Methods for Costing Family Planning Services

The aim was to introduce procedures for estimating all costs to each service delivery channel within a family planning program whether funded partially funded or paid for in some capacity. Manuals on costing health services may not be applicable to the various requirements and components of family planning programs. The cost accounting used a “bottom up” approach based on individual service delivery. All services are listed and then the resources needed to produce each service are costed. The manual was directed to those engaged in organizing and conducting costing analyses of family planning programs but without the “cookbook” strategy. Chapter topics were devoted to the uses of cost analysis framework for calculating costs fundamentals of cost analysis framework for calculating costs fundamentals of cost analysis collecting cost data cost allocation in clinical settings costing nonclinic based services converting cost per visit into cost per couple year protection (CYP) and costing applications. For example in costing in clinics only joint costs were considered: those that could be directly allocated to particular visit types. Two options (fee for service and inputs based on time and usage) were identified and actual costing projects in Ecuador the Dominican Republic and Honduras were discussed. The actual allocation of joint costs to clinic visits and the issue of noncontact time were addressed. Costs of an IUD insertion would require staff costs for a physician and a nurse materials costs for the IUD and other materials equipment and supplies for the examination table lamp physical space and utilities. The cost per person was $46. Many programs however pay doctors and clinic staff a fixed fee and pay for equipment and space for fixed periods of time. In this system costs are allocated among the services provided. Assumptions are made that each visit uses the same amount of joint resources. This applies well to clinics with limited services. In this manner any variation in total visit costs would be due to fee for service labor or disposable supplies as nonjoint costs. The benefit of this approach is simplicity and limitations on resources. Allocation on visit duration assumptions depends on the availability of visit duration data and observational time motion studies. Allocation would be based on personnel equipment infrastructure miscellaneous costs per reception area examination area education and miscellaneous.