No. 3: Reproductive Health Costs Literature Review Elizabeth Mumford, Varuni Dayaratna, William Winfrey, Jeffrey Sine, and William McGreevey (July 1998)  Full Document (English)      Order for free      email to me  The 1994 ICPD expanded the population agenda far beyond family planning. Reproductive health, and the preventive and curative services that could assure it in developing countries, became a key objective accepted by the more than 180 signatory governments. Left unclear were the cost of this expansion and the source of funds to finance it. To fill that cost-estimation gap, the authors reviewed 160 publications issued between 1970 and June 1997, most of them about the time of the Cairo conference. The studies highlighted in this paper offer some quantitative data on the costs of reproductive health services identified as part of the Cairo agenda. In this review, cost data are reported for eight categories of reproductive health interventions: family planning, safe motherhood programs, maternal/infant nutrition and immunizations, obstetric care, abortion/postabortion care, STI/HIV/AIDS, reproductive cancers, and miscellaneous gynecology. The review of family planning cost data is treated differently from other reproductive health interventions. For the seven non-family-planning reproductive health elements, there were about 75 examples (29 studies) of unit cost data. We found only 17 instances of cost-effectiveness estimates (i.e., quantitative relations established between costs and health outcomes) in 15 studies. Furthermore, there were only six studies that referred to inter-disease measures of health outcomes, such as disability-adjusted life-years (DALYs), producing 16 cost-effectiveness estimates. This literature review identifies the gaps in cost information regarding potential reproductive health interventions within the individual reproductive health elements; within geographic regions; and by costing methods. First, about one-half of the expected reproductive health (mostly clinical) services have been costed in at least one setting. Second, only four countries—Bolivia, Ecuador, Mexico, and Zimbabwe—have cost information for more than two services. Third, there is considerable variability in the costing methods applied. Some of the reviewed studies do not clearly report the method used and the assumptions made in calculating the cost results. Nor do they provide all the necessary data to make recalculation of the results possible. Even given valid and replicable measurement, the cost-estimates as presented are generally not comparable because of the lack of a common denominator. This review recommends that "filling the gaps" should be based on local information needs, and that issues of quality, access, and integrated service delivery require closer attention. In addition, the ongoing debate about existing measures of health outcomes suggests that alternative methods for comparing health interventions merit attention. Finally, collecting the cost information available in developing countries (i.e., not in the international literature) would be useful both to local decision makers and others involved in setting priorities and allocating resources for health services.