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  • Title: A cost analysis of family planning in Bangladesh.
    Author: Fiedler JL, Day LM.
    Journal: Int J Health Plann Manage; 1997; 12(4):251-77. PubMed ID: 10177415.
    Abstract:
    This article presents a step-down cost analysis using secondary data sources from 26 Bangladesh non-government organizations (NGOs) providing family planning services under a US Agency for International Development-funded umbrella organization. The unit costs of the NGOs' Maternal-Child Health (MCH) clinics and community-based distribution (CBD) systems were calculated and found to be minimally different. Several simulations were conducted to investigate the impact of alternative cost-reduction measures. The more general financial analysis proved more insightful than the unit cost analysis in terms of identifying means by which to improve the efficiency of the family planning operations of these NGOs. The analysis revealed that 56 per cent of total expenditures in the two-tiered umbrella's organizational structure are incurred in management operations and overheads. Of the remaining 44 per cent of project expenditures, 39 per cent is spent on the CBD program and 5 per cent on the MCH clinics. Within the CBD program, most resources are spent providing 4 million contacts (two-thirds of the annual total) which do not involve contraceptive re-supply. The clinics devote more resources to providing MCH services than to providing family planning services. The findings suggest that significant savings could be generated by containing administrative costs, improving operational efficiency, and reducing unnecessary or redundant fieldworker contacts. The magnitude of the potential savings raises a fundamental question about the continued viability and sustainability of this supply-driven CBD strategy. A successful supply-side approach has governed the delivery of family planning in Bangladesh for the past 20 years. The heart of the current system is an extensive community-based distribution (CBD) system which provides free door-to-door services and visits almost every eligible couple in the country 6 times per year. However, considerable program overlap and duplication waste resources. The current system is also inefficient because of its reliance upon relatively more expensive re-supply methods and its failure to consider contraceptive demand. With US Agency for International Development (USAID) funding likely to be reduced in the coming years, an impending need exists to improve system efficiency. Findings are presented from a step-down cost analysis using secondary data sources from 26 Bangladeshi nongovernmental organizations (NGOs) which provide family planning services through a USAID-funded umbrella organization. 56% of total expenditures in this 2-tiered umbrella's organizational structure are incurred in management operations and overhead expenses. 88% of the remaining program funds are spent upon the CBD program and 12% are spent upon maternal-child health (MCH) clinic activities. Most CBD program resources are spent providing 4 million contacts which do not involve contraceptive re-supply, with the clinics devoting more resources to providing MCH services than to providing family planning services. Significant savings could be generated through containing administrative costs, improving operational efficiency, and reducing unnecessary or redundant field worker contacts.
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