Cost-effectiveness of the family planning programme in Pakistan.

The author compares the per unit costs of different types of service outlets and contraceptive methods, and highlights methodological issues related to costing studies in his assessment of the most cost-effective way to provide family planning services from a wide range of service delivery modes and methods. Couple-year of protection and births averted data are analyzed from Sheikhupura district of Punjab for 1991-92. The low volume of activity has resulted in high per unit cost. Service outlet productivity or volume of activity can, however, be increased by increasing the variable or operational costs and without any change in the fixed staffing and capital costs up to an optimal limit to gain from economies of scale. The increase in the volume of activity by every existing service outlet will lower the per unit cost achieving economic efficiency and increase the number of births averted and couple-protection rate increasing the demographic impact. Strategic shifts can also be made between contraceptive mixes, but demand must be generated for family planning in order to ensure greater use of existing service outlets and increase the volume of activity to reduce per unit costs. Demand for family planning can be increased through an assortment of appropriate mass media venues, improving service quality, and a range of long-term initiatives including a push for female literacy, incentives/disincentives to have small families, tax benefits to individuals and corporations which donate time and/or other resources to family planning, and pricing contraceptives on the ability to pay.