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At least 19 recordsLinked to original sources
PubMed1991

Measuring natural family planning in terms of couple-years of protection.

Couple-years protection is a summary index of contraceptive protection. Couple-years protection allows comparisons of natural family planning with other methods. One couple-year protection for condoms is equal to 1 couple-year protection for pills and 1 couple-year protection for natural family planning. Critical in the calculation of couple-year protection for natural family planning is average duration of use. A working group on natural family planning recommended that 2 years of use be used as average duration until more data are available.

Contraception↗
PubMed2000

Empirically based conversion factors for calculating couple-years of protection.

Couple-years of protection (CYP) is one of several commonly used indicators to assess international family planning efforts. It has been the subject of much debate, relating in part to the specific conversion factors used to translate the quantity of the respective contraceptive methods distributed to a single measure of protection. This article outlines a comprehensive effort to revisit those conversion factors based on the best available empirical evidence. In most instances, the analysis supports previously established standard conversion factors. However, there are two notable departures. Fewer condoms and spermicides are recommended for each CYP (120 vs. 150), primarily because coital frequency among condom users is lower than previously assumed. Furthermore, for sterilization, the authors recommend the use of country or region-specific conversion factors. Every program evaluation indicator has strengths and weaknesses, and the best program evaluation efforts use a variety of indicators. If CYP is used to evaluate programs, however, the authors believe that the conversion factors presented reflect the best available evidence.

Adolescent↗
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

Using financing to motivate a for-profit health care provider to deliver family planning services: is it a cost-effective intervention? A study of AAR health services in Kenya.

Despite much discussion of the role of private health care providers, there are no tried and tested models for supporting for-profit providers in ways that produce cost-effective public health outcomes. This paper examines the cost effectiveness of using a loan mechanism to motivate a for-profit provider to deliver family planning services. The intervention examined directly resulted in a private provider delivering family planning services, however, it did not create a long-term financial incentive for the private provider to promote the use of family planning. The cost effectiveness of this intervention is analysed using a methodology that captures long term sustainability of the intervention within a traditional family planning outcome measure, such as couple years protection (CYP), by discounting future expected CYPs. Depending on the method for analysing costs and assumptions regarding future CYPs, this intervention produced family planning outcomes at no or very low cost (0 dollars-4.11 dollars per CYP). The analysis demonstrates that innovative family planning interventions with private providers should be considered as they can be more cost effective than traditional programmes.

Capital Financing↗
PubMed1994

Trial of a new method of natural family planning in Liberia.

This paper describes the evaluation of a new method of natural family planning (NFP) in Liberia. The Modified Mucus Method (MMM) was developed to address the need for a simple method of charting for poor and illiterate women. The acceptance, use, and cost-effectiveness of the MMM were compared with standard NFP methods, the sympto-thermal and ovulation method (ST/OM), used in the same population. The personal discontinuation rate of MMM users was 27.3 per 100 women per year compared with 3.2 among ST/OM users. Unplanned pregnancy rates were low for both MMM and ST/OM, 6.6 and 1.5 respectively. The cost per couple year protection (CYP) for MMM was $55.80 and for ST/OM $56.10. There were differences in characteristics between MMM and ST/OM clients. The MMM clients were more likely to have attended school and to have used a family planning method previously, and were less likely to be housewives. We conclude that the MMM in Liberia was provided to an inappropriate sample of women, educated and middle-class rather than poor and illiterate. The MMM users were dissatisfied and discontinued at the rate of 44 per 100 women entering per year. This is an unfair evaluation of the MMM because of the unsuitable study population. It is our opinion that the MMM needs more study to become part of the inventory of birth spacing methods.

Adult↗
PubMed1996

The cost-effectiveness of family planning service provision.

BACKGROUND: Family planning services are amongst the most highly utilized services in the National Health Service. There have, however, been few empirical studies of the cost-effectiveness of these services. METHODS: Two measures of output were used to calculate the cost-effectiveness of family planning services. The first measure is based on the number of pregnancies averted. The second measure uses the couple year of protection as the measure of output. Accordingly, two cost-effectiveness ratios are calculated: cost per pregnancy averted and cost per couple year of protection. RESULTS: The direct cost per pregnancy averted is between 48 pounds and 167 pounds for reversible and 18 pounds and 21 pounds for non-reversible methods. The cost per couple year of protection is between 49 pounds and 184 pounds for reversible and 17 pounds and 21 pounds for non-reversible methods. For both approaches, if averted NHS costs associated with family planning services are included these translate into resource savings to the NHS resulting from the provision of these services. CONCLUSION: From the perspective adopted in this study, family planning services are highly cost-effective. According to calculations made in this paper, these services provide a high rate of return to the NHS and, when the resource consequences of unplanned pregnancies in the health sector as a whole are considered, result in resource savings.

Cost Savings↗
PubMed1977

Measuring the effectiveness of contraceptive marketing programs: Preethi in Sri Lanka.

The Preethi marketing program resulted in sales of more than 11 million condoms during its first 33 months, multiplying Sri Lanka's annual per capita condom use by a factor of five. Estimates for 1974 show 144,000 new acceptors (8% of married women of reproductive age), totaling 50,000 couple-years of protection. It is also estimated that more than half of the nation's 1.8 million couples of childbearing age were educated about the function of a condom. Unit costs were low for this new, nationwide program: about US $2.00 for each new acceptor; 6.00 dollars for each couple-year of protection; and 0.09 dollars for each couple educated. The program's success suggests that a social marketing approach can advance family planning at a relatively low cost.

Advertising↗
PubMed1997

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

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).

Cost-Benefit Analysis↗
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↗
PubMed2002

Supply-level measures to increase uptake of family planning services in Niger: the effectiveness of improving responsiveness.

OBJECTIVE: To show that low-cost attitudinal, structural and procedural changes aimed at improving responsiveness to patients have the potential to increase uptake of family planning (FP) even among populations considered reluctant to do so by health personnel. METHODS: Intervention study with before-after comparison of contraceptive acceptance, couple-years of protection (CYP) and an 'index of contraceptive uptake' (IUC) in rural health centres in Niger. The intervention consists of a package of instructions to actively propose family planning, integrated within curative and under-fives consultations, coupled with measures to increase the health centres' responsiveness to their clients. RESULTS: Implementation of the intervention package was followed by marked increases in family planning uptake. CONCLUSION: Health services in Niger present an untapped potential for improving family planning through low-cost supply-side measures.

Ambulatory Care Facilities↗
PubMed1992

Oral contraceptive marketing in Ibadan, Nigeria.

The demographic transition in Nigeria is gradually moving towards the second stage. There is clear evidence of a declining mortality but the fertility rate remains exceptionally high. A realistic approach towards reducing fertility rate is the use of oral contraceptive. This study assesses the distribution system of oral contraceptive in Ibadan, the second largest city in Nigeria. The findings revealed that the people are aware of modern oral contraceptives as they purchase them freely at chemist shops. But effective distribution is hampered by existing channels and high costs. A local source recommended is the proprietary medicine stores, often at convenient locations to the potential users of contraceptives. The current cost which is between $1.3 and $19.5 per couple-years of protection is exorbitant, consuming 0.5-7.8% of the gross annual income of the average individual. Therefore, the government should subsidize the prices of oral contraceptives, to facilitate freedom from the tyranny of excessive fertility.

Contraception↗
PubMed2003

Cost-effectiveness analysis of behaviour change interventions: a proposed new approach and an application to Egypt.

This paper presents a new approach to cost analysis of family planning programmes that focuses on behaviour change of programme clients as the final 'output' rather than units of contraceptive services delivered, as does the familiar couple-years-of-protection index. It is useful to know how much it costs to deliver a unit of contraceptive services, but it would also seem useful to know how much it costs to change a prospective client's behaviour. The proposed approach rests on the familiar 'steps to behaviour change' paradigm and: (1) develops a methodology for applying a client-behaviour-change-centred cost analysis to programme activities; (2) tests the methodology and concepts by applying them retrospectively to a case study of mass media interventions in Egypt; (3) derives cost per unit of behaviour changes for these Egyptian communications campaigns to demonstrate the workability of the approach. This framework offers a new approach to impact evaluation that would seem to be applicable to other components of family planning and reproductive health programmes.

Adolescent↗
PubMed1984

[A contraceptive social marketing (CSM) program needs continuity of management: the Asociacion Demografica Salvadorena (ADS) in 1983].

The Association Demografica Salvadorena (ADS) learned an important lesson during 1983--a contraceptive social markeing (CSM) program needs continuity of management to ensure that all components remain inegrated and all actions are coordinated within the organization. Ever since in early 1983, ADS has not had an executive specifically assigned to run the CSM project and make the important month-by-month, tactical decisions that keep a program's activities focused on meeting sales goals. Instead, executive tasks were delegated on an ad hoc basis to ADS' administrative staff. Fortunately, the program's administrative design was well-developed, and ADS' dedicated personnel were able to effectively accomplish the daily business of keeping records and getting products out to retailers. Advertising, promotion and product development suffered, however. So the new executive or general manager will need to examine these areas 1st. Although El Salvador's CSM operates in unstable social and economic conditions, and despite a dramatic fall in condom sales last year, the ADS can still do much to increase its couple years of protection at costs significantly lower than those of clinic and community-based distribution systems. Research done thus far indicates a substantial demand for ADS products. Consequently, while not set in ideal conditions, physical distribution and marketing functions can be accomplished. But, as the ADS has discovered, even with a strong leader like Dr. Gustavo Argueta, CSM enterprises do not function automatically. Producing projected sales goals depends on the continuity of "hands-on" management.

Americas↗
PubMed2002

Assessing the cost-effectiveness of contraceptive methods in Shiraz, Islamic Republic of Iran.

To determine the cost-effectiveness of seven contraceptive methods from the providers' perspective, the cost per adjusted couple-years of protection (ACYP) was calculated for each method based on region-specific conversion factors. More than 74,800 ACYPs were provided during March 1999 to February 2000. Intrauterine devices and implants offered the highest and lowest ACYP respectively. Condom was the single most expensive contraceptive method. Vasectomy was the most cost-effective method and implant provided the highest cost per ACYP.

Adult↗
PubMedDate not supplied

A comparison of the performance of male and female CBD distributors in Peru.

This report presents the results of an operations research project to increase male involvement in family planning in Peru. Two community-based distribution (CBD) programs, PROFAMILIA of Lima and CENPROF of Trujillo, Peru, recruited male contraceptive distributors and compared their performance to that of female distributors recruited at the same time. Both programs found it harder to recruit men than women as distributors. Program supervisors, who were women, were less comfortable with men than with other women, even though there were no differences in distributor compliance with program norms. Male distributors were more likely to serve male clients and sell male methods (condoms), while female distributors were more likely to serve female clients and sell female methods (pills). Men sold as much or more total couple-years of protection than did women, and they recruited as many or more new acceptors. Gender was found to exert an impact on method mix independent of other distributor characteristics, such as age, education, marital status, and number of living children. The study suggests that family planning programs can influence method mix and client characteristics by recruiting men as CBD distributors.

Contraceptive Devices, Male↗
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↗
PubMed1980

Teaching family planning management and evaluation skills.

In the last several years the need for training schemes in family planning programme administration has become increasingly apparent with the rapid growth of family planning services throughout the world. This paper reports on the development and use of a series of 16 practical classroom training exercises designed for teaching planning, management and evaluation skills. Each exercise can be introduced, worked and discussed in a morning or an afternoon. It is available in an individual booklet, which contains worksheets, blank tables and step-by-step instructions for working the exercise, along with a discussion of the skills being taught. Topics covered include demographic rates and concepts, the Dryfoos-Polgar-Varkey formula, risk factor analysis, target-setting, case load forecasting, service statistics, contraceptive supplies, manpower planning, couple-year of protection, cost-effectiveness, contraceptive use-effectiveness, life table techniques, numerator analysis, fertility pattern method, sampling methods and questionnaire design. These curriculum materials concentrate on imparting through the medium of actual experience a series of specific management techniques of a quantitative nature that will enhance the ability of the trainees to plan, administer and evaluate any family planning programme anywhere in the world. The exercises in this series have been tested in the family planning training programmes at Columbia University and at Downstate Medical Center in New York. They have also been used in WHO workshops in Thailand and Tanzania and in training programmes in France, Kenya and Nicaragua.

Family Planning Services↗