A comparison of four approaches for measuring clinician time use.

Concern about rapid growth in demand for reproductive health services in developing countries has created interest in productivity and costs of existing programmes. Staff costs usually constitute the largest share of total service costs, meriting special effort to ensure that they are measured accurately. Several techniques have been used in the literature to analyze staff activity, but these techniques have not been validated. This paper reports on a study conducted in three Ecuadoran clinics. The study uses an observational time-motion (TM) technique as a benchmark, and compares results from three other techniques to those obtained using TM. None of the alternative techniques produces estimates that agreed with TM estimates; deviations from TM are particularly large for non-contact time, defined as clinician activities carried out when clients are not present. Implications of these findings for productivity and cost studies are discussed, and possible avenues for future research are proposed.

Three strategies to promote sustainability of CEMOPLAF clinics in Ecuador. Céntros Médicos de Orientación y Planificación Familiar.

The continuing trend of donor attention and resources away from Latin America threatens the sustainability of nongovernmental family planning organizations in that region. Managers can improve sustainability through cost control, cost recovery, and income generation. The Population Council's INOPAL II and INOPAL III projects and Family Health International assisted CEMOPLAF, an Ecuadoran private voluntary organization, in carrying out operations research in each of these areas. Studies included cost-savings analysis from altering IUD revisit norms (cost control), an ability-to-pay study that showed potential gains from increased prices for reproductive health services (cost recovery), and a feasibility study to estimate income from ultrasound services (income generation). Results indicate that any one intervention will probably have a limited impact, and that managers likely will need to undertake several initiatives simultaneously to make significant progress toward sustainability.

Impact of social marketing on contraceptive prevalence and cost in Honduras.

In 1984, the Honduran Family Planning Association launched a contraceptive social marketing program by introducing the oral contraceptive, Perla. This report examines the impact of the program on overall oral contraceptive use, use by particular subgroups, source of supply, and costs. Although use of oral contraceptives increased only slightly over the period 1984-87 (from 12.7 percent to 13.4 percent among women in union aged 15-44), the social marketing program significantly increased its share of the oral contraceptive market (from 7 percent in 1984 to 15 percent in 1987, and from 20 percent to 40 percent of sales at pharmacies). For the Honduran Family Planning Association to have realized cost savings as a result of clients switching from community-based distribution programs and commercial supply sources to contraceptive social marketing programs, the association would have had to reallocate its resources. Instead, the number of distributors in the community-based distribution program increased, while the amount of couple-years of protection from oral contraceptives decreased.

PIP: Researchers used data from 2 national surveys of maternal-child health and family planning (1984 and 1987) and from a 1989 study of economic costs by method and program to examine the impact of the contraceptive social marketing program of the Honduran Family Planning Association (ASHONPLAFA). ASHONPLAFA launched the program in 1984 by introducing the oral contraceptive (OC) Perla. Between 1984 and 1987, OC use increased minimally (12.7-13.4% among 15-44 year old women in union), yet the contraceptive social marketing program increased its share of the OC market (7-15% overall, 20-40% at pharmacies). The analysis showed that costs to ASHONPLAFA would fall if more women bought OCs from the contraceptive social marketing program instead of the community- based distribution (CBD) program, and if the resources earmarked to the CBD program in urban areas decreased. Yet, the number of distributors in the CBD program in urban areas actually increased, so ASHONPLAFA did not achieve cost savings. Further, the amount of couple-years of protection from OCs fell. The findings showed that market forces did not work and may not do so in like programs, where profit is not a goal and managers are not held accountable for cost increases. They also indicate that, in urban areas, the contraceptive social marketing program can serve more clients and the CBD program can be cut back. Further research is needed to examine whether and by how much ASHONPLAFA could reduce the CBD program without losing clients.