TCI Helps Address Family Planning Cost Barriers in Cotonou and UCOZ, Benin, with Standardized Pricing

Contraceptive method harmonization meeting in Cotonou.

As in most of Francophone West Africa, the cost of family planning services in Benin is a huge barrier to the uptake of family planning services. This is why FP special days – designated days when health centers offer free family planning services – are so successful. But because it is not always feasible to offer free services in the region, it is critical to have standardized costs or pricing schedules for commodities and services.

While family planning commodities in Cotonou and the Union of Communes of Zou (UCOZ) come from the same source – apart from a few private facilities where the products are subsidized by Population Services International – the Coordinating Body of Doctors and Obstetric Care Managers found significant differences in commodity costs from one health zone to another. For example, long-acting reversible contraception (LARCs) (e.g., implants and IUDs) can cost up to 2,000 FCFA (or $3.75 USD). This may not sound like much but is cost-prohibitive when the minimum monthly wage in Benin is around $74.00 and monthly rent for housing can cost anywhere between $65.00 and $400.00 in cities. Short-term methods (e.g., injectables) reach 1,000 FCFA (or $1.86). It is the same for removal, which can reach 2,000 FCFA for implants and 1,000 FCFA for the IUD. Landry Gansou, the family planning/adolescent and youth sexual and reproductive health (AYSRH) focal person for Cotonou, shared:

Some providers used to influence the cost of consumables, which means that the adoption of contraceptive methods was more expensive for women. Apart from that, some private health centers set the price of contraceptive methods according to how well-known and popular they are, their location in the city and how long they have been providing services.”

To remedy this situation, The Challenge Initiative (TCI) recommended that the program coordinating bodies established to oversee TCI implementation – as well as the focal points in municipalities and health systems – conduct a series of cost harmonization meetings. Administrators and management team members of the health regions in UCOZ and Cotonou were invited to present the prices charged by both public and private health facilities. At the end of these presentations, all stakeholders agreed to harmonize prices to improve access to family planning services among women of reproductive age.

Despite this agreement, the first cost reduction proposals made by the health system were not enough to address the concerns of all stakeholders. Community representatives – including the Presidents of the COGECS (Management Committee of Health Centers) and town hall representative who had previously received managerial and advocacy coaching from TCI – called for reduced costs for both the adoption and removal of LARCs to more affordable prices.

Thanks to the advocacy efforts carried out by the Young Transformational Leaders (JLT) of UCOZ and Cotonou towards the Departmental Directors of Health of Zou and Littoral, the authorities finally agreed to standardize the costs. The JLT President of UCOZ, Armand Guehou, shared:

Today at UCOZ, with 1,000 francs, a woman can adopt a long-term contraceptive method, whereas a few weeks ago, it cost double this amount.”

The new costs per contraceptive method, which were enacted in early 2021, can be found in the table below, compared to the previous costs.

As shown in the table, the price of long-acting methods fell by 50% in UCOZ. The cost for removing implants and IUDs was reduced by 80% in UCOZ. The Departmental Director of Coastal Region Departmental Health Director, Dr. Mathilde Adjoavi Houssou, said:

The disparity in the costs of providing FP services has been a problem in Cotonou for a long time. We have often asked health regions to apply the same rates to contraceptive methods used in health centers, but this recommendation has not been followed until now. And as TCI’s interventions cover the entire department and this opportunity presented itself, we took the opportunity to solve the problem once and for all. Through this memo, we will be able to apply the resolutions of the cost harmonization meeting initiated by TCI to all health centers – public or private.”

The hope is that this decision will inevitably increase the use of contraceptive methods by women of reproductive age, including adolescents and youth, because a health center that doesn’t follow these rates will be subject to financial penalties.