MOH Brief 3 An Extremely Low-Cost Option

Publication date: 2003

Sustainable and affordable for Kenya’s reproductive health programme The Kenya Ministry of Health has the challenge of meeting the reproductive health needs of a growing nation under the constraints of shrinking health resources. Providing high-quality family planning services to an increasing number of clients will require creative programming and efficient use of available resources. The IUCD is a valuable component of a sustainable contraceptive method mix. Government procurement and service-delivery costs for IUCDs are extremely low compared with those of many other methods. When all program costs (including those of staff time for initial and follow-up visits and for commodities) as well as the length of time each method will protect a woman from pregnancy are taken into account, the IUCD proves to be the most cost-effective contraceptive the health care system can provide. The graph below, based on data collected in 1996 from a case study in Mombasa, illustrates this point. Low cost for clients The IUCD not only is an inexpensive option for the health care system but also has extremely low costs for clients over time. When choosing a contraceptive method, a woman must consider several factors: her health, domestic circumstances, specific family planning needs, and the safety and effectiveness of the methods available to her. But to make a fully informed decision, she should also be aware of the affordability of each of her contraceptive options over the long term. It is important that clients are counselled on the long-term costs of different contraceptive methods. Contraceptive pills, for example, may initially appear cheaper than the IUCD because of their low monthly price. But over time, the IUCD Method Brief No. 3 An Extremely Low-Cost Option KEY POINT FOR PROVIDERS: n When discussing method options with clients, providers should always mention information on the low medium- to long-term cost of the IUCD, in addition to its risks and benefits. KEY POINT FOR CLIENTS: n The IUCD is a very economical medium- to long-term contraceptive method. KEY POINTS FOR POLICY-MAKERS: n The IUCD is an extremely inexpensive method to provide in a national family planning programme. n A balanced method mix that includes the IUCD and meets the needs of family planning clients will be more sustainable than a method mix that is focused on more costly family planning methods. Average Cost to Health Care System per Year of Protection, by Method 1996 data in 2003 prices K en ya n Sh ill in gs IUCD Pills Depo Norplant Condoms Tubal Ligation 2500 – 2000 – 1500 – 1000 – 500 – 0 – The United Nations Population Fund provides IUCDs for public sector purchases. Prices (at current exchange rates) are listed as: IUCD KShs 25 to KShs 50 Injection KShs 44 to KShs 78 Pill packet KShs 14 to KShs 36 Implant KShs 1800 cumulative cost of pills and injectables can be surprisingly high, due to the costs of return visits and resupply of the method. The IUCD, on the other hand, has a higher one-time “start-up” cost for the device and its insertion. Unfortunately, the cost of the IUCD cannot be paid off over time. However, the IUCD proves quite economical over a period of two or more years. If a woman is thinking about medium- to long-term reversible contraception, she should consider an IUCD, not just on the basis of its safety and effectiveness, but because over time it will result in substantially lower out-of- pocket expenditures. The graph below illustrates this point. The graph compares the average annual costs to the client for the IUCD, Depo-Provera, and pills at years one, two, and five in urban clinics in Kenya (taking into account that clients will require 12 packets of pills per year, with three dispensed at the first visit; four Depo- Provera injections per year; or only one IUCD insertion at the first clinic visit). Despite variations in contraceptive pricing in Kenya,1 the average annual cost of the IUCD decreases over time when compared with that of other methods. Prices at rural public health facilities are much lower than those at urban clinics, and prices in nonpublic health facilities are slightly higher, but the trend remains the same. In all settings, the IUCD proves to be the most economical method over time. Summary The IUCD is a low-cost option for both family planning programmes and clients over time. The IUCD not only has low procurement and service-delivery costs when compared with many other methods but also is an extremely economical method for women looking for medium- to long- term contraception. While price should not be the only reason a woman chooses a particular contraceptive method, it is an important consideration that health care providers should discuss with each client. While the IUCD is an excellent method, it will not meet the needs of all women, and comprehensive counselling that includes the IUCD as well as all other available contraceptive options is essential. These briefs were produced by the Kenya Ministry of Health and its collaborating partners. This work is supported by the U.S. Agency for International Development (USAID). The contents do not necessarily reflect USAID policy. For more information or additional copies, please contact: Head, Division of Reproductive Health, Kenya Ministry of Health Old Mbagathi Road, P.O. Box 43319, Nairobi, Kenya Telephone: 254-2-2725105 Fax: 254-2-2716814 or Regional Director, Population and Reproductive Health Programs Family Health International, The Chancery, 2nd Floor, Valley Road P.O. Box 38835, Nairobi, Kenya E-mail: Telephone: 254-2-2713913-6 Fax: 254-2-2726130 February 2003 1Clients pay about KShs 20 for an IUCD insertion in rural areas but may pay between KShs 100 and KShs 200 in urban areas. A single injection of Depo-Provera costs KShs 10 in rural settings and between KShs 10 and KShs 50 in urban settings. Likewise, a packet of pills costs KShs 10 in rural areas and from KShs 10 to KShs 50 in urban areas. Norplant has traditionally been priced around KShs 200 but has recently been free at public health clinics owing to an overstock. In the future, other implantable contraceptives may replace Norplant. K en ya n Sh ill in gs 250 – 200 – 150 – 100 – 50 – 0 – At one year At two years At five years Average Annual Contraceptive Method Costs to Clients at 1, 2, and 5 Years at Urban Public Health Facilities Pills Depo IUCD

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