_Private sector coverage of thefanmily planning market_ _23_ TABLE 4 Productivity and cost recovery among five selected Peruvian NGOs (in percentages)

||||AGENCY|||
|---|---|---|---|---|---|
|CATEGORY|A<br>(Lima)|B<br>(Lima)|C<br>(Lima)|D|E|
|CENTRAL CLINIC<br>Capacity utilization|<br>76<br>|54<br>|63<br>|66<br>|32<br>|
|Cost recovery|42|48|9|84|6|
|MEDICAL POSTS||||||
|Capacity utilization|<br>99|78|57|52|35|
|<br>Cost recovery|<br>3|7|3|4|6|

NGOs are listed in order of installed capacity. The first-listed and largest agency is the Peruvian IPPF affiliate. As can be seen, none of the clinics were operating at full capacity (defined as 85 percent utilization of space and staff), and only two agencies warranted expansion of their rotating medical posts based on current utilization. None of the rotating posts could be expected to recover more than 7 percent of its costs. It is clear that at the time of the study, none of the NGOs was remotely close to selfsufficiency and that raising productivity without simultaneously raising prices and/or lowering costs would have little impact on cost recovery. The near-total operating subsidies were justified on the grounds of equity, although the degree to which services were targeted exclusively to the poor could also be questioned.

NGOs see their role as serving clients who are unable to pay commercial prices for family planning. The ability of clients to pay for goods and services received is a great unknown, due to the lack of information about client income and purchasing patterns. None of the NGOs studied collected these data, but information was available for two proxy variables-education and place of residence.

Client education and residence data were collected for the three programs in Lima. For the IPPF affiliate, client records showed that 87 percent of the clinic clients and 59 percent of the rotating post clients had a secondary education or higher, which would suggest that they could afford to pay at least part of the cost of the services they received. In ternis of residence, 85 percent of the clinic clients and 27 percent of the post clients did _not_ live in marginal urban areas ('pueblos jovenes"). Combining the two variables, 79 percent of the clinic clients and 19 percent of the post clients both had at least a secondary education and did not live in rarginal areas and thus probably did not need the near-total subsidy they received from the program. The other two NGOs also served many clients whose educational levals and/or place of residence suggested that thew could afford to pay more than they were being charged, although their incomes were probably lower than the clients served by the IPPF affiliate.

These findings were corroborated by results of a survey conducted in two of the NGOs (INANDEP, no date). Clients were asked where they sent their children to school: 40 percent of the clients of the IPPF affiliate with school-age children used private schools, as did 15 percent of the clients of the other NGO. Although private school tuition in Peru is relatively low, nevertheless, a family that can afford private tuition should still be able to pay for a larger portion of family planning services than was being charged by the NGOs. (A third, self-supporting, NGO was included in the survey; on all indicators its clients showed lower income levels than the clients served by the heavily subsidized IPPF