An economic appraisal of alternative strategies for the delivery of MCH-FPservices in urban Dhaka, Bangladesh

The strategy of distributing maternal and child health and family planning (MCH-FP) services at the doorsteps of the clients-through routine visits to the eligible couples by trained fieldworkers-has been instrumental in incr easing the contraceptive prevalence rate (CPR), reducing fertility and atta ining a considerably high immunization coverage of children and women in Ba ngladesh. The doorstep strategy, however, appeared to be labour-intensive a nd costly. With the maturity of the programme, priorities of the national M CH-FP programme have shifted to a stage that calls for more cost-effective service-delivery strategies, capable of offering a broader package of repro ductive and other essential health services. The main objective of the pres ent study was to examine the cost and effectiveness implications of the alt ernative strategies of delivering services from fixed sites-field-tested wi thin an ICDDR,B operations research-in comparison to the conventional (exis ting) doorstep strategy. The key findings of the economic appraisal indicated that, at the end of th e operations research intervention, both cost per birth averted and cost pe r QALY gained were lowest for the option of delivering services from static (fixed-site) clinics: US$13 and US$17 compared with the corresponding valu es of US$18 and US$42 for the doorstep strategy. Provision of health and fa mily planning services from clinics-complemented with a reduced system of o utreach workers to inform and target the hard-to-reach clients-was found to be the most cost-effective service-delivery alternative. Copyright (C) 200 0 John Wiley & Sons, Ltd.