Private sector approaches to
            effective family planning
Even if per-user costs are controlled or
            reduced, the rising demand for family planning services will
            far outstrip governments' and donors' financial
            resources in most parts of the developing world. This
            "resource gap" lies at the heart of
            donor-sponsored initiatives to involve the private sector in
            family planning, but there are other equally good arguments
            for doing so. Governments and donors are often unaware of
            how much the private sector (especially the commerical
            sector) already participates - and could participate - in
            family planning. The author discusses why the private sector
            should be involved in planning, how the private sector
            should be defined, what the experience has been so far with
            private sector involvement, and what might be expected in
            the future. To support family planning in the private
            sector, the author recommends that donors: (1) expand the
            total family planning market to help satisfy existing and
            future unmet needs for contraception; and (2) shift current
            users from subsidized to more nearly self-supporting outlets
            - without compromising coverage, equity, or quality of care.
            The kinds of private sector activities that donors should
            support depend in part on which contraceptive methods are to
            be emphasized. Nonclinical systems, for example, are the
            most efficient way to distribute supply methods (for
            example, oral contraceptives and condoms), as long as
            medical backup is available for women who suffer side
            effects or who wish to switch to another method. These
            systems of distribution free up scarce resources in clinical
            facilities and the time of limited medical personnel for the
            resupply of contraceptives. However, if sterilization is to
            be emphasized, a close link with existing hospital
            infrastructure is necessary. Nonclinical distribution favors
            commercial systems in urban and periurban settings and
            community-based distribution systems (either public or
            private) where commercial networks break down. Price
            subsidies might be considered in areas served by commercial
            systems, but where consumers cannot afford prevailing
            commercial prices. The author discusses a wide range of
            experiences in providing both "supply" methods and
            clinical methods, such as sterilization (including tubal
            ligation). Roving sterilization camps have proved effective
            in Nepal and Thailand, for example, where demand for the
            procedure was high; they may have backfired in other areas,
            such as India. Mobile clinic vans have been tried in such
            countries as Colombia and Guatemala, but their effectiveness
            and cost-efficiency have not been carefully analyzed. Among
            the topics the author covers: when to subsidize goods and
            services, when to introduce new subsidized nongovernmental
            organization outlets, which regulations may inhibit the
            expansion of private family planning efforts, how to foster
            demand for private sector family planning goods and
            services, and how to promote the private supply of such
            goods and services.