South Sudan: Women’s Integrated Sexual Health: WISH2ACTION Consortium Case Study, Value for Money: Efficiency (July 2021)

Executive summary:

A Value for Money (VfM) analysis was conducted by IRC to assess the cost-efficiency of family planning services delivered through different service delivery channels in South Sudan under the Women’s Integrated Sexual Health (WISH2ACTION) project funded by FCDO in 2020. The analysis revealed that:

·Family planning services delivered in South Sudan cost £79 ($100) per couple-year of protection (CYP) against unwanted pregnancy. This is higher than the IRC’s average cost because of higher health worker costs covered by WISH2ACTION which would otherwise typically be covered by local health systems or other funders, as well as investments in stakeholder engagement that did not immediately result in high uptake of contraceptive methods.

·Community-based distribution (£108 or $138) had a higher cost per CYP than mobile outreach (£78 or $100) or static facilities (£72 or $92), partly due to its small scale—this delivery channel was in its first year; the cost per CYP is expected to fall as community distributions scale up.

·The majority (84 percent) of methods distributed were short-acting methods, which are often cheaper to deliver but provide a shorter duration of coverage against unwanted pregnancy. Improving service provider attitudes, competencies, and facility infrastructure to enable the provision of long-acting methods, and enhancing community acceptance of family planning to increase client coverage and uptake of long-acting methods may improve VfM.

·Cost-efficiency analysis can help identify areas in need of improvement, such as focusing more attention on lower-performing service delivery points in Aweil for course correction, while finding ways to improve service quality and client satisfaction in Bentiu. Beyond the regular monitoring of financial expenditures and CYPs generated every quarter, it is more meaningful to assess the VfM of programme interventions at the end of every implementation year (instead of every quarter) for performance management and course correction purposes.