Increasing efficiency to meet future demand: Family manning services provided by the Mexican Ministry of Health

Context: With fewer external funds for family planning programs and a growing reliance on the public sector for services, developing countries will need to find new resources if they are to maintain existing levels of service. By estimating the costs of services and evaluating the service delivery system for inefficiencies, a better understanding of future resource needs can be achieved. Methods: Data for this study were collected in 1996 at 82 Mexican Ministry of Health facilities, which included observations of providers and ancillary information for estimating costs of services. The cost per minute of provider labor was used to estimate the cost of various types of family planning visits and the cost per couple-year of protection for different contraceptive methods. Some service delivery parameters were modified hypothetically to estimate the effects on costs. Results: Mexico's Ministry of Health is currently spending approximately $29 per person per year on contraceptive services. As demand increases, the system can be made more efficient by increasing the length of providers' workday and the proportion of time they spend with clients, and by dispensing more contraceptive protection at each visit. Increasing the proportion of time a provider spends with clients will reduce the cost per couple-year of protection for all methods. Doubling the number of pill cycles distributed during a visit reduces the cost per couple-year of protection from $27 to $19. Providing twice as many condoms per visit reduces the overall cost per couple-year of protection from $29 to $19. If providers lengthen their workday increase the amount of time they spend with clients and dispense more contraceptives during a visit, the overall cost per couple-year of protection would decline from the 1995 level of $29 to $22 by 2010. Conclusions: Correcting the service delivery inefficiencies that exist in their current system should enable the Mexican Ministry of Health to meet the rising demand for services without expanding current programs through the next decade.