_Private sector coverage of the family planning market_ _19_

# BOX: A TIPPS Project in Peru

The TIPPS project conducted a study of the potential costs and benefits of providing family planning to employees and spouses at Milpo Mining Company, located in the interior of Peru. The study found 35 percent contraceptive prevalence among married women and a general marital fertility rate of 221 births per 1000 married women. The company paid only US$50 per birth in maternity care, but deferred benefits for medical care, housing, and schooling averaged over US$4,000 per child. It was estimated that providing family planning could raise contraceptive prevalence to 72 percent and improve method mix. Achieving this target would produce a 74 percent fertility decline by the fifth year of the program, for annual savings of $11,000 in immediate costs averted plus future costs averted. Program costs would total about $14,000 in the first year and about $8,000 thereafter. The program would generate a positive cash flow in the third year and recover its initial investment in the sixth year.

A unique feature of the Milpo study was the addition of a child survival module. It was fount" that the company could achieve significant savings in expenditures for pharmaceuticals by instituting well-baby care and appropriate treatment of diarrhea and respirr tory infection among children under age five.

As a result of the study, Milpo initiated integrated family planning/MCH services in 1988. All costs have been paid by the company. Milpo hired an additional physician and nurse educator and contracted with two local NOOs for training and supervision. TIPPS brokered the original training and supervision contracts and provided occasional technical assistance in program coordination. In the first 20 months, vaccination coverage among children under age five rose from 5 percent to 75 percent, and almost all children under age one were enrolled in growth monitoring. Standardized diagnostic and treatment protocols for acute diarrheal and respiratory infection were implemented. The annual wholesale value of savings in pharmaceuticals was estimated at US$ 5,000 (Foreit et al. 1991a).

In less than two years, contraceptive prevalence rose from 34 to 48 percent, and use of modern methods more than doubled. Thirty-one percent of the wives of reproductive age accepted IUDs in 1989, accounting for 11 percent of all IUD acceptance in the Lima/east health region (Foreit et al. 1991b). Fertility rates did not decline in the first years, but pregnancy rates appeared to be declining. (Initiating family planning should have no impact on fertility during the first year of operations, since the services would not interrupt pregnancies conceived before the program began).

The Milpo model was promoted among other mining companies in the area. Top management and medical staff from Milpo met with their counterparts from five mines to describe their experiences with the new services. Two mines added the family planning/MCH services with existing medical staff and contracted for training and supervision. Two other mines expressed interest in adding the services as soon as their economic conditions improve.