Excess Capacity and the Cost of Adding Services at Family Planning Clinics in Zimbabwe. (Articles)

By Janowitz, Barbara; Knight, Laura et al. | International Family Planning Perspectives, June 2002 | Go to article overview

Excess Capacity and the Cost of Adding Services at Family Planning Clinics in Zimbabwe. (Articles)


Janowitz, Barbara, Knight, Laura, Thompson, Andy, West, Caroline, Marangwanda, Caroline, Maggwa, Ndugga Baker, International Family Planning Perspectives


CONTEXT: With the expense of providing reproductive health services increasing, information on how staff members spend their time can help program managers determine whether there is sufficient downtime to add new services at minimal additional cost.

METHODS: Providers in Zimbabwe were retrained in syndromic management of reproductive tract infections. Before and after retraining, mini-situation analyses were performed at several clinics to determine how staff spent their contact time with clients. The mean length of visits was calculated, as was the amount of time spent on risk assessments, pelvic exams and collection of lab specimens. Time-motion studies were conducted to determine how providers spent their time following retraining, including client services, administrative activities and unoccupied time.

RESULTS: The median length of visits for new acceptors was longer following retraining (27 minutes) than it was before (20 minutes), and the proportion of such clients who received various syndromic management services increased. Yet even after retraining, providers spent less than 40% of their time with clients. Observation revealed substantial unoccupied time in early morning and late afternoon. If more clients received services, time spent with clients would increase and unoccupied time would decrease; thus, the labor cost of a clinic visit could be cut--at one clinic, by almost one-half. Overall, the average provider cost of family planning visits could be reduced by more than one-third if providers increased the share of time spent with clients from 40% to 60%.

CONCLUSIONS: Reduction of provider downtime (time absent from the clinic, time spent unoccupied or time not otherwise used productively) at family planning clinics in the developing world could increase capacity to provide services with a minimal rise in costs. Poorly paid providers, however, may require financial incentives to increase their workload.

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The United Nations Population Fund (UNFPA) estimates that the costs of family planning and other reproductive health services are increasing and that donors and countries will find it difficult to meet them. (1) However, the UNFPA estimate is not based on detailed country studies; even if it were, simply extrapolating the findings of such studies may overstate future costs. For example, in recent research calculating the costs of adding various reproductive health services to family planning programs in Mexico and Zimbabwe, the authors argued that "many institutions delivering reproductive health services operate significantly below their physical capacity to see clients, and...much of the equipment required for expanding reproductive health services may already be available for use in family planning and other health services. Thus, the marginal capital costs of adding most types of...services should be small." (2) The authors argued that "many institutions delivering reproductive health services operate sig nificantly below their physical capacity to see clients, and that much of the equipment required for expanding reproductive health services may already be available for use...." (3) The same argument may apply to staff time.

The costs of providing reproductive health care could be lower than those implied either by UNFPA estimates or by estimates obtained from combining average costs from microlevel studies conducted at service-delivery points. For example, with studies such as that described above, aggregating data would create total cost estimates that are likely to be too high, as these assume that expanding service provision requires hiring additional staff. But just as there may be excess physical capacity, there may also be excess human capacity. Thus, if workers spend much of their time waiting for clients or performing unnecessary paperwork, this time can be reallocated to serving clients. …

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