Costing of reproductive health services

Context: The principles endorsed by delegates to the 1994 International Conference on Population and Development expanded on the areas typically included in reproductive health. Yet implementation of more comprehensive reproductive health programs has been slow, and the impediments to program expansion need to be identified Methods: The elements of a reproductive health care program were identified, and in 1995, the disaggregated costs of providing some of these services were gathered from a program of the Zimbabwe National Family Planning Council (ZNFPC) and from MEXFAM, a nongovernmental organization in Mexico affiliated with the International Planned Parenthood Federation. These data were used to estimate and compare the costs (in U.S. dollars) of various components of reproductive health care per visit (or per diagnosis and treatment) in the two countries. Results: The costs of providing contraceptive methods, particularly surgical ones, as well as gynecologic and general health services, varied between ZNFPC and MEXFAM. Whereas tubal ligation cost $70 and oral contraceptives $3 at ZNFPC, a tubal ligation cost $269 and oral contraceptives $4 at MEXFAM. During a gynecologic visit, the cost of treatment fora sexually transmitted disease was $19 at ZNFPC and $29 at MEXFAM. The cost of providing an adolescent with a routine examination and iron supplement was $5 at ZNFPG and $4 at MEXFAM. At ZNFPC, providing a Pap smear, screening for a reproductive tract infection and checking an IUD during a single visit cost $4, compared with $6 when the procedures were performed separately. Conclusions: Costing reproductive health programs requires breaking service components into individual cost elements. This process can help managers understand both the financial and programmatic implications of alternative implementation strategies.