness and cost-effectiveness of natural family planning (NFP) were conducted in Liberia and Zambia. The Liberian programme provided uni-purpose NFP services to 1055 clients mainly in rural areas; the Zambian programme provided NFP services integrated with MCH to 2709 clients predominantly in urban areas. The one-year life table continuation and unplanned pregnancy rates were 78.9 and 4.3 per 100 woman-years in Liberia, compared to 71.2 and 8.9 in Zambia. However, high rates of loss to follow-up mandate caution in interpretation of these results, especially in Zambia. More women progressed to autonomous NFP use in Liberia (58%) than in Zambia (35.3%). However, programme costs per couple-year protection were lower in Zambia (US$25.7) than in Liberia (US$47.1). Costs per couple-year protection were higher during learning than autonomy, and declined over time. These studies suggest that NFP programmes can achieve acceptable use- and cost-effectiveness in Africa.

Adult↗
PubMedDate not supplied

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

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.

Bangladesh↗
PubMedDate not supplied

Impact of social marketing on contraceptive prevalence and cost in Honduras.

In 1984, the Honduran Family Planning Association launched a contraceptive social marketing program by introducing the oral contraceptive, Perla. This report examines the impact of the program on overall oral contraceptive use, use by particular subgroups, source of supply, and costs. Although use of oral contraceptives increased only slightly over the period 1984-87 (from 12.7 percent to 13.4 percent among women in union aged 15-44), the social marketing program significantly increased its share of the oral contraceptive market (from 7 percent in 1984 to 15 percent in 1987, and from 20 percent to 40 percent of sales at pharmacies). For the Honduran Family Planning Association to have realized cost savings as a result of clients switching from community-based distribution programs and commercial supply sources to contraceptive social marketing programs, the association would have had to reallocate its resources. Instead, the number of distributors in the community-based distribution program increased, while the amount of couple-years of protection from oral contraceptives decreased.

Adolescent↗
PubMed1998

From efficacy to effectiveness: selecting indicators for a community-based lactational amenorrhoea method promotion programme.

This paper reviews the results of clinical trials and community studies of lactational amenorrhoea and its role as a contraceptive method (LAM). Indicators which are used in efficacy trials and effectiveness interventions are compared and sets of indicators of effectiveness appropriate to community-based LAM programmes are recommended. A five-tiered ecological framework is used to facilitate selection of indicators which range from individual to policy level outcomes. The indicator framework is intended as a tool for health practitioners in family planning and maternal and child health service delivery settings who are interested in designing programmatic interventions for the promotion of LAM, particularly among less well-educated women of lower socioeconomic communities.

Amenorrhea↗
PubMedDate not supplied

Maternal care receptivity--an innovative approach for the evaluation of MCH services.

Despite rapid expansion in the maternal and child health and family planning services, there have been few attempts made to study the extent of utilisation of these services and their impact. The present study reports a simple method evolved in the quantification of utilisation of maternal care services (called maternal care receptivity - MCR), the relationship of factors such as age, parity, caste of the women and the distance of the health centre on the MCR and the impact of MCR on perinatal and neonatal mortalities. An inverse relationship was observed between MCR and perinatal and neonatal mortality rates and the two rates were three times less among babies born to mothers with high MCR scores compared to those with poor MCR scores.

Analysis of Variance↗
PubMed1995

Quality assessment of reproductive health services.

Systematic information on the quality of health services is being sought by purchasers and providers of health care. Consensus on an appropriate set of quality assessment criteria should stimulate the development of data collection tools and analytic methods. To begin the dialogue, criteria for evaluating the quality of family planning services, routine gynecologic care, infertility care, male reproductive health services, prenatal care, and early postnatal care are necessary. The effect of report cards on measurement and reporting and the challenges of assessing quality in family planning and other clinic settings are discussed.

Family Planning Services↗