Utilisation, excess capacity, and performance of family welfare centres in a district of Punjab.

This study examines service delivery patterns in the provision of family planning in a representative district of the Punjab in Pakistan. Data were obtained from 100 out of 1288 family welfare centers (FWCs) in Sheikhupura district in 1992. FWCs had about 34.6% of the average market share of women who had used family planning and 41% among women living within 1 km of an FWC. 35% of IUD users and 21% of pill and injectable users use FWCs as the major source of supply. 78% of sterilized women relied on government hospitals and clinics as the major source. 48% of pill users and 43% of condom users obtained supplies from drugstores and other shops. Sample data from FWCs in Sheikhupura indicated that 18-58% of time was spent by center staff on family planning and administrative work. Less than 25-30% of time was spent on family planning, and 15-20% of time was spent on general ailments. 15-20% of time was spent on maternity-related services. The remaining time was unproductive. An average of 6 clients visited an FWC for family planning, of which 1-2 were new clients. Clients received 10-15 minutes per visit. Most centers received 2-3 clients per day for all services. Factors affecting client use of FWCs include distance from centers, harvesting activities, extreme weather conditions, and the Ramsan. 8-10 centers served under 150 clients monthly. FWCs contributed to 15 births averted (BA) in a year through 56 couple years of protection (CYP). 49-53% of program costs went for staffing, capital, and operating. 23-26% of costs were for contraceptive supplies. 24-25% was indirect overhead. Total cost was positively and strongly correlated with CYP and weakly positively related to time use. CYP and time use were weakly positively related. Time use and staff cost were negatively correlated. This article identifies a variety of factors affecting FWC use and a variety of measures to increase use.