"I think for the poorest of the poor you do need to offer free services or almost free services. By all means, let women who need family planning get it; [at] whatever price they can afford."
-John Stanback [Listen to this interview]
Without free or subsidized family planning services, many people in developing countries would be unable to afford the full costs of using modern contraception. Offering free or subsidized services can help programs make family planning more accessible and affordable for the poor.
Q. Why is it important to offer free or subsidized family planning services?
A. All women and men should have access to the means to prevent unintended pregnancies. Indeed, preventing unintended pregnancies may most benefit the poorest people, on a number of levels including health-level and economic-level. For those unable to pay the full price for contraception, programs can offer free or subsidized services.
Q. Should everyone have access to free or subsidized services?
A. The price that programs charge for services should be scaled to a client’s ability to pay. Programs may find that a needs test can help determine who should be eligible for free or subsidized services.
[Social Marketing Models for Product-Based Reproductive Health Programs: A Comparative Analysis]
Q. Who actually pays for family planning?
A. Virtually all family planning programs strive to make contraceptives available to clients either free of charge or at easily affordable prices. This generally requires subsidies. In developing countries contraceptive users as a group pay only about 10% of the total cost of family planning. Developing-country governments pay about 75% of family planning costs. International donor agencies, such as USAID, pay about 15%.
Q. If programs need to increase fees, should poor clients be exempt from paying for services?
A. Even if most people are able to pay something for family planning services, some people cannot. As a rule, imposing or raising fees reduces use of services, and the poor, of course, are the first to go without. If fees are instituted or increased, programs should try to ensure that the poor will continue to have access to services.
Q. Don’t people prefer to pay for family planning services because they associate price with quality?
A. Research shows that most people, even those who cannot afford the full costs of contraception, are willing to pay something for family planning services that meet their needs. Even where free services are available, some associate price with quality. Some mistrust the motivation behind the offer of free services. For some, easier access is worth a small price.
In many places poor people pay for health care in the private sector. They think it is better quality than free care from the government. Because of the financial burden the poor use their limited funds for curative care. They cannot afford family planning and other preventive health care services. Strategies to expand access to good-quality family planning services for poor clients include social marketing and voucher systems. Also, public-sector programs and NGOs are improving the quality of their free or low-cost services and making the improvements known to the public.
Q. What is social marketing? Can it expand access to services for poor people?
A. Social marketing uses commercial strategies to make good-quality health products and services available to poor people at prices below the full commercial price. These programs typically “brand” their products and services to associate them with high quality. When clients see the brand on services, for example, they know that the staff is going to be well-trained, the facility will be clean and attractive, and services may be quicker than in a public-sector clinic. Social marketing programs combine the attractiveness of private-sector services and products with low prices made possible by public subsidies. In this way they help increase the poor’s use of healthful products and services, such as family planning.
Q. How does social marketing benefit public-sector programs?
A. Social marketing programs offer resupply methods, such as pills, condoms, and injectables, through retail outlets and private providers. Then public-sector providers can focus on providing long-acting and permanent methods. They can help the poorest of the poor. They also can help clients who are having problems with their method.
Q. How does a voucher system help subsidize family planning services for the poor?
A. Vouchers usually take the form of certificates or other tokens that can be redeemed when seeking care or supplies. Programs can distribute such vouchers specifically to the poor.
Case Study: Pakistan
Franchising private-sector family planning services to make them more widely available and affordable to the urban poor
The social marketing program in Pakistan expanded from condoms to clinical methods in the mid 1990s. It became essential to find additional skilled family planning providers serving poor communities. The solution was social franchising—that is, recruiting health care providers from the private sector to add family planning to their existing practices and marketing those services under an easily recognized brand name. Population Services International (PSI) and its local affiliate, Social Marketing Pakistan (SMP), designed and launched the Green Star franchise network in 1995. Green Star providers agree to offer a range of low-cost Green Star-brand contraceptives and services. Later, Green Star added Lady Health Visitors to their network. Green Star Lady Health Visitors deliver health care in the home to the poorest and least served urban neighborhoods. By 1997, 93% of survey respondents in low-income urban areas recognized the Green Star logo and identified it as a symbol of high-quality family planning at affordable prices.
The Green Star franchise network has tapped underutilized capacity in the private sector to make family planning more accessible and more affordable for the poor. Through the Green Star network more than 11,000 private-sector outlets in 40 urban areas have added family planning services. Together, they serve an estimated 7.5 million family planning clients annually, nearly three-fourths of whom are from low-income groups.
Each of the 10 elements was chosen based on online survey results and was discussed in an online forum hosted by the Implementing Best Practices (IBP) Knowledge Gateway. Read more about the survey, forum and results in the Forum Synopsis. Learn more about IBP Knowledge Gateway, and join their Initiative here.
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