Delivering reproductive health services through non-state providers in Pakistan: understanding the value for money of different approaches

Adrian Gheorghe,Sophie Witter,Rashid Uz Zaman,Molly Scott

doi:10.1186/s41256-018-0089-4

Adrian Gheorghe, Sophie Witter + Show 2 more

Open Access

https://doi.org/10.1186/s41256-018-0089-4

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Abstract

BackgroundDelivering Reproductive Health Results(DRHR) programme used social franchising (SF) and social marketing (SM) approaches to increase the supply of high quality family planning services in underserved areas of Pakistan. We assessed the costs, cost-efficiency and cost-effectiveness of DRHR to understand the value for money of these approaches.MethodsFinancial and economic programme costs were calculated. Costs to individual users were captured in a pre-post survey. The cost per couple years of protection (CYP) and cost per new user were estimated as indicators of cost efficiency. For the cost-effectiveness analysis we estimated the cost per clinical outcome averted and the cost per disability-adjusted life year (DALY) averted.ResultsApproximately £20 million were spent through the DRHR programme between July 2012 and September 2015 on commodities and services representing nearly four million CYPs. Based on programme data, the cumulative cost-efficiency of the entire DRHR programme was £4.8 per CYP. DRHR activities would avert one DALY at the cost of £20. Financial access indicators generally improved in programme areas, but the magnitude of progress varies across indicators.ConclusionsThe SF and SM approaches adopted in DRHR appear to be cost effective relative to comparable reproductive health programmes. This paper adds to the limited evidence on the cost-effectiveness of different models of reproductive health care provision in low- and middle-income settings. Further studies are needed to nuance the understanding of the determinants of impact and value for money of SF and SM.

Highlights

Delivering Reproductive Health Results(DRHR) programme used social franchising (SF) and social marketing (SM) approaches to increase the supply of high quality family planning services in underserved areas of Pakistan
Financial access indicators generally improved in programme areas, but the magnitude of Interpretation of findings Our findings need to be viewed in reference to the broader family planning context in Pakistan
We identified in the University of California at San Francisco (UCSF) Clinical Social Franchising Compendium 2014 [30] seven SF programmes for which we could calculate the cost per couple years of protection (CYP), which ranged from £3.5 (Senegal) to £92.5 (Haiti), with five of seven estimates below £10 per CYP (Additional file 1: Appendix 2)

Summary

Introduction

Delivering Reproductive Health Results(DRHR) programme used social franchising (SF) and social marketing (SM) approaches to increase the supply of high quality family planning services in underserved areas of Pakistan. While there is agreement that contraceptives are cost-efficient and cost-effective, a research gap persists as to the costs and impacts of demand creation strategies for contraceptives to increase service coverage [5,6,7]. Under SF, outlets (e.g. NGOs, clinics, pharmacies) run by service providers (e.g. nurses, community health workers) deliver family planning services under contracts with an agency or franchisor providing standardized products and services under a common brand [9]. Another systematic review focused on SF found an weak evidence base [13], with at least two other quasi-experimental evaluation published since showing no overall impact of SF on FP coverage [14, 15]

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