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# _7h Madab Project_

The cost estimates provided above (bookkeeping costs) represent those under the assumption of an experimental design model (Model I) under which the Treatment and Comparison Areas theoretically differ only by the presence of MCH-FP Project In the Treatment Area. The Model I has the following two deficiencies: (i) the cost estimates do not include the government's expenditures on compensation fees to clients served by the MCH-FP Project and (ii) they include the cost incurred by the Project in the Comparison Area and some non-Project areas. The MCH-FP is responsible for paying about 10 percent of the services provided by the Comparison Area. The revised set of estimates which adjusts the bookkeeping costs by adding the costs of the compensation fees is called "adjusted costs-l" of model H1. The second set of estimates that subtracts the costs of externally provided clinical services from "adjusted costs-l" is called "adjusted costs-2" of Model H. From 1978 to 1985, the total core service cost under "adjusted costs-l" of Model I was $1,268,019, and the total core service cost under "adjusted costs-2" of Model UI was $1,198,162.

The adjusted cost-I and the adjusted cost-2 under Model II have been estimated assuming no cost of government workers assigned to the Treatment Area. According to the Model MA which modifies the adjusted cost-2 by taking account of the full costs of government workers in the Treatment Area, the total core service cost in the Treatment Area when external effects generated by the MCH-FP are not included is estimated to be $1,382,852. When the full cost of government workers in the Treatment Area is included in the adjusted cost-i (external effects included), the total core service cost estimate in the Treatment Area becomes $1,452,702. The total cost service costs in the Comparison Area are estimated to be $403,867 when external effects are included (Model HA) and $388,489 when external effects are not included (Model TUB). Thus whatever models are used for estimation, the total core service cost in the Treatment Area is more or less three times as great the cost in the Comparison Area.

The cost-effectiveness of the Project has been measured in terms of the average core service cost per contraceptive user and per birth prevented. The estimated cost-effectiveness ratios in the Treatment and Comparison Areas under different models are given in Table 5.

The above table shows that the cost per birth prevented by the MCH-FP Project in the Treatment Area ranges from $158 to $220, on the average, during 1978-85, depending on the range of activities, effects, and the study design used to estimate the cost-effectiveness. The corresponding cost in the Comparison Area ranges from $240 to $298 during the same period. The average cost per contraceptive user is also less in the Treatment Area for most of the models used for estimation. Thus although the total core service cost in the Treatment Area is about three times as great the cost in Comparison Area, the services in the former are more cost-effective than in the latter.

The method-mix of contraceptive prevalence is an important factor in interpreting the difference in the cost per birth prevented between the Matlab Project and the Bangladesh government family planning program. The cost of birth prevented by sterilization is substantially less than by reversible methods. For example, Simmons et al. (1986) estimated that, in 1983, the cost of a birth prevented was $45 for sterilization and $125 for reversible methods. For the sake of comparison, the cost per birth prevented (for all methods) in the Treatment Area of Matlab Project was $165 in 1982 and $163 in 1983, according to Model I. With the adjustment in Model H, the cost per birth prevented was $122 in 1982 and $145 in 1983. The ratios are not very different from those of the government program for reversible methods. This indicates that as the