DMPA provision in PSS clinics in Uttar Pradesh: costs and prices.

The effect of price on demand for the injectable contraceptive depot medroxyprogesterone acetate (DMPA) was assessed in three family planning clinics operated by Parivar Seva Sanstha (PSS) in Uttar Pradesh India. Since April 1996 DMPA has been available at no charge at the Varanasi clinic and for Rs. 50 in Agra and Rs. 100 in Lucknow; the wholesale cost is Rs. 95. All three sites charge a medical fee of Rs. 40 at the initial visit. DMPA-related client visits encompass clients seeking information on DMPA first-time DMPA users continuing users and those seeking relief from method-related side effects. DMPA administration including supplies accounts for 75-82% of the total cost of services to new clients. Annual revenues were approximately Rs. 13080 in Varanasi Rs. 25540 in Agra and Rs. 29160 in Lucknow. Maximum annual costs (excluding advertising) were Rs. 52621 Rs. 51359 and Rs. 36213 respectively. Maximum advertising costs were Rs. 102004 Rs. 107700 and Rs. 96604 respectively. Under current pricing strategies only the Lucknow clinic has the potential for a positive balance between revenues and costs. However at prevailing DMPA prices PSS could have an overall positive balance of Rs. 8180 per 100 clients if advertising costs were wholly subsidized by a donor. Other options to reduce costs include sharing costs for advertising with related health services or restricting publicity to selected media. Most effective however would be a reduction of the wholesale cost of DMPA to Rs. 35. This way both the Agra and Lucknow clinics would generate income. PSS is urged to work with potential suppliers to reduce costs of DMPA before expanding service delivery.