Cost of one month’s supply of contraceptives as a percent of monthly wages
“Costs” refer to out-of-pocket expenses for contraceptive supplies and services
This indicator is calculated as:
(Cost of one month’s supply of contraceptives/ One month’s wages) x 100
Information on monthly expenditures on contraceptive supplies and services and estimated monthly income
Information from population-based surveys on service and supply costs; fees may also be available from facility records.
This indicator provides a measure of the relative economic burden represented by monthly service and supply costs of contraceptive use. This measure applies specifically to family planning (FP), but evaluators can adapt it to other areas of reproductive health by substituting the cost of the product in question for contraceptives in this definition.
Service and supply costs exceeding one percent of monthly wages for a significant proportion of clients may constitute an economic barrier to contraceptive use (Ross et al., 1992).
The illustrative indicator for this element was chosen from among several alternatives in large part because the data required for its computation are the most likely among the alternatives to be available in a reasonably large number of developing country settings. However, evaluators should recognize that the indicator suffers from several important limitations.
One limitation is that the indicator ignores other costs of contraceptive use that may be just as, or perhaps more, important barriers to contraceptive use than direct service or supply costs are. For example, FP clients may also incur out-of-pocket expenses for transportation to and from the facility and (possibly) for child care, as well as opportunity costs of time spent traveling to and from the service delivery point and waiting for service or supplies once clients reach the facility. Thus, a more valid measure of the costs of FP
services would also include these costs in the computation of the indicator.
Another issue concerns the stream of income that evaluators should consider in computing the indicator. Since not all income (gross income) is likely to be available for use in paying for contraceptive services, a more appropriate specification of the indicator will limit the denominator of the measure to monthly disposable income. Furthermore, since men and women do not have equal access to household financial resources in many societies, a further refinement may be to limit the denominator of the measure to income or wages controlled by the client (especially female clients).
Evaluators should recognize, however, that these refinements add to the data requirements for computing the indicator. In many countries, the required information may be available only from special studies. For most practical purposes, the simpler indicator should suffice to guide program management decisions regarding the affordability of contraceptive services. In programs where cost recovery and sustainability are priority management issues, however, the added costs of gathering data required for the more refined measures may be justified.
access, health system strengthening (HSS)
Ross J.A., W.P. Mauldin, S.R. Green, and E.R Cooke. 1992. Family Planning and Child Survival Program, as Assessed in 1991. New York, NY: The Population Council