Can the Bangladeshi Family Planning Program Meet Rising Needs Without Raising Costs?

Abstract

This study examines the costs and productivity of home service delivery and clinic programs for motivation acceptance and follow-up of family planning in Bangladesh. Costs are figured per couple year of protection (CYP) under a variety of scenarios including changes in work patterns and meeting increased demand. Data were obtained during October 1993-February 1994 from interviews and observations at different types of government clinics from 4 geographic divisions. Costs are based on type and number of visits method continuation rates and costs of contraceptives supplies capital and labor. Monthly work patterns were constructed from the logbooks of 64 fieldworkers and 48 clinic workers. About 25% of family welfare assistants (FWAs) and over 50% of supervisors did not work and did not have authorized leave. The mean length of time of work among the 24 FWAs was 3.25 hours. FWAs averaged 3.75 hours of work during the observation period. FWAs spent 66% of their time traveling. Visits averaged about 4 minutes or 12 minutes including travel time. Clinic workers average 4.5 hours per day at the clinic and about 38 minutes per client. Clients received about 3.6 visits/person. Eliminating unauthorized leave would increase visits per month from 219/field worker to 293 and lower costs per CYP by 17% to $2.51. Adding an hour more to work time would reduce costs for CYP for oral pills to $2.35 and in combination with reduced leave time would reduce costs to $1.97. Clinics would decrease costs of CYP for IUDs to $1.32 by increasing work time by 50%. The total costs per CYP would be reduced by 14% to $3.92. Clinics would be able to meet demand by 2004 even with increased contraceptive prevalence and minimal increases in productivity. However program costs could remain at the current 1994 level over the next 10 years if the number of days and hours worked were increased.