Effectiveness and Cost-Effectiveness of Family Planning in the Philippines by Eric R. Jensen. East-West Center Working Papers, Population and Health Series, No. 97. January 1998. 28 pp.

Abstract

This study uses the 1993 National Demographic Survey (NDS) to examine issues of contraceptive effectiveness and cost-effectiveness in the Philippines. Sterilization and IUDs are attractive alternatives on both cost and effectiveness grounds. However, while sterilization is widely used in the Philippines, the pill is far more popular than the IUD, and injectable contraceptives are gaining in popularity. These "resupply" methods are relatively expensive, and, because they require positive action on the part of their users, they are more prone to failure than are sterilizations or IUDs. Users demand resupply methods, however, and a "cafeteria" of methods is generally thought to be one indicator of service quality. Therefore, resupply methods are likely to play important roles in most national family programs, including the program in the Philippines.

Focusing on pills, the analysis indicates substantial performance differences among outlets delivering the same contraceptives to comparable populations. Women who most recently obtained pills from public hospitals tend to have poor success in avoiding pregnancy, with much shorter predicted birth intervals than those of comparable women supplied from barangay (local administrative unit) health stations or rural health units. Private clinical facilities (hospitals, clinics, and doctors' offices) and pharmacies hold an intermediate position in terms of their effectiveness as sources of pills, measured by predicted birth intervals.

On the basis of numbers of contraceptives distributed, public hospitals appear to be a cost-effective provider of all methods. However, if effectiveness is measured in terms of impact on fertility, public and private hospitals and private clinics are much less effective than barangay health stations or rural health units. To the extent that service provision is constrained by demand, rather than supply, allocation of resources toward these poorly performing facilities will lead to increased fertility. On the other hand, women who currently obtain pills from barangay health stations or rural health units might be encouraged to switch to less labor-intensive sources (such as community-based distribution) for their pill supplies, without a rise in fertility, if such policy opportunities arise.

NDS results also provide evidence that different sources of contraceptive pills attract different types of clients, and this, in turn, affects the observed performance of the sources. For example, women who obtain pills from private clinical facilities tend to have birth intervals that are slightly longer than those of women who obtain pills from barangay health stations but shorter than those of women who obtain pills from rural health units. The data suggest that the performance of the private clinics is related to the characteristics of their clients, who tend to be wealthier and better educated than the clients of the two public sources and thus are likely to use pills successfully to extend their birth intervals. An analysis that separates the effects of the sources from the characteristics of the clients indicates that private clinics actually contribute less than barangay health stations or rural health units to helping pill users extend their birth intervals.