ArticleBMC health services research2025
The impact of investing in private clinics and pharmacies on modern contraceptive uptake: an agent-based model of a segmented market.
Article in BMC health services research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundThe widespread availability of private-sector family planning services in low- and middle-income countries can be complementary to public-sector efforts to increase population coverage of modern contraceptive methods. The comparative advantages of a private-sector family planning program are more locations with shorter wait time. The disadvantages are higher prices and more variation in service quality. Our study quantifies how the balance of relative advantages and disadvantages might alter levels of contraceptive uptake in simulated urban and rural markets that present characteristics of markets throughout many low- and middle-income countries.
methodsWe used agent-based simulation, a computational model that simulates the actions and interactions of artificial agents in a defined environment to understand how their collective behaviors affect outcomes of interest. Our agent-based model simulated one public vendor and one private vendor competing to serve a heterogeneous population of varied income and varied demand for higher service quality. We allocated new funding to one of the two policies: (1) invest in public-sector marketing and quality; or (2) invest in private-sector marketing, quality, and/or offer price support. Linear regression was applied to 6000 person-months of simulated outcomes per policy to compare modern contraceptive prevalence rates for each policy option.
resultsThe optimal policy differed for urban and rural market segments. Price reductions accompanying quality improvements in the private sector enhanced overall service utilization to the greatest extent. In the urban market, low-income women with a high preference for quality were the most responsive to price reductions from private vendors. In the rural market, high-income women with a high preference for quality were the most responsive to quality improvements while other population subgroups were responsive to price reductions in a similar manner.
conclusionsThe factors that family planning policies should target to maximize their effect on modern contraceptive prevalence differ for markets characterized by different social contexts. Success of a policy will require policymakers' attention to the relative preferences for low price, short wait time, short travel time, and quality among population subgroups. Our study results suggest that quality improvement in the private sector most benefit the urban populations, while price reductions are crucial for making family planning services more accessible to urban low-income populations and to rural populations across all income levels.
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