重新审视巴基斯坦公共部门计划生育服务的成本和利用情况。

Research and Development Solutions, Islamabad, Pakistan.

J Pak Med Assoc. 2021 Nov;71(Suppl 7)(11):S33-S37.

OBJECTIVE

We revisited the costs of Family Planning per woman served per year in the public sector using data from the Pakistan Demographic and Health Survey 2017-18. These costs were estimated previously in 2006-07. The public sector (Population Welfare Department and the Department of Health) accounts for around 35% of all family planning services provided each year. We looked at utilization patterns of public sector family planning services and estimated its costs of FP per woman served per year and cost per Couple Years of Protection (CYP).

METHODS

Pakistan Demographic and Health Survey 2017-18 was used to estimate the number of users of public sector services and their usage patterns. These were depicted using simple tables and with binary logistic regression analysis. National Health Accounts 2012-16 were used to estimate government allocations for family planning. Costs of FP were estimated by simply dividing the allocation by the two public sector departments - Population Welfare (PWD) and Health (DoH) - with the number of users they serve each year. Costs were also depicted per CYP generated.

RESULTS

Both the public and private sectors provide family planning services. The PWD serves an estimated 724,320 clients annually compared to 915,817 by DoH. Together these amount to around 5% of all MWRA, a proportion that remains unchanged over past decade. Due to their very different method mix PWD serves 2,344,411 CYP while DoH serves 988,603. DoH delivers most of its services in the form of condoms and pills which LHWs can carry. The PWD, having increased its range of products as compared to a decade ago, provides condoms, pills, IUDs and tubal ligations. Users of the public sector tend to belong to urban areas (AOR 1.2, range 1.2-1.2), are poor (AOR 2.7, range 2.7-2.7), and tend to have more children (AOR 1.1, range: 1.1-1.1). The exception is that DoH's lady health workers serve a large portion of rural population. Costs of FP per woman per year for PWD are USD 28 and for DOH are USD 14, costs per CYP are calculated are USD 9 and 13 respectively.

CONCLUSIONS

The public sector fills an important niche by serving a poorer population and through rural household outreach. While costs have decreased since 2007, they remain higher than regional averages and suggest significant inefficiencies as both fixed facilities and lady health workers are considerably underutilized.

目的

本研究利用 2017-18 年巴基斯坦人口与健康调查的数据，重新评估了公共部门每服务一名女性的计划生育成本。此前曾于 2006-07 年进行过此类成本估算。公共部门（人口福利部和卫生部）每年提供的计划生育服务约占所有计划生育服务的 35%。本研究观察了公共部门计划生育服务的利用模式，并估算了其每服务一名女性的计划生育成本和每对夫妇生育保护年数（CYP）的成本。

方法

本研究利用 2017-18 年巴基斯坦人口与健康调查的数据来估算公共部门服务的使用者数量及其使用模式。这些数据通过简单表格和二元逻辑回归分析进行展示。本研究还利用 2012-16 年国家卫生账户来估算政府对计划生育的拨款。通过将拨款除以两个公共部门部门（人口福利部和卫生部），并除以他们每年服务的用户数量，来估算计划生育的成本。成本也按照每生成一个 CYP 进行展示。

结果

公共和私营部门都提供计划生育服务。人口福利部每年服务的估计客户数量为 724320 人，而卫生部为 915817 人。这两个部门加起来约占所有 MWRA 的 5%，这一比例在过去十年中保持不变。由于它们的方法组合非常不同，人口福利部提供了 2344411 个 CYP，而卫生部提供了 988603 个。卫生部主要通过能够携带的避孕套和药丸来提供服务。人口福利部与十年前相比增加了产品种类，提供避孕套、药丸、宫内节育器和输卵管结扎术。公共部门的使用者往往来自城市地区（AOR1.2，范围 1.2-1.2），经济条件较差（AOR2.7，范围 2.7-2.7），且往往有更多的孩子（AOR1.1，范围：1.1-1.1）。例外的是，卫生部的女卫生工作者为大量农村人口提供服务。人口福利部每服务一名女性的计划生育成本为 28 美元，卫生部为 14 美元，每 CYP 的成本分别为 9 美元和 13 美元。