Efficient Family Planning for Third World?

CHARITIES, says Philip Harvey, should have a bottom line. They should be concerned about efficiency and effectiveness, keeping the cost per service delivered to a minimum. Mr. Harvey has applied that thesis at Population Services International (PSI), a nonprofit organization he cofounded in 1969 to help developing countries with their family-planning programs.

Family planning itself is a highly cost-effective way of helping development in third-world countries, he says. By limiting the number of births, it reduces the burden to government of providing new schools, hospitals, and other facilities needed for raising children. Parents can better feed, clothe, and otherwise care for their fewer children.

What's more, PSI has devised a cost-effective, business-like way of distributing contraceptives in developing countries, says Harvey. He calls it a ``social-marketing program.''

PSI currently helps run birth-control programs in Bangladesh, India, Pakistan, and Zaire. It has a pilot program in Kenya, is test marketing in Nigeria, and has been talking with governments in Morocco, the Congo, Guinea, and Burundi about programs.

In its programs, PSI uses the resources and know-how of modern business in getting contraceptives to couples. It surveys markets, studies shopping habits, and applies advertising, packaging, and promotional skills. It enlists the support of community leaders. It works through existing distribution and retailing channels.

In Bangladesh, for example, PSI sells condoms through 100,000 outlets, often small retail stalls that may also be selling soap, tea, salt, batteries, or whatever. The outlets are located conveniently for even those living in small villages. The condoms are advertised. They are subsidized to keep their cost low. PSI's salespeople are paid commissions according to their sales success.

Birth-control pills are more likely sold through pharmacies.

The result, says Harvey, is an extremely low-cost method for providing birth-control services, five times less than setting up specific clinics throughout a developing country.

As a yardstick for measuring the effectiveness of family-planning programs, the various birth-control techniques can be converted to a measure called ``couple years of protection'' (CYP). From that, costs per CYP can be calculated.

PSI's delivery of contraceptives costs approximately $2 a CYP, about the same as sterilization. These two methods are by far the most cost-effective programs of those currently being funded by international donors, says Harvey, who is executive director of PSI.

PSI has a budget this year of more than $5.8 million. The United States Agency for International Development (AID) provides about $5 million of this, plus some $7 billion in contraceptives.

The US has been spending about $200 million a year for the last five years on birth control. Harvey holds that AID spends too much of that money on research and reports, rather than actually delivery of family-planning services. The World Bank and United Nations agencies, which also fund family-planning programs, are handicapped by the need to work only with central governments. These governments have proven to be inept in providing family-planning services, he charges.

With its money, PSI programs have managed to reduce births by about 500,000 a year, estimates Harvey. That compares with about 85 million births a year in the entire world.

``It is something, and it is not easy to get that far,'' he says. ``But we need 100 programs like this.''