Reproductive health costs : literature review

Left unclear was the cost of this expansion and the source of funds to finance it. To fill that cost-estimation gap, this report reviews 160 publications issued between 1970 and June 1997, most of them about the time of the Cairo conference, and reports cost data for eight categories of RH interventions: family planning (FP), safe motherhood programs, maternal/infant nutrition and immunizations, obstetric care, abortion/postabortion care, sexually transmitted infection/HIV-AIDS, reproductive cancers, and miscellaneous gynecology; FP cost data is treated differently from other RH interventions. For the seven non-family-planning RH elements, there were about 75 examples (29 studies) of unit cost data. Only 17 instances of cost- effectiveness estimates (i.e., quantitative relations established between costs and health outcomes) in 15 studies were found. Furthermore, only six studies referred to inter-disease measures of health outcomes, such as disability-adjusted life-years (DALYs), producing 16 cost- effectiveness estimates. The gaps in cost information regarding potential RH interventions are reviewed within the individual RH elements; within geographic regions; and by costing methods. Findings are as follows: (1) About one-half of the expected RH services (mostly clinical) have been costed in at least one setting. (2) Only four countries -- Bolivia, Ecuador, Mexico, and Zimbabwe -- have cost information for more than two services. (3) There is considerable variability in the costing methods applied. Some of the reviewed studies do not clearly report the method used and the assumptions made in calculating the cost results, nor do they provide all the necessary data such that recalculation of the results is possible. Even given valid and replicable measurement, the cost-estimates as presented are generally not comparable because of the lack of a common denominator. This review recommends that "filling the gaps" should be based on local information needs, and that issues of quality, access, and integrated service delivery require closer attention. In addition, the ongoing debate about existing measures of health outcomes suggests that alternative methods for comparing health interventions merit attention. Finally, collecting the cost information available in developing countries (i.e., not in the international literature) would be useful both to local decision makers and others involved in setting priorities and allocating resources for health services. (Author abstract, modified)