Abstract

This paper explores two programs designed to address concerns with costs and coverage of the current family planning home service delivery programs in Bangladesh. One program employs part-time workers and is designed to reduce the costs of providing contraceptive services to women in their homes. The second program uses volunteers in addition to full-time paid workers in order to improve coverage of households and therefore program effectiveness. These programs are compared with the traditional programs run by both the government and various non-governmental organizations (NGOs) that are designed to replace or supplement them. Observation of workers provided information on their work performance, including time worked and activities accomplished. Our results show that the NGO program using part-time workers is far less costly than the typical NGO program employing full-time workers, but that it provides poorer coverage and lower quality of services. The program that uses volunteers to increase household coverage is costlier than is the typical government program and is no more effective in terms of the number and quality of visits to eligible couples. Moreover, the contraceptive prevalence rates where volunteers supplement field workers are very similar, suggesting that outcomes for the two programs are the same. Apparently the presence of volunteers allows full-time workers to decrease their workload. Financial sustainability can be increased by substituting part-time for full-time workers. Use of volunteers does not increase coverage though it increases costs. [To view this article, please download the PDF.]