The Rural Service Delivery Project (RSDP) delivers an essential health services package (ESP) in rural Bangladesh, which includes the provision of family planning (FP), maternal and child health, and general health services through village depots and satellite and static clinics. To increase sustainability, RSDP charges nominal fees for services and supplies ($.03-$.20). RSDP has a built-in “safety net” for the poorest customers, so that no one seeking health services is refused because they cannot pay.
Data from a willingness to pay study, conducted in 2000, were used to determine if the nominal fees act as a barrier to the poor. 53% of the poor reported that they were using a FP method, equivalent to the national average. About 55% of the poorest FP users obtained supplies from RSDP. This compares with 33% of FP users in the highest income bracket, where people are more likely to obtain FP from private sources. While the poor were less likely to seek ANC services overall, 55% of those that went for care did so at an RSDP clinic.
Conclusions: In rural Bangladesh, there is a high demand for FP services across all income categories and the poor are often willing to pay. However, they are less inclined to seek non-FP services, such as ANC and immunizations. It is important to ensure that the poor are offered subsidies or free services when they cannot afford to pay and that they are informed about the services available at RSDP, regardless of their ability to pay.
Learning Objectives: By the end of this session, the participant will be able to: (1) discuss RSDP’s strategy to serve the poor with essential family health services; (2) assess if RSDP’s pricing policy is a barrier to poor people seeking FP and ANC services; and (3) describe strategies to increase the use of services among the very poor.
Keywords: Cost Issues, International Health
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.