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Revisiting the costs and utilization of family planning services in the public sector in Pakistan
Authors: Adnan Ahmad Khan, Khadija Shujaat
Source: Journal of Pakistan Medical Association, Volume 71, issue 11
Topic(s): Family planning
Health care utilization
Country: Asia
Published: NOV 2021
Abstract: Objective: We revisited the costs of Family Planning per woman served per year in the public sector using data from the Pakistan Demographic and Health Survey 2017-18. These costs were estimated previously in 2006-07. The public sector (Population Welfare Department and the Department of Health) accounts for around 35% of all family planning services provided each year. We looked at utilization patterns of public sector family planning services and estimated its costs of FP per woman served per year and cost per Couple Years of Protection (CYP). Methods: Pakistan Demographic and Health Survey 2017-18 was used to estimate the number of users of public sector services and their usage patterns. These were depicted using simple tables and with binary logistic regression analysis. National Health Accounts 2012-16 were used to estimate government allocations for family planning. Costs of FP were estimated by simply dividing the allocation by the two public sector departments - Population Welfare (PWD) and Health (DoH) — with the number of users they serve each year. Costs were also depicted per CYP generated. Results: Both the public and private sectors provide family planning services. The PWD serves an estimated 724,320 clients annually compared to 915,817 by DoH. Together these amount to around 5% of all MWRA, a proportion that remains unchanged over past decade. Due to their very different method mix PWD serves 2,344,411 CYP while DoH serves 988,603. DoH delivers most of its services in the form of condoms and pills which LHWs can carry. The PWD, having increased its range of products as compared to a decade ago, provides condoms, pills, IUDs and tubal ligations. Users of the public sector tend to belong to urban areas (AOR 1.2, range 1.2-1.2), are poor (AOR 2.7, range 2.7-2.7), and tend to have more children (AOR 1.1, range: 1.1-1.1). The exception is that DoH's lady health workers serve a large portion of rural population. Costs of FP per woman per year for PWD are USD 28 and for DOH are USD 14, costs per CYP are calculated are USD 9 and 13 respectively. Conclusion: The public sector fills an important niche by serving a poorer population and through rural household outreach. While costs have decreased since 2007, they remain higher than regional averages and suggest significant inefficiencies as both fixed facilities and lady health workers are considerably underutilized.