Charging Fees for Family Planning Services

Governments in the developing world pay for between 63 and 75 percent of all family planning costs, international donor agencies pay for between 15 and 20 percent, and the clients themselves pay for between 10 and 17 percent of the costs of services [Lande and Geller 1991]. But, as the demand for family planning services continues to increase, governments and donors will find it increasingly difficult to cover the costs of providing these services. Recognizing this problem, family planning organizations are beginning to look at other ways to fund their health and family planning services. As part of this effort to find new sources of revenue, many managers are asking the question, “Should family planning programs charge fees for services?”

Surprisingly, some studies indicate that continuation rates do not decline when fees for services are introduced. In fact, they show that contraceptive use rates often remain the same even after moderately priced services are introduced. Other experiences indicate that introducing fees may actually improve the quality of services and make the client a more responsible contraceptive user [Ashford 1992].

This edition of The Family Planning Manager looks at the pros and cons of charging for services. It reviews how managers can assess the feasibility of charging their clients for services, and how to overcome resistance to introducing fees. It then reviews the basics of developing a system for charging client fees, and concludes by outlining a basic system for managing fees.