An economic appraisal of alternative strategies for the delivery of MCH-FP services in urban Dhaka, Bangladesh

The strategy of distributing maternal and child health and family planning (MCH-FP) services at the doorsteps of the clients-through routine visits to the eligible couples by trained fieldworkers-has been instrumental in increasing the contraceptive prevalence rate (CPR), reducing fertility and attaining a considerably high immunization coverage of children and women in Bangladesh. The doorstep strategy, however, appeared to be labour-intensive and costly. With the maturity of the programme, priorities of the national MCH-FP programme have shifted to a stage that calls for more cost-effective service-delivery strategies, capable of offering a broader package of reproductive and other essential health services. The main objective of the present study was to examine the cost and effectiveness implications of the alternative strategies of delivering services from fixed sites-field-tested within an ICDDR,B operations research-in comparison to the conventional (existing) doorstep strategy. The key findings of the economic appraisal indicated that, at the end of the operations research intervention, both cost per birth averted and cost per QALY gained were lowest for the option of delivering services from static (fixed-site) clinics: US$13 and US$17 compared with the corresponding values of US$18 and US$42 for the doorstep strategy. Provision of health and family planning services from clinics-complemented with a reduced system of outreach workers to inform and target the hard-to-reach clients-was found to be the most cost-effective service-delivery alternative. Copyright (C) 2000 John Wiley & Sons, Ltd.