|The Female Condom: a guide for planning and programming under (UNAIDS, 2000, 81 p.)|
This Section highlights recent findings from cost-effectiveness research and provides a guide to determining cost-effectiveness in programmes.
Perhaps the most important new research to emerge about the female condom is that it may be cost-effective to provide the female condom in reproductive health programmes. Particularly in target g roups that practise high-risk behaviours, female condom programmes can even be cost-saving. Family Health International (FHI), The Female Health Company (FHC), Health Strategies International (HSI), the Institute of Health Policy Studies at the University of California, the London School of Hygiene and Tropical Medicine, Population Services International (PSI) and UNAIDS have all been engaged in research to measure the cost-effectiveness of introducing the female condom into reproductive health programmes.
The findings from these various studies indicate that the female condom can be a cost-effective addition to prevention programmes. This cost-effectiveness is maximized under the following conditions:
1. Targeting in high-prevalence areas
Not surprisingly, the female condom becomes increasingly cost-effective and even cost-saving as the level of risk of STIs and HIV/AIDS increases among users and their partners. By targeting sex workers and other women and men with multiple sexual partners, the female condom can be not only cost-effective but also cost-saving to the health care system.
2. Providing the female condom in combination with the male condom
The purpose of introducing the female condom into national reproductive health programmes is to increase the number of protected sexual acts, decrease the incidence of STIs and HIV/AIDS and unintended pregnancy, and thus decrease the associated costs. Because the female condom has a higher unit cost, the female condom should be targeted at populations that already have ready access to the male condom or are not able to use the male condom consistently. By focusing on these groups, female condom use increases the number of protected sexual acts without necessarily decreasing male condom use.
3. Incremental increase in protection
The experience from family planning programmes over many years highlights the importance of simply expanding peoples choice. The addition of contraceptive methods to the options available to people produces incremental increases in contraceptive prevalence. Similarly, the addition of the female condom to the options for safer sexual behaviour has produced incremental increases in protected sexual acts.
Source: John Edwards
Recent research indicates that the female condom may not be
only a cost-effective but also a cost-saving addition to prevention programmes,
particularly when specifically targeted at groups that practise high-risk
Determining cost-effectiveness for new programmes
Policy-makers need to consider a number of issues when determining the level of investment in female condom activities:
· fertility and disease epidemiology in specific vulnerable populations
· socio-economic conditions related to risky sexual behaviour
· gender relations
· the current capacity of public and private sector service delivery systems
· the extent to which the male condom is already being used; and
· the advantages and disadvantages of the female condom relative to the male condom.
Additionally, decisions related to resource allocation will have to be taken within the context of socio-cultural dynamics that may have a significant impact on ultimate use of the female condom. These mitigating influences might include the extent to which men and women agree to use the female condom (i.e. familiarity with their anatomy and comfort in touching their bodies, gender relations), the strengths and weaknesses of the service delivery systems, and the extent to which the demand for the male condom is already being met.
As part of an introductory strategy for the female condom, a cost-effectiveness workbook has been created by researchers at Health Strategies International (HSI) based on their UNAIDS-funded research. Data from within a country can be collected and analysed with this model to determine whether allocating funds to female condom programmes is a reasonable option.
The following data is the type of information that needs to be collected. This data collection and analysis can be part of an initial programme assessment and design.
· HIV prevalence among female condom users and partners
· Syphilis and gonorrhoea prevalence among female condom users and partners
· Syphilis and gonorrhoea periods of infectivity
· Rate of male condom use before introduction of the female condom
· Female condom use rates
· Rate of substitution of male condom with female condom
· Partners per year
· Episodes of intercourse per partnership
· Rates of partner change
· Types of sexual partnerships (regular, casual, commercial)
· Cost per male condom (commodity plus logistics and programme)
· Cost per female condom (commodity plus logistics and programme)
· Cost of treating a person with HIV/AIDS
· Cost of diagnosing and treating syphilis and gonorrhoea
· Cost of obstetric care per delivery