Strengthening the financial sustainability of two population services and training center (PSTC) clinics

Nominal fees are paid for these services that cannot sustain services. Donors requested that PSTC reduce dependency on external financial support by increasing cost recovery, while the Government of Bangladesh (GOB) restricted PSTC"s right to collect service fees for vaccination (EPI), tetanus toxoid (TT), and family planning (FP) services. The objective of this study was to conduct an operations research (OR) study to determine the feasibility of improving cost recovery in two clinics by raising prices Cost and income information were to be collected during the study. A willingness to pay survey (WTP) was conducted prior to the price increase to estimate feasible price increase levels. Collection of cost data could not be completed as planned as estimation of costs had serious validity problems. Consequently, the WTP survey did not obtain the required number of interviews. Widespread exoneration of fees was practiced by the clinics without proper documentation, thus the impact of price increases on demand could not be judged. The study was not implemented correctly and so the results cannot be considered valid. It appears that the study design was too ambitious for PSTC, a service delivery organization with no prior research experience. Lack of experience was compounded by the resignation of all three PSTC research staff during the study, and by turnover of economists providing technical assistance from FRONTIERS staff at Population Council/India and Family Health International. (Author abstract)