Private sector approaches to effective family planning

Even if per-user costs are controlled or reduced, the rising demand for family planning services will far outstrip governments'and donors'financial resources in most parts of the developing world. This"resource gap"lies at the heart of donor-sponsored initiatives to involve the private sector in family planning, but there are other equally good arguments for doing so. Governments and donors are often unaware of how much the private sector (especially the commerical sector) already participates - and could participate - in family planning. The author discusses why the private sector should be involved in planning, how the private sector should be defined, what the experience has been so far with private sector involvement, and what might be expected in the future. To support family planning in the private sector, the author recommends that donors: (1) expand the total family planning market to help satisfy existing and future unmet needs for contraception; and (2) shift current users from subsidized to more nearly self-supporting outlets - without compromising coverage, equity, or quality of care. The kinds of private sector activities that donors should support depend in part on which contraceptive methods are to be emphasized. Nonclinical systems, for example, are the most efficient way to distribute supply methods (for example, oral contraceptives and condoms), as long as medical backup is available for women who suffer side effects or who wish to switch to another method. These systems of distribution free up scarce resources in clinical facilities and the time of limited medical personnel for the resupply of contraceptives. However, if sterilization is to be emphasized, a close link with existing hospital infrastructure is necessary. Nonclinical distribution favors commercial systems in urban and periurban settings and community-based distribution systems (either public or private) where commercial networks break down. Price subsidies might be considered in areas served by commercial systems, but where consumers cannot afford prevailing commercial prices. The author discusses a wide range of experiences in providing both"supply"methods and clinical methods, such as sterilization (including tubal ligation). Roving sterilization camps have proved effective in Nepal and Thailand, for example, where demand for the procedure was high; they may have backfired in other areas, such as India. Mobile clinic vans have been tried in such countries as Colombia andGuatemala, but their effectiveness and cost-efficiency have not been carefully analyzed. Among the topics the author covers: when to subsidize goods and services, when to introduce new subsidized nongovernmental organization outlets, which regulations may inhibit the expansion of private family planning efforts, how to foster demand for private sector family planning goods and services, and how to promote the private supply of such goods and services.