1. Type of provider/facilities Private Sector Providers
Reducing Out-of-pocket Expenditure to reach adolescents with Family Planning Services: Experiences from a pilot project in Yangon, Myanmar
May Me Thet, Swai Mon Oo, Myint Myint Win, Phyo Myat Aung and Manuela Tolmino
Population Services International Myanmar
The mean cost for getting a contraceptive service at pilot GP clinics was 700 Myanmar Kyats less than that of non-pilot GP clinics (p<0.001), 50.4% reduction from (1.07 USD) to (0.53 USD) Myanmar Kyats.
As contraceptive injection is the most common service taken by the adolescents, mean cost for having an injection service was also compared between the two groups.
The mean cost for receiving a contraceptive injection at the pilot clinics was Myanmar Kyats less than that of GPs (p<0.001), 50.8% reduction from (1.06 USD) to (0.52 USD) Myanmar Kyats.
BACKGROUND
Family Planning in Myanmar
Myanmar has achieved high modern contraceptive prevalence rate at 51%1 but there is still unmet need for many women and adolescent girls. Reproductive health (RH) services are often available but inaccessible for adolescents in Myanmar. One of the barriers to access reproductive health services was reported to be financial aspects in sub-urban areas of major cities2. PSI/Myanmar has launched a strategic purchasing pilot to improve access to voluntary family planning (FP) services in selected townships while reducing the financial barrier.
PSI/Myanmar’s Strategic Purchasing Pilot
Due to chronic under-investment in health, private sector plays an important role in Myanmar. Out-of-pocket expenditure (OOPE) on health is high (over 70%). The Government of Myanmar is currently on its way to achieve Universal Health Coverage as determined by National Health Plan (2017 – 2021) 3. To support the Government of Myanmar, PSI/Myanmar’s pilot aims at providing primary health care services through 5 private GPs partnered with PSI/Myanmar by introducing a new financing mechanism in 2 townships of Yangon through a capitation payment system.
Capitation payment is a fixed sum of money pre-paid by the project to the provider to manage the health care needs for all individuals registered with that provider for an agreed package of services over a period of time. The package include FP, communicable and non-communicable diseases, services targeting children under five and general illness.
TABLE 1: TYPE OF DIFFERENT FACILITIES AND PROVIDERS FOR FAMILY PLANNING SERVICES
Type of provider/facilities N %
Private Sector providers
168
93.9
Public Sector providers 1
0.6
Charity Clinics 3
1.7
Non-facility based providers 7
3.9
Total
179
100
TABLE 2: TYPE OF PRIVATE SECTOR PROVIDERS FOR FAMILY PLANNING SERVICES
Private Sector Providers N %
Pharmacy 56
33.3
Non-pilot GP Clinics 84
50.0
Pilot GP clinics 28
16.7
Total
168
100
METHODOLOGY
A cross-sectional study aimed to evaluate whether the capitation payment system can reduce the out-of-pocket expenditure (OOPE) after six months from the launch of the pilot was conducted. A household survey with a sample size of 1000 households was conducted in October and November Face-to-face interviews were conducted with respondents using structured questionnaire. Criteria for recruitment were any woman receiving a FP service within a specific period: daily pills within past month, 3-month injection within past 3 months, or IUD and implant within past 1 year. Data collection tool included sections on demographics, types of FP service obtained, source of FP service and related costs.
The analysis focuses on examining the cost related to FP services paid by adolescent populations that attended two similar types of private clinics in pilot townships.
Cost analyses was conducted to reflect the study objectives and it examined cost paid by women at PSI/Myanmar pilot clinics and non-pilot clinics. Cost calculation covered both medical and non-medical costs (i.e. transportation). Cost is expressed in Myanmar Kyats (exchange rate 1 US$=1300 Myanmar Kyats). Descriptive analyses were done for presenting percentages and T-test was used for comparing mean FP costs. Statistical significance was set at p=0.05. Stata Statistical Software, version 14.0 was used for analysis.
Ethical approval was obtained by PSI Research Ethics Board and Department of Medical Research Myanmar.
FIGURE 1: MEAN COST COMPARISON BETWEEN PILOT AND NON-PILOT GP CLINICS
P<0.001
P<0.001
LIMITATION
RESULTS
One limitation of the study is that the cost data was taken as the respondents reported and it was not directly from the providers’ clinics or facilities. So there may be recall bias with the cost paid by women.
Of the 219 adolescents who participated in the survey, 179 (81.7%) received FP services. Different FP methods used were 3-month injection (60.9%), daily pills (35.8%), IUD (1.7%) and implant (1.7%). Different types of providers that provided the FP services were private sector mainly 168 (93.9%), public sector 1 (0.6%), charity clinics 3 (1.7%) and non-facility based providers 7 (3.9%).
Among all types of private facilities, 84 (50 %) of adolescents received the contraceptive services from GP clinics while 28 (16.7%) did from the pilot clinics and 56 (33.3%) from pharmacy. The cost of having a contraceptive service at pilot GP clinics and non-pilot GP clinics was compared because they are similar in provider qualifications and service availability.
CONCLUSION
Based on the findings women can access quality family planning services with reduced cost at PSI/Myanmar pilot clinics
By contracting the GPs with a capitation system, the OOPE on FP services in the adolescent population can be reduced
The findings highlights that supporting private sector GPs financially might benefit adolescents to access quality FP services without financial hardship
References
Myanmar Demographic and Health Survey (2015 – 16)
Thin Zaw, P. P., Liabsuetrakul, T., Htay, T. T., & McNeil, E. (2012). Equity of access to reproductive health services among youths in resource-limited suburban communities of Mandalay City, Myanmar. BMC Health Services Research, 12,
Myanmar National Health Plan (2017 – 2021)
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