Abstract
This study reports on the effectiveness and efficiency from the program funder's perspective of the Suraj Social Franchise (SSF) voucher program in which private health-care providers in remote rural areas were identified, trained, upgraded, and certified to deliver family planning services to underserved women of reproductive age in 29 districts of Sindh and 3 districts of Punjab province, Pakistan between October 2013 and June 2016. A decision tree compared the cost of implementing SSF to the program funder and its effects of providing additional couple years of protection (CYPs) to targeted women, compared to business-as-usual. Costs included vouchers given to women to receive a free contraceptive method of their choice from the SSF provider. The vouchers were then reimbursed to the SSF provider by the program. A total of 168,206 married women of reproductive age (MWRA) received SSF vouchers between October 2013 and June 2016, costing $3,278,000 ($19.50/recipient). The average effectiveness of the program per voucher recipient was an additional 1.66 CYPs, giving an incremental cost-effectiveness of the program of $4.28 per CYP compared to not having the program (95% CI: $3.62-5.31). The result compares favorably to other interventions with similar objectives and appears affordable for the Pakistan national health-care system. It is therefore recommended to help address the unmet need for contraception among MWRA in these areas of Pakistan and is worthy of trial implementation in the country more widely.
Highlights
This study reports on the effectiveness and efficiency from the program funder’s perspective of the Suraj Social Franchise (SSF) voucher program in which private health-care providers in remote rural areas were identified, trained, upgraded, and certified to deliver family planning services to underserved women of reproductive age in 29 districts of Sindh and 3 districts of Punjab province, Pakistan between October 2013 and June 2016
In 2012, the London Summit on Family Planning proposed the ambitious “FP2020” commitment to increase coverage of modern contraceptive methods (MCMs) for 120 million more women and girls by 2020 [1]. To work toward this commitment, Marie Stopes International (MSI) has implemented interventions to increase access to modern contraception through methods including social franchising in low-income settings where the unmet need for contraception is highest [2]
Access, and quality of family planning (FP) and reproductive health (FP/RH) services for women appears to contribute to addressing the problem in this setting [5, 6]
Summary
This study reports on the effectiveness and efficiency from the program funder’s perspective of the Suraj Social Franchise (SSF) voucher program in which private health-care providers in remote rural areas were identified, trained, upgraded, and certified to deliver family planning services to underserved women of reproductive age in 29 districts of Sindh and 3 districts of Punjab province, Pakistan between October 2013 and June 2016. In 2012, the London Summit on Family Planning proposed the ambitious “FP2020” commitment to increase coverage of modern contraceptive methods (MCMs) for 120 million more women and girls by 2020 [1]. To work toward this commitment, Marie Stopes International (MSI) has implemented interventions to increase access to modern contraception through methods including social franchising in low-income settings where the unmet need for contraception is highest [2]. Access, and quality of FP and reproductive health (FP/RH) services for women appears to contribute to addressing the problem in this setting [5, 6]
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