Cost recovery and user fees in family planning.

This paper presents major issues to consider when assessing whether and what type of user fees would be appropriate in a family planning program. It is intended to be used by project personnel as a guide in designing analyses or initiating activities designed to increase sustainability of family planning services. It is concluded that total program revenue will increase only if user fees supplement rather than replace public subsidies. The authors suggest reducing subsidies by a percentage of revenue collected from users fees in the interest of financing service expansion. Fees must generally be kept and used at the operational level where they are collected or else service providers and administrators will have little incentive to collect them. Revenues can be allocated equally among all services where fees are collected uniformly for all services. The authors argue against charging for family planning services and not other preventive health care services. Family planning is a low-cost service. If differential fees are instituted however revenues generated by family planning should be returned to the sector especially if separate charges are made for commodities. Full cost recovery for family planning services will probably not result in most developing country public health systems due to low demand. Family planning will therefore be a recipient rather than a source of most cross-subsidization programs.